[Mental disorders and cognitive impairment in patients with antiphospholipid syndrome]

Mental disorders (mainly anxiety and depressive disorders) and cognitive impairment are often found in patients with antiphospholipid syndrome (APS), but their prevalence, structure, and mechanisms of occurrence are not well researched. The review provides literature data on the frequency, spectrum and possible causes of mental disorders and cognitive impairment in patients with APS, the pathogenetic mechanisms of these disorders (in particular, the important role of antiphospholipid antibodies, stress factors, chronic inflammation), the relationship between APS, mental disorders and as well as cognitive impairment is examined. Special attention is paid to the influence of mental disorders and cognitive impairment on patients adherence to treatment, their quality of life, as well as the particularities of psychopharmacotherapy of mental disorders in patients with APS. The aim of the review is to actualize the interdisciplinary problem of mental disorders and cognitive impairment in patients with APS and the need to introduce a partnership model of care.

Fifteen-minute consultation: an approach to a child presenting to the emergency department with acute psychotic symptoms

Presentation of a child in the A&E with altered behaviour including psychotic features is not unusual. New-onset psychotic symptoms in children pose a significant diagnostic challenge due to several reasons. First, primary psychotic conditions are uncommon in pre-pubertal children. Second, differentiating between delirium and psychosis can be difficult in children, more so in infants, toddlers and young children. Third, intervening and managing a secondary cause of psychosis can significantly optimise outcome. Prompt recognition of a possible underlying cause for a child's psychotic behaviour is essential, and at the same time challenging, in the emergency department. This article attempts to present a systematic approach to a child with acute onset of psychotic symptoms in an emergency setting.

Association of psychosis with antiphospholipid antibody syndrome: A systematic review of clinical studies

OBJECTIVE

In this systematic review, we reviewed the association between Antiphospholipid antibody syndrome (APS) and psychosis and focused on the prevalence, clinical presentation, immunologic and neurological workup, treatment options, and clinical outcomes.

METHODOLOGY

We performed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)'s guidelines. We searched eight databases for potential articles and manually searched references and relevant articles of included studies. We included all articles reporting psychotic symptoms in patients with APS. Article quality was assessed using an adapted version of the Cancer Council Australia tool for case-series.

RESULTS

We included 23 articles of 454 articles found. The mean patient age at presentation was 39years and most patients were women. Delusions and hallucinations were the common clinical manifestations of APS-associated psychosis. Findings on neuroimaging were attributed to APS-associated thrombosis in most cases. Most patients had a complete resolution of psychotic symptoms.

CONCLUSION

APS-associated psychosis is rare. Later age of onset for psychosis, sudden onset, female sex, and comorbid medical and psychiatric symptoms should raise the suspicions for the presence of APS. APS-associated psychosis may have a favorable prognosis. However, further studies need to validate this conclusion.

Pathological gambling and primary antiphospholipid (Hughes) syndrome: a unique neuropsychiatric association

Neuropsychiatric conditions are common in patients with primary antiphospholipid syndrome (APS) with or without vascular thrombosis of the central nervous system. There are frequent descriptions of memory alterations, cognition and mood disorders, such as depression, anxiety, and even conditions of mania and psychosis preceding the diagnosis of primary APS. However, this study is the first to present primary or secondary APS associated with habit or impulse control disorders. The authors describe the case of a 53-year-old male patient who had been a pathological gambler since adulthood and who has had APS for more than 20 years. We describe the case and review its characteristics, criteria for diagnosis and treatment offered for patients with this specific subtype of impulse disorder.