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Restrepo-Martínez M, Ramirez-Bermudez J, So I, Coleman K, Finger E. Delusions of love and passion in the behavioral variant of frontotemporal dementia. Neurocase 2024:1-9. [PMID: 38678305 DOI: 10.1080/13554794.2024.2345110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Erotomania (de Clérambault's syndrome) refers to the delusional belief that another person, usually socially unreachable, is in love with the holder of the delusion. The occurrence of erotomania in Frontotemporal Dementia has rarely been reported. We present the unique case of a 59-year-old woman with a strong family history of early-onset dementia in whom erotomania was the initial manifestation that led to a diagnosis of definite Behavioral Variant of Frontotemporal Dementia with a pathogenic missense mutation in the MAPT gene. Based on this case, we propose a hypothetical model for developing erotomania in patients with FTD.
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Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Isis So
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kristy Coleman
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Restrepo-Martínez M, Ramirez-Bermudez J, Chacon-Gonzalez J, Ruiz-Garcia R, Malik R, Finger E. Defining repetitive behaviours in frontotemporal dementia. Brain 2024; 147:1149-1165. [PMID: 38134315 DOI: 10.1093/brain/awad431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Repetitive behaviours are common manifestations of frontotemporal dementia (FTD). Patients with FTD exhibit various types of repetitive behaviours with unique behavioural and cognitive substrates, including compulsivity, lack of impulse control, stereotypy and hoarding. Other sources of repetitive behaviours, such as restrictive interests and insistence on sameness, may also be seen in FTD. Although repetitive behaviours are highly prevalent and potentially discriminatory in this population, their expression varies widely between patients, and the field lacks consensus about the classification of these behaviours. Terms used to describe repetitive behaviours in FTD are highly heterogeneous and may lack precise definitions. This lack of harmonization of the definitions for distinct forms of repetitive behaviour limits the ability to differentiate between pathological behaviours and impedes understanding of their underlying mechanisms. This review examines established definitions of well-characterized repetitive behaviours in other neuropsychiatric disorders and proposes operational definitions applicable to patients with FTD. Building on extant models of repetitive behaviours in non-human and lesion work and models of social behavioural changes in FTD, we describe the potential neurocognitive bases for the emergence of different types of repetitive behaviours in FTD and their potential perpetuation by a predisposition towards habit formation. Finally, examples of distinct therapeutic approaches for different forms of repetitive behaviours are highlighted, along with future directions to accurately classify, measure and treat these symptoms when they impair quality of life.
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Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Deparment of Cognitive Neurology, Parkwood Institute, London, ON N6C 5J1, Canada
| | - Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, 14269, Mexico
| | - Jacobo Chacon-Gonzalez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, 14269, Mexico
| | - Ramiro Ruiz-Garcia
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, 14269, Mexico
| | - Rubina Malik
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Deparment of Cognitive Neurology, Parkwood Institute, London, ON N6C 5J1, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Deparment of Cognitive Neurology, Parkwood Institute, London, ON N6C 5J1, Canada
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Ramirez-Bermudez J, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Lopez-Hernandez JC, Hernandez-Vanegas LE, Martinez-Carrillo F, Ruiz-Garcia R, Rivas-Alonso V, Flores-Rivera J, Pollak TA. Examining the Features of Neuroleptic Malignant Syndrome in Anti-NMDA Receptor Encephalitis: A Case-Control Study. J Acad Consult Liaison Psychiatry 2023:S2667-2960(23)00853-4. [PMID: 38151160 DOI: 10.1016/j.jaclp.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a neuroimmunological disorder that frequently improves with immunotherapy. Symptomatic treatment with antipsychotics is common in the early stages when psychiatric symptoms predominate, and their use has been associated with serious side effects including neuroleptic malignant syndrome (NMS). The observation of an adverse response to antipsychotics, raising the suspicion of NMS, has been included as a criterion for possible autoimmune psychosis. METHODS This case-control study included patients who received antipsychotics before referral to the National Institute of Neurology and Neurosurgery of Mexico, where they were diagnosed as having definite ANMDARE, and patients with ANMDARE who did not receive antipsychotics before referral. The neurologic and systemic features that are used to measure an adverse response to antipsychotics, raising the suspicion of NMS, were measured in both groups, including akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, and hyperthermia. A logistic regression analysis was used to determine the relationship between the previous use of antipsychotics and the occurrence of NMS-like reactions. RESULTS A total sample of 112 patients with definite ANMDARE were included in the study. Fifty patients received antipsychotics before being referred to our institution. In this group, thirty-six patients (72%) were initially classified as having an adverse response, raising the suspicion of NMS, with the following features: akinesia (64%), autonomic instability (58%), generalized rigidity (52%), elevated concentrations of creatine phosphokinase (50%), and hyperthermia (14%). Six patients fulfilled the criteria for NMS (12%). The comparison with patients who did not receive antipsychotics before the clinical assessment did not show a significant difference between groups regarding the frequency of akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, or hyperthermia. Among different antipsychotics, only haloperidol was significantly associated with generalized rigidity as compared to patients who did not receive antipsychotics. CONCLUSIONS Our study supports previous observations about the high frequency of autonomic dysfunction, hyperthermia, tachycardia, rigidity, and elevated creatine phosphokinase levels in patients with anti-NMDAR encephalitis following the administration of antipsychotic medications. Nevertheless, our study does not suggest a causal link between atypical antipsychotics and the onset of these neurological symptoms, as they were equally frequent among the group of patients who did not receive antipsychotic treatment.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico.
| | - Miguel Restrepo-Martinez
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Mariana Espinola-Nadurille
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Victoria Martinez-Angeles
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Juan Carlos Lopez-Hernandez
- Department of Neurological Emergencies, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Laura E Hernandez-Vanegas
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Francisco Martinez-Carrillo
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Ramiro Ruiz-Garcia
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Veronica Rivas-Alonso
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Jose Flores-Rivera
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
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Espinola-Nadurille M, Restrepo-Martínez M, Bayliss L, Flores-Montes E, Rivas-Alonso V, Vargas-Cañas S, Hernández L, Martínez-Juarez I, Gonzalez-Aguilar A, Solis-Vivanco R, Fricchione GL, Flores-Rivera J, Ramirez-Bermudez J. Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study. Psychol Med 2023; 53:4266-4274. [PMID: 35534479 DOI: 10.1017/s0033291722001027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments. METHODS A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF. RESULTS After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia-delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia. CONCLUSIONS Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia-delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE.
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Affiliation(s)
- M Espinola-Nadurille
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - M Restrepo-Martínez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - L Bayliss
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - E Flores-Montes
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - V Rivas-Alonso
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - S Vargas-Cañas
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - L Hernández
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - I Martínez-Juarez
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - A Gonzalez-Aguilar
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - R Solis-Vivanco
- Laboratory of Cognitive and Clinical Neurophysiology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - G L Fricchione
- Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA
| | - J Flores-Rivera
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - J Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
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Tellez-Martinez A, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Martínez-Carrillo F, Easton A, Pollak T, Ramirez-Bermudez J. Suicidal Thoughts and Behaviors in Anti-NMDA Receptor Encephalitis: Psychopathological Features and Clinical Outcomes. J Neuropsychiatry Clin Neurosci 2023; 35:368-373. [PMID: 37151035 DOI: 10.1176/appi.neuropsych.20220200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE A wide variety of neuropsychiatric symptoms are described during the acute phase of anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE), including psychosis, mania, depression, and catatonia, but there are few reports on suicidal thought and behaviors in ANMDARE. To address this gap in the literature, the authors measured the presence of suicidal thoughts and behaviors among a large cohort of Mexican patients diagnosed with definite ANMDARE. METHODS This observational and longitudinal study included patients with definite ANMDARE hospitalized at the National Institute of Neurology and Neurosurgery of Mexico between 2014 and 2021. Suicidal thoughts and behaviors were assessed before and after treatment by means of a clinical interview with relatives and a direct clinical assessment with each patient. Thoughts of engaging in suicide-related behavior and acts of suicidal and nonsuicidal self-directed violence before and during hospitalization were recorded. RESULTS From a total sample of 120 patients who fulfilled the diagnostic criteria for definite ANMDARE, 15 patients (13%) had suicidal thoughts and behaviors during the acute phase of the disease. All 15 of these patients experienced psychosis and had suicidal ideation with intention. Three patients engaged in preparatory behaviors and seven carried out suicidal self-directed violence. Psychotic depression and impulsivity were more frequent among those patients with suicidal thoughts and behaviors than among those without any form of suicidality. Four patients engaged in self-directed violence during hospitalization. Remission was sustained in 14 of 15 patients, with suicidal ideation and self-directed violence persisting during follow-up in only one patient. CONCLUSIONS Suicidal thoughts and behaviors are not uncommon during the acute phase of ANMDARE. On the basis of our sample, the persistence of these features after immunotherapy is rare but may be observed. A targeted assessment of suicidal risk should be strongly considered in this population.
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Affiliation(s)
- Alberto Tellez-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Miguel Restrepo-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Victoria Martinez-Angeles
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Francisco Martínez-Carrillo
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Ava Easton
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Thomas Pollak
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Jesus Ramirez-Bermudez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
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Ramirez-Bermudez J, Medina-Gutierrez A, Gomez-Cianca H, Arias P, Pérez-Gonzalez A, Lebrija-Reyes PA, Espinola-Nadurille M, Aguilar-Venegas LC, Ojeda-López C, Restrepo-Martínez M, Bayliss L, Juárez-Jaramillo CA, Peñaloza G, Rivas-Alonso V, Flores-Rivera J, Gómez-Amador JL, Rios C, Sachdev PS. Clinical Significance of Delirium With Catatonic Signs in Patients With Neurological Disorders. J Neuropsychiatry Clin Neurosci 2022; 34:132-140. [PMID: 35040665 DOI: 10.1176/appi.neuropsych.18120364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE According to DSM-5, catatonia and delirium are mutually exclusive clinical syndromes. The investigators explored the co-occurrence of delirium and catatonia (i.e., catatonic delirium) and the clinical significance of this syndrome with a sample of neurological patients. METHODS This prospective study with consecutive sampling included patients diagnosed with delirium at the National Institute of Neurology and Neurosurgery of Mexico. DSM-5 criteria for delirium, the Confusion Assessment Method, and the Delirium Rating Scale-Revised-98 were used to select and characterize patients. Catatonia was assessed using the Bush-Francis Catatonia Rating Scale and DSM-5 diagnostic criteria. Logistic regression analysis was performed to identify etiological factors associated with catatonic delirium. RESULTS A total of 264 patients with delirium were included, 61 (23%) of whom fulfilled the criteria for catatonia and delirium simultaneously. Brain tumors, subarachnoid hemorrhage, acute hydrocephalus, and ischemic stroke were associated with delirium without catatonic signs. Catatonic delirium was observed among patients with encephalitis, epilepsy, brain neoplasms, and brain tuberculosis. After multivariate analysis, the association between catatonic delirium and encephalitis (both viral and anti-N-methyl-d-aspartate receptor [NMDAR]) was confirmed. CONCLUSIONS Delirium is a common complication of neurological diseases, and it can coexist with catatonia. The recognition of catatonic delirium has clinical significance in terms of etiology, as it was significantly associated with viral and anti-NMDAR encephalitis.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Angela Medina-Gutierrez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Heraclides Gomez-Cianca
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Patricia Arias
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Andres Pérez-Gonzalez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Paulina Angélica Lebrija-Reyes
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Luis Carlos Aguilar-Venegas
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Carmen Ojeda-López
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Miguel Restrepo-Martínez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Leo Bayliss
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Cynthia Areli Juárez-Jaramillo
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Guillermo Peñaloza
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Verónica Rivas-Alonso
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - José Flores-Rivera
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Juan Luis Gómez-Amador
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Camilo Rios
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Perminder S Sachdev
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
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Gomez-Figueroa E, Garcia-Estrada C, Paredes-Aragon E, Salado-Burbano J, Cortés-Enriquez F, Marrufo-Melendez O, Espinola-Nadurille M, Ramirez-Bermudez J, Rivas-Alonso V, Corona T, Flores-Rivera J. Brain MRI volumetric changes in the follow-up of patients with anti-NMDAr encephalitis. Clin Neurol Neurosurg 2021; 209:106908. [PMID: 34488009 DOI: 10.1016/j.clineuro.2021.106908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Autoimmune anti-NMDAr encephalitis is an antibody-mediated disorder characterized by psychiatric symptoms followed by decreased consciousness, dysautonomia and seizures. The pathophysiology of the disease is related to the internalization of NR1 subtype NMDA receptors and the dysfunction of structures where they are abundant (frontotemporal and insular regions). Some reports suggest the existence of cerebral atrophy in the follow-up of these patients, with conflicting evidence regarding its presence and usefulness as a marker of prognosis. METHODS In a longitudinal, observational study, all patients with the diagnosis of definite anti-NMDAr autoimmune encephalitis with initial and control MRI studies were included. Conventional MR Brain acquisition was performed using a 3-Tesla Skyra MRI System. Automated brain segmental analysis was performed using the Volbrain volumetry system. The differences between baseline MRI volumetric characteristics and volumetric measures at follow-up was assessed. RESULTS 25 patients were included (mean age 26.6, SD 9.6). 44% were females. The mean time between the studies was 24 (SD 21.4, 3-24) months. Significant volume loss was identified in the total brain volume (- 0.02%, p = 0.029), cerebellar volume (- 0.27%, p = 0.048) and brainstem volume (- 0.16%, p = 0.021). CONCLUSIONS This study supports previous observations regarding volume loss in several brain regions of patients with antiNMDAr encephalitis. Further analyses are required to understand the role of treatment and severe clinical forms, as well as the relationship between volume loss and functional outcome.
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Affiliation(s)
- Enrique Gomez-Figueroa
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, México City, Mexico.
| | | | - Elma Paredes-Aragon
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, México City, Mexico
| | | | | | - Oscar Marrufo-Melendez
- Neuroimaging Department, Instituto Nacional de Neurología y Neurocirugía, México City, Mexico
| | | | - Jesus Ramirez-Bermudez
- Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, México City, Mexico
| | - Verónica Rivas-Alonso
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, México City, Mexico
| | - Teresita Corona
- Neurodegenerative Diseases Laboratory, Instituto Nacional de Neurología y Neurocirugía, México City, Mexico
| | - José Flores-Rivera
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, México City, Mexico
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8
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Restrepo-Martinez M, Ramirez-Bermudez J, Bayliss L, Espinola-Nadurille M. Delirious mania as a frequent and recognizable neuropsychiatric syndrome in patients with anti-NMDAR encephalitis. Gen Hosp Psychiatry 2020; 64:50-55. [PMID: 32182491 DOI: 10.1016/j.genhosppsych.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous case reports showed that delirious mania could be one of the many neuropsychiatric presentations of Anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE). OBJECTIVE To evaluate the frequency of delirious mania and its associated factors in ANMDARE. METHOD A prospective study, including all patients with ANMDARE admitted to the National Institute of Neurology and Neurosurgery of Mexico, from January 2014 to April 2019. The diagnosis of delirious mania was established when diagnostic criteria for mania and delirium were fulfilled simultaneously. RESULTS 79 patients with definitive ANMDARE were included. Delirious mania was identified in 20 (25.3%) of these patients. Catatonia, psychomotor agitation, disinhibition, impulsivity, and grandiose delusions were significantly associated with delirious mania. Also, a lower frequency of EEG abnormalities, absence of extreme delta brush, and a shorter hospital stay was observed in these patients. CONCLUSION Delirious mania proved to be a frequent neuropsychiatric presentation of ANMDARE, and its presence should warn the physician about the possibility of this diagnosis. It was mainly associated with higher rates of catatonia, psychomotor agitation, disinhibition, and psychotic symptoms. The lack of recognition of delirious mania as a neuropsychiatric presentation in ANMDARE may be a source of diagnostic and therapeutic errors, as most physicians associate this with bipolar disorder.
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Affiliation(s)
- Miguel Restrepo-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico
| | - Jesus Ramirez-Bermudez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico
| | - Leo Bayliss
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico; Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico; Neurology and Neurosurgery Center, Medica Sur Puente de Piedra 150, Toriello Guerra, Mexico, Mexico.
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9
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Kerik-Rotenberg N, Diaz-Meneses I, Hernandez-Ramirez R, Muñoz-Casillas R, Reynoso-Mejia C, Aguilar-Palomeque C, Flores-Rivera J, Espinola-Nadurille M, Ramirez-Bermudez J. "Reply: Methodological and Ethical Concerns in the Study of AntiNMDA Encephalitis With Positron Emission Tomography". Psychosomatics 2020; 61:863-864. [PMID: 32312524 DOI: 10.1016/j.psym.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Nora Kerik-Rotenberg
- PET-CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Ivan Diaz-Meneses
- PET-CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Rodrigo Hernandez-Ramirez
- PET-CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Rodrigo Muñoz-Casillas
- PET-CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Carlos Reynoso-Mejia
- PET-CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Carlos Aguilar-Palomeque
- PET-CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jose Flores-Rivera
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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10
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Kerik-Rotenberg N, Diaz-Meneses I, Hernandez-Ramirez R, Muñoz-Casillas R, Reynoso-Mejia CA, Flores-Rivera J, Espinola-Nadurille M, Ramirez-Bermudez J, Aguilar-Palomeque C. A Metabolic Brain Pattern Associated With Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Psychosomatics 2019; 61:39-48. [PMID: 31611047 DOI: 10.1016/j.psym.2019.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis causes substantial neurological disability. Autoantibodies causing encephalitis directed against the neuronal cell surface or synapse are of diagnostic importance giving the possibility of successful immunotherapy. OBJECTIVE In this study, we aim to provide supporting evidence that brain 18F-FDG-PET may be helpful in identifying likely patterns of regional brain glucose metabolism. METHODS Thirty-three patients (18 men and 15 women; age range of 17-55 y) with positive NMDA receptor antibody encephalitis that underwent an 18F-FDG-PET imaging examination were prospectively selected and compared with a reference group of 14 brain 18F-FDG-PET scans from healthy volunteers using voxel-based statistical analysis. Clusters of hyper- and hypo-metabolism were reported for the whole sample of patients (FWE-corrected P < 0.05), and uncorrected at P < 0.005 for a group of relapsed patients. RESULTS Mixed metabolic patterns (focal/bilateral hypermetabolism in the temporal lobe, insula, and cerebellum; associated with severe bilateral hypometabolism in the occipital and parietal lobes) were found. CONCLUSIONS Our findings suggest that 18F-FDG-PET should be included as an imaging tool when assessing affected patients in the clinical workup to rule out anti-NMDA encephalitis and help determine the most effective treatment.
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Affiliation(s)
- Nora Kerik-Rotenberg
- PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Ivan Diaz-Meneses
- PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Rodrigo Hernandez-Ramirez
- PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Rodrigo Muñoz-Casillas
- PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Carlos A Reynoso-Mejia
- PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jose Flores-Rivera
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Mariana Espinola-Nadurille
- Department of Neuropsychiatry, Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Carlos Aguilar-Palomeque
- PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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11
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Espinola-Nadurille M, Flores-Rivera J, Rivas-Alonso V, Vargas-Cañas S, Fricchione GL, Bayliss L, Martinez-Juarez IE, Hernandez-Vanegas LE, Martinez-Hernandez R, Bautista-Gomez P, Solis-Vivanco R, Perez-Esparza R, Bustamante-Gomez PA, Restrepo-Martinez M, Ramirez-Bermudez J. Catatonia in patients with anti-NMDA receptor encephalitis. Psychiatry Clin Neurosci 2019; 73:574-580. [PMID: 31115962 DOI: 10.1111/pcn.12867] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
AIM There is a lack of studies related to the frequency, phenomenology, and associated features of catatonic syndrome in patients with anti-NMDA receptor encephalitis (ANMDARE). This study aimed to measure the frequency of catatonia in this condition and to delineate its particular symptoms. METHODS A prospective study was done with all inpatients who fulfilled the criteria of definite ANMDARE admitted to the National Institute of Neurology and Neurosurgery of Mexico from January 2014 to September 2018. The Bush-Francis Catatonia Rating Scale and Braünig Catatonia Rating Scale were administered at admission. RESULTS Fifty-eight patients were included and catatonia was diagnosed in 41 of these patients (70.6%). Immobility, staring, mutism, and posturing were the most frequent catatonic signs. Catatonia was associated with delirium, hallucinations, psychomotor agitation, generalized electroencephalography dysfunction, and previous use of antipsychotics. Mortality was present in 10% of the total sample; it was associated with status epilepticus, and was less frequent in the catatonia group. After immunotherapy, all cases showed a complete recovery from catatonic signs. CONCLUSION This systematic assessment of catatonic syndrome shows that it is a frequent feature in patients with ANMDARE as part of a clinical pattern that includes delirium, psychomotor agitation, and hallucinations. The lack of recognition of this pattern may be a source of diagnostic and therapeutic errors, as most physicians associate catatonia with schizophrenia and affective disorders.
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Affiliation(s)
- Mariana Espinola-Nadurille
- Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico.,Center of Neurology and Neurosurgery, Medica Sur, Mexico City, Mexico
| | - Jose Flores-Rivera
- Neurology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Veronica Rivas-Alonso
- Neurology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Steven Vargas-Cañas
- Neurology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Gregory L Fricchione
- Intensive Care Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Leo Bayliss
- Neurology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | | | | | - Ruben Martinez-Hernandez
- Neurology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Paola Bautista-Gomez
- Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Rodolfo Solis-Vivanco
- Neuropsychology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico.,School of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rodrigo Perez-Esparza
- Addiction Research Laboratory, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | | | | | - Jesus Ramirez-Bermudez
- Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
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12
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Espinola-Nadurille M, Bustamante-Gomez P, Ramirez-Bermudez J, Bayliss L, Rivas-Alonso V, Flores-Rivera J. Frequency of neuropsychiatric disturbances in anti-NMDA receptor encephalitis. Acta Psychiatr Scand 2018; 138:483-485. [PMID: 30367468 DOI: 10.1111/acps.12963] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M Espinola-Nadurille
- Department of Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico (NINN), Mexico City, Mexico
| | - P Bustamante-Gomez
- Department of Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico (NINN), Mexico City, Mexico
| | - J Ramirez-Bermudez
- Department of Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico (NINN), Mexico City, Mexico.,Commission of the National Institutes of Health, Mexico City, Mexico
| | - L Bayliss
- Department of Neurology, NINN, Mexico City, Mexico
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Ramirez-Bermudez J, Higuera-Calleja J, Espinola-Nadurille M, Corona T. Neuropsychiatric disorders in patients with neurocysticercosis. Asia Pac Psychiatry 2017; 9. [PMID: 27496560 DOI: 10.1111/appy.12250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The purpose of this study was to explore the presence of neuropsychiatric disorders in patients with neurocysticercosis (NCC). METHOD Patients with untreated NCC (n = 45) and healthy controls (n = 45) underwent psychiatric and neuropsychological assessments. RESULTS The majority of patients in the NCC group (64.4%) had at least 1 psychiatric diagnosis, compared with a minority in the control group (31.1%). The frequency of neurocognitive disorders, and particularly dementia (major neurocognitive disorder), was significantly higher in the group of patients with NCC. DISCUSSION This study confirms the relationship between NCC and cognitive disorders.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Jesus Higuera-Calleja
- Department of Neuroradiology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Mariana Espinola-Nadurille
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Teresa Corona
- Department of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
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14
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Espinola-Nadurille M, Ramirez-Bermudez J, Fricchione GL, Ojeda-Lopez MC, Perez-González AF, Aguilar-Venegas LC. Catatonia in Neurologic and Psychiatric Patients at a Tertiary Neurological Center. J Neuropsychiatry Clin Neurosci 2017; 28:124-30. [PMID: 26670787 DOI: 10.1176/appi.neuropsych.15090218] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study describes the prevalence, phenomenology, treatment, and outcome of neurological patients and psychiatric patients with catatonia at a tertiary neurological center. Clinical variables included nosological diagnoses and complications. Admission length and days with catatonia were used as outcome measures. Of 2,044 patients who were evaluated prospectively, 68 (3.32%) had catatonia, 42 (61.7%) were neurological patients, 19 (27.9%) were psychiatric patients, and 7 (10.2%) had drug-related diagnoses. Of all patients, the ratio of neurological to psychiatric patients was 3:1. Encephalitis was the most common diagnosis (N=26 [38.2%]), followed by schizophrenia (N=12 [17.6%]). Psychiatric patients exhibited a stuporous type of catatonia (15 [83.3%] versus 14 [33.3%], p>0.001), whereas neurological patients exhibited a mixed form of catatonia (25 [59.5%] versus 1 [5.6], p<0.001). Neurological patients had more complications, longer hospitalizations, and more days with catatonia. A total of 56 patients (82.3%) received lorazepam, and 14 patients (20.5%) underwent ECT. Second- and third-line treatments included amantadine, bromocriptine, and levodopa. Catatonia is a prevalent syndrome that can remit with proper and opportune treatment.
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Affiliation(s)
- Mariana Espinola-Nadurille
- From the Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico (ME-N, JR-B, MCO-L, LCA-V); the Division of Postgraduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico (ME-N, JR-B); the Division of Psychiatry and Medicine, Dept. of Psychiatry, Massachusetts General Hospital, Boston (GLF); and the Dept. of Psychiatry, Antioquia University, Colombia, South America (AFP-G)
| | - Jesus Ramirez-Bermudez
- From the Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico (ME-N, JR-B, MCO-L, LCA-V); the Division of Postgraduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico (ME-N, JR-B); the Division of Psychiatry and Medicine, Dept. of Psychiatry, Massachusetts General Hospital, Boston (GLF); and the Dept. of Psychiatry, Antioquia University, Colombia, South America (AFP-G)
| | - Gregory L Fricchione
- From the Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico (ME-N, JR-B, MCO-L, LCA-V); the Division of Postgraduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico (ME-N, JR-B); the Division of Psychiatry and Medicine, Dept. of Psychiatry, Massachusetts General Hospital, Boston (GLF); and the Dept. of Psychiatry, Antioquia University, Colombia, South America (AFP-G)
| | - M Carmen Ojeda-Lopez
- From the Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico (ME-N, JR-B, MCO-L, LCA-V); the Division of Postgraduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico (ME-N, JR-B); the Division of Psychiatry and Medicine, Dept. of Psychiatry, Massachusetts General Hospital, Boston (GLF); and the Dept. of Psychiatry, Antioquia University, Colombia, South America (AFP-G)
| | - Andres F Perez-González
- From the Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico (ME-N, JR-B, MCO-L, LCA-V); the Division of Postgraduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico (ME-N, JR-B); the Division of Psychiatry and Medicine, Dept. of Psychiatry, Massachusetts General Hospital, Boston (GLF); and the Dept. of Psychiatry, Antioquia University, Colombia, South America (AFP-G)
| | - Luis C Aguilar-Venegas
- From the Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico (ME-N, JR-B, MCO-L, LCA-V); the Division of Postgraduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico (ME-N, JR-B); the Division of Psychiatry and Medicine, Dept. of Psychiatry, Massachusetts General Hospital, Boston (GLF); and the Dept. of Psychiatry, Antioquia University, Colombia, South America (AFP-G)
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Muñoz Zúñiga JF, Ramirez-Bermudez J, Flores Rivera JDJ, Corona T. Catatonia and klüver-bucy syndrome in a patient with acute disseminated encephalomyelitis. J Neuropsychiatry Clin Neurosci 2016; 27:e161-2. [PMID: 25923869 DOI: 10.1176/appi.neuropsych.14060120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jose Fernando Muñoz Zúñiga
- From the Neuropsychiatric Unit (JFMZ, JR-B), Neurology Dept. (JdJFR), and Neurodegenerative Disease Clinical Laboratory (TC), National Institute of Neurology and Neurosurgery, Mexico City
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Abstract
Thalamic dysfunction has been associated with schizophrenia and other psychotic disorders. We describe an adult patient with a lacunar infarct in the posterior region of the right thalamus exhibiting a paranoid schizophrenia-like psychosis as the only clinical manifestation. Neuropsychological assessment showed alterations in visuospatial memory and executive functions at follow up. This case highlights the role of information processing by the thalamus in the development of delusions. We suggest that dysfunction of the right mediodorsal and pulvinar thalamic nuclei disrupts both thalamic sensory processing and thalamo-prefrontal circuits mediating belief evaluation, leading to delusional beliefs.
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Affiliation(s)
- D Crail-Melendez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
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Ramirez-Bermudez J, Aguilar-Venegas LC, Crail-Melendez D, Espinola-Nadurille M, Nente F, Mendez MF. Cotard syndrome in neurological and psychiatric patients. J Neuropsychiatry Clin Neurosci 2011; 22:409-16. [PMID: 21037126 DOI: 10.1176/jnp.2010.22.4.409] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors describe the frequency and characteristics of Cotard syndrome among neurological and psychiatric inpatients at a tertiary referral center. All inpatients from the National Institute of Neurology of Mexico (March 2007-May 2009) requiring neuropsychiatric consultation were reviewed. Among 1,321 inpatient consultations, 63.7% had neurological disease and one (0.11%) had viral encephalitis and Cotard syndrome. Of inpatients, 36.2% had pure psychiatric disorders and three (0.62%) had Cotard syndrome, associated with psychotic depression, depersonalization, and penile retraction (koro syndrome). This review discusses potential mechanisms for Cotard syndrome, including the role of a perceptual-emotional dissociation in self-misattribution in the deliré des negations.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Department of Neuropsychiatry at the National Institute of Neurology and Neurosurgery of Mexico in Mexico City, Mexico.
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Espinola-Nadurille M, Colin-Piana R, Ramirez-Bermudez J, Lopez-Gomez M, Flores J, Arrambide G, Corona T. Mental disorders in Mexican patients with multiple sclerosis. J Neuropsychiatry Clin Neurosci 2010; 22:63-9. [PMID: 20160211 DOI: 10.1176/jnp.2010.22.1.63] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors aim to explore psychiatric disorders in Mexican patients with multiple sclerosis. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Montgomery-Asberg Depression Rating Scale, and the Hamilton Anxiety Rating Scale were administered to 37 consecutive multiple sclerosis patients and 37 healthy comparison subjects. The multiple sclerosis group had higher rates of any axis I disorder (OR 1.97; 95% CI=1.78-3.306). The most common comorbid diagnoses were depressive disorders (46% of the multiple sclerosis cases) with higher anxiety scores (p=0.001). No correlations between psychiatric variables, number of relapses, and clinical course of multiple sclerosis were found.
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Affiliation(s)
- Mariana Espinola-Nadurille
- Research Department and Neuropsychiatric Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
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Ramirez-Bermudez J, Espinola-Nadurille M, Loza-Taylor N. Delusional parasitosis in neurological patients. Gen Hosp Psychiatry 2010; 32:294-9. [PMID: 20430233 DOI: 10.1016/j.genhosppsych.2009.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 10/21/2009] [Accepted: 10/21/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Delusional parasitosis has been described in a wide range of patients with general medical conditions, but there are few reports about its frequency and possible pathogenic mechanisms in neurological patients. This paper describes this delusional syndrome in a sample of neurological patients. METHODS We reviewed all clinical charts of hospitalized patients at the neuropsychiatry ward of a neurological center, from January 2005 to June 2009. Cases with delusional parasitosis were described in terms of demographic, clinical and brain imaging features. RESULTS From a total sample of 1598 patients, we identified 636 patients with neurological disease (39.80%); of these, four patients showed delusional parasitosis (0.62% of the neurological sample). Their diagnoses were brain cysticercosis (n=1), cerebrovascular disease (n=2), and dementia due to vitamin B12 deficit (n=1). They were women in late life, with depressive features. Three of them had significant cognitive decline. Two of them had paraesthesia and pruritus related to peripheral neuropathy. One of them had pruritus of unknown origin (possibly hallucinatory). CONCLUSIONS Delusional parasitosis was infrequent in this sample of hospitalized neurological patients. Female sex, advanced age, depressive features, cognitive decline, pruritus and paraesthesia of peripheral or central origin may contribute to delusional parasitosis in this population.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, México Distrito Federal 14000, México.
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Espinola-Nadurille M, Vargas Huicochea I, Raviola G, Ramirez-Bermudez J, Kutcher S. Mental health care reforms in Latin America: child and adolescent mental health services in Mexico. Psychiatr Serv 2010; 61:443-5. [PMID: 20439361 DOI: 10.1176/ps.2010.61.5.443] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column provides an overview of child and adolescent mental health services in Mexico, where prevalence rates of mental disorders among young people are up to twice as high as U.S. and Canadian rates. The mental health care system in Mexico is underdeveloped and underfunded, and for the approximately 40% of the population with no insurance, access to and quality of care are particularly poor. This column offers policy recommendations aimed at better meeting the needs of this vulnerable population.
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Abstract
Different factors have been related with interictal anxiety, reported in 10%-25% of patients with epilepsy. We determined the frequency of interictal anxiety in 196 patients with active epilepsy in a cross-sectional survey to know which symptoms of anxiety were most frequently reported in patients with epilepsy and to analyze the factors associated with their presence. Patients were assessed with the Beck Depression Inventory (BDI), Montgomery-Asberg Depression Rating Scale (MADRS), and the Hamilton Anxiety Scale (HAMA). Data were analyzed with a logistic regression model. The HAMA ratings revealed that 38.8% experienced significant anxiety symptoms, as defined by a rating above 18 points. Use of primidone, depression, cryptogenic, and posttraumatic etiologies significantly predicted anxiety after logistic regression. Symptoms related to higher scores on HAMA were anxious mood, tension, insomnia, intellectual function, depressed mood, cardiovascular and genitourinary symptoms. Further studies should be performed to define the role of psychosocial factors in the development and evolution of anxiety among these patients.
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Affiliation(s)
- M López-Gómez
- Departments of Neurology. National Institute of Neurology and Neurosurgery of Mexico. Insurgentes Sur 3877 Colonia La Fama Delegación Tlalpan México, Distrito Federal México.
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Ramirez-Bermudez J, Ruiz-Chow A, Perez-Neri I, Soto-Hernandez JL, Flores-Hernandez R, Nente F, Montes S, Rios C. Cerebrospinal fluid homovanillic acid is correlated to psychotic features in neurological patients with delirium. Gen Hosp Psychiatry 2008; 30:337-43. [PMID: 18585537 DOI: 10.1016/j.genhosppsych.2008.01.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 01/05/2008] [Accepted: 01/24/2008] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to determine if cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) are related to the clinical features of delirium in a group of patients with acute onset neurological illness. METHODS Fifty-one patients with probable acute brain infection were classified as delirious and nondelirious according to Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) and Delirium Rating Scale (DRS). CSF HVA concentration was analyzed by high-performance liquid chromatography. RESULTS Delirium was present in 60.8% of the total sample. HVA levels were not significantly different between delirious and nondelirious patients. Remarkably, patients with psychotic symptoms shown higher levels of CSF HVA as compared to nonpsychotic patient values. In addition, HVA levels were positively correlated to specific items of DRS such as delusions (r=0.463, P=.001), hallucinations (r=0.438, P=.001), cognitive dysfunction (r=0.286, P=.042) and fluctuation of symptoms (r=0.280, P=.046) in the total sample. Subanalyses excluding patients taking antipsychotic drugs revealed that HVA CSF levels were higher in those patients with delusions, and furthermore, the dopamine metabolite remained positively correlated to delusion subscale of DRS. CONCLUSIONS Our results suggest that psychotic symptoms in delirious patients may be related to increased dopamine neurotransmission, as reflected by increased CSF HVA concentration, providing direct evidence to support the dopaminergic theory of psychosis.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur 3877, Tlalpan 14269, Mexico City, Mexico
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Nente F, Carrillo-Mezo R, Mendez MF, Ramirez-Bermudez J. Pathological hyperfamiliarity for others from a left anterior cingulate lesion. J Neuropsychiatry Clin Neurosci 2007; 19:345-6. [PMID: 17827429 DOI: 10.1176/jnp.2007.19.3.345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prospero-Garcia KA, Torres-Ruiz A, Ramirez-Bermudez J, Velazquez-Moctezuma J, Arana-Lechuga Y, Teran-Perez G. Fluoxetine-mirtazapine interaction may induce restless legs syndrome: report of 3 cases from a clinical trial. J Clin Psychiatry 2006; 67:1820. [PMID: 17196069 DOI: 10.4088/jcp.v67n1122d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ramirez-Bermudez J, Lopez-Gómez M, Sosa Ana L, Aceves S, Nader-Kawachi J, Nicolini H. Frequency of delirium in a neurological emergency room. J Neuropsychiatry Clin Neurosci 2006; 18:108-12. [PMID: 16525078 DOI: 10.1176/jnp.18.1.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors present a cross-sectional survey designed to evaluate the presence of delirium in patients with neurological emergencies. Two hundred and two patients were included in the study: 14.9% of subjects had delirium; 62.4% had no arousal disturbances; and 22.7% presented a coma or stupor state. Findings revealed that the presence of a cerebral infection, the presence of multiple etiologies, and the location of lesions in the frontal and temporal lobes were all associated with delirium. Results substantiate that delirium is a frequent occurrence in neurological patients and that the presence of multiple etiologies must be investigated in each patient.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, Neurological Emergencies of the National Institute of Neurology and Neurosurgery, México City, México
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Lopez-Meza E, Corona-Vazquez T, Ruano-Calderon LA, Ramirez-Bermudez J. Severe impulsiveness as the primary manifestation of multiple sclerosis in a young female. Psychiatry Clin Neurosci 2005; 59:739-42. [PMID: 16401253 DOI: 10.1111/j.1440-1819.2005.01446.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Severe impulsiveness in the absence of apparent neurological signs has rarely been reported as a clinical presentation of multiple sclerosis (MS). An 11-year-old female developed progressive and sustained personality disturbances including disinhibition, hypersexuality, drug abuse, aggressiveness and suicide attempts, without neurological signs. She was given several unsuccessful psychopharmacological and psychotherapeutic interventions. At age 21, a diagnosis of MS was made, confirmed by imaging, laboratory and neurophysiological studies. Although unusual, MS may produce pure neurobehavioral disturbances. In the present case, widespread demyelinization produced a complex behavioral disorder, with features compatible with orbitofrontal and Klüver-Bucy syndromes.
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Affiliation(s)
- Elmer Lopez-Meza
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Abstract
Aripiprazole is an agent for treating schizophrenia. The authors assume that aripiprazole as a dopamine receptor partial agonist may be useful in treating PD patients. Three cases are presented in this study. All patients were evaluated by the same clinician, a neuropsychiatrist well trained in the use of Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI). Aripiprazole was effective for reducing psychosis in each case.
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Affiliation(s)
- Elmer López-Meza
- Clinical Investigation Dept., National Institute of Neurology and Neurosurgery of México. Insurgentes sur 3877, Colonia la fama, Tlalpan, Mexico DF 14269.
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Abstract
OBJECTIVE To determine the correlates and outcome of dementia in patients with neurocysticercosis (NCC). METHODS Ninety consecutive patients with untreated NCC underwent a cognitive assessment (Mini-mental State Examination, Neurobehavioral Cognitive Status Examination, and IQCODE) and were classified as having or not having dementia according to DSM-IV criteria. Imaging and cerebrospinal fluid examination data were recorded. The cognitive measures were repeated six months after treatment with albendazole and steroids. RESULTS At the initial evaluation 15.5% (n = 14) of the patients were classified as having dementia. Dementia was associated with older age, lower education level, increased number of parasitic lesions in the brain (mostly in the frontal, temporal, and parietal lobes). After six months, 21.5% of the patients from the dementia group continued to have a full dementia disorder and 78.5% no longer fulfilled the DSM-IV criteria for dementia, although some of these patients still showed mild cognitive decline. CONCLUSIONS The results of this study suggest that dementia occurs frequently in patients with untreated NCC, and it is reversible in most cases.
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Affiliation(s)
- J Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Lopez-Gomez M, Ramirez-Bermudez J, Campillo C, Sosa AL, Espinola M, Ruiz I. Primidone is associated with interictal depression in patients with epilepsy. Epilepsy Behav 2005; 6:413-6. [PMID: 15820351 DOI: 10.1016/j.yebeh.2005.01.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 01/26/2005] [Accepted: 01/27/2005] [Indexed: 11/30/2022]
Abstract
Depressive symptoms are common in epilepsy. To determine associations between depression and demographic, clinical, and pharmacological factors among epileptic patients, we conducted a cross-sectional survey. We evaluated 241 epileptic outpatients at a neurological center in a 6-month period. Depressive syndrome was diagnosed when both the Montgomery-Asberg Scale and the Beck Depression Inventory were rated above the standard cutoff points. Bivariate and multivariate analyses were performed to assess the differences between depressed and nondepressed patients with respect to demographic, clinical, and pharmacological features. Depressive syndrome was diagnosed in 42.7% of patients (n=103). Factors associated in the bivariate analysis were: cryptogenic etiology, posttraumatic epilepsy, use of primidone, and inadequate seizure control. After logistic regression, inadequate seizure control (OR 3.08, 95% CI 1.40-6.77, P=0.005) and use of primidone (OR 4.08, 95% CI 2.09-7.98; P<0.001) remained significantly associated. Depression was common and associated with inadequate seizure control and use of primidone.
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Affiliation(s)
- M Lopez-Gomez
- Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico.
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