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At least 217 records · Page 12Linked to original sources
PubMed2006

Affirming the right to care, preserving the right to die: disorders of consciousness and neuroethics after Schiavo.

In this article, I attempt to untangle some of the cultural, philosophical, and ethical currents that informed the Schiavo case. My objective is to better apprehend what the Schiavo case means for end-of-life care in general and to assert that our discourse about the ethical issues attendant to brain injury will be impoverished if we limit our discussions about disorders of consciousness solely to the vegetative state. If we ignore emerging developments in neuroscience that are helping to elucidate the nature of these disorders and fail to broaden the conversation about brain injury, beyond the unmitigated futility of the permanent vegetative state, we will imperil others who might improve and be helped. Through such efforts we can help mitigate the tragedy of the Schiavo case and overcome the rhetoric that marked the national discourse in March 2005. Once the complexity of disorders of consciousness is appreciated, rhetorical statements about a right to die or a right to life are exposed as being incompatible with the challenge of providing care to such patients. This is especially true as neuroscience brings greater diagnostic refinement to their assessment and management, a topic addressed in this article, which specifically focuses on the clinical and ethical implications of the recently described minimally conscious state. Instead of staking out ideological positions that do not meet the needs of patients or families, we should strive to both preserve the right to die for those who are beyond hope while affirming the right to care to those who might benefit from coming advances in neuroscience. If we can achieve that delicate balance, we will be able to transcend the partisan debate that shrouded the life and death of Theresa Marie Schiavo and begin to articulate a palliative neuroethics of care for those touched by severe brain injury and disorders of consciousness.

Brain Damage, Chronic↗
PubMed2004

[A study of factors effecting on an observation time needed for outpatient treatment of acute alcohol intoxication in Japan].

The purpose of this study was to investigate the factors effecting on an observation time needed for outpatient treatment of acute alcohol intoxication. Subjects were 181 patients with acute alcohol intoxication who visited at the Center of Critical Care Medicine of St. Luke's International Hospital from June 1999 to May 2000. One of 181 patients was admitted as an inpatient. The mean observation time of 180 outpatients was about 3 hours. Ninety-nine outpatients (55%) needed observation time less than 3 hours. High level of Blood Alcohol Concentration (BAC), moderate consciousness disorder (Japan Coma Scale; JCS 10-30), and severe consciousness disorder (JCS 100-300) were significant factors to increase observation time more than 3 hours. Gender and age were not significant factors associated with more-than-3-hour observation time. Observation time of mild consciousness disorder (JCS 1-3) was significantly decreased against that of clear consciousness (JCS 0). Effects of acetaldehyde might be related to elongation of the observation time among clear consciousness patients. Medical resources of emergency medicine in Japan are not enough in some cases (such as few beds and small numbers of staffs), and it is occasionally difficult for patients to stay at a emergency unit for a long time. And the number of hospitalization for acute alcohol intoxication is likely to increase in Japan. Consideration on the attributes, such as BAC or patient's consciousness, associated with observation time of outpatient treatment might be useful to reduce the number of hospitalization and the cost of medical care for acute alcohol intoxication in emergency medicine.

Acute Disease↗
PubMed2006

Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness.

OBJECTIVE: To describe the theoretic framework, design, and potential clinical applications of functional neuroimaging protocols in patients with disorders of consciousness. DATA SOURCES: Recent published literature and authors' own work. STUDY SELECTION: Studies using functional neuroimaging techniques to investigate cognitive processing in patients diagnosed with vegetative and minimally conscious state. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Positron-emission tomography activation studies suggest that the vegetative state represents a global disconnection syndrome in which higher order association cortices are functionally disconnected from primary cortical areas. In contrast, patterns of activation in functional magnetic resonance imaging studies of patients in the minimally conscious state show preservation of large-scale cortical networks associated with language and visual processing. CONCLUSIONS: Novel applications of functional neuroimaging in patients with disorders of consciousness may aid in differential diagnosis, prognostic assessment and identification of pathophysiologic mechanisms. Improvements in patient characterization may, in turn, provide new opportunities for restoration of function through interventional neuromodulation.

Auditory Perception↗
PubMed2005

Clinical pragmatism and the care of brain damaged patients: toward a palliative neuroethics for disorders of consciousness.

Unraveling the mysteries of consciousness, lost and regained, and perhaps even intervening so as to prompt recovery are advances for which neither the clinical nor the lay community are prepared. These advances will shake existing expectations about severe brain damage and will find an unprepared clinical context, perhaps even one inhospitable to what should clearly be viewed as important advances. This could be the outcome of this line of inquiry, if this exceptionally imaginative research can continue at all. This work faces a restrictive research environment that has the potential to imperil it. Added to the complexity of the scientific challenges that must be overcome is the societal context in which these investigations must occur. Research on human consciousness goes to the heart of our humanity and asks us to grapple with fundamental questions about the self. Added to this is the regulatory complexity of research on subjects who may be unable to provide their own consent because of impaired decision-making capacity, itself a function of altered or impaired consciousness. These factors can lead to a restrictive view of research that can favor risk aversion over discovery. In this paper, I attempt to explain systematically some of these challenges. I suggest that some of the resistance might be tempered if we view the needs of patients with severe brain injury through the prism of palliative care and adopt that field's ethos and methods when caring for and conducting research on individuals with severe brain damage and disorders of consciousness. To make this argument I draw upon the American pragmatic tradition and utilize clinical pragmatism, a method of moral problem-solving that my colleagues and I have developed to address ethical challenges in clinical care and research.

Brain Damage, Chronic↗
PubMed2006

How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs?

PURPOSE OF REVIEW: We discuss the problems of evidence-based neurorehabilitation in disorders of consciousness, and recent functional neuroimaging data obtained in the vegetative state and minimally conscious state. RECENT FINDINGS: Published data are insufficient to make recommendations for or against any of the neurorehabilitative treatments in vegetative state and minimally conscious state patients. Electrophysiological and functional imaging studies have been shown to be useful in measuring residual brain function in noncommunicative brain-damaged patients. Despite the fact that such studies could in principle allow an objective quantification of the putative cerebral effect of rehabilitative treatment in the vegetative state and minimally conscious state, they have so far not been used in this context. SUMMARY: Without controlled studies and careful patient selection criteria it will not be possible to evaluate the potential of therapeutic interventions in disorders of consciousness. There also is a need to elucidate the neurophysiological effects of such treatments. Integration of multimodal neuroimaging techniques should eventually improve our ability to disentangle differences in outcome on the basis of underlying mechanisms and better guide our therapeutic options in the challenging patient populations encountered following severe acute brain damage.

Brain↗
PubMed1987

The disorder of consciousness in schizophrenia.

The schizophrenic experience is described as an inability to sustain an intentional focus to attention. Attention is captured by incidental details in the schizophrenic patient's environment, and this gives rise to a spurious sense of significance. The patient's inability to direct a train of thought prevents full access to long-term memory so that early components of perception, which are designed to give early warning of threat, are overly influential and unmodulated by further mental processing. These hasty ideas are given delusional conviction when they capture attention and induce a sense of significance similar to the false significance of perception. The schizophrenic patient's lack of control over his mental processes makes him passive in relation to his own thinking. It prevents him from attending to the slight promptings of his subconscious, and when these emotions and intuitions are not amplified by being brought into focus, he loses a sense of himself.

Attention↗
PubMed1989

[Causes and incidence of traffic accidents caused by precipitous disorders of consciousness and illnesses of drivers. A one year study in Upper Austria and Salzburg].

It was attempted to make a survey of all traffic accidents due to sudden disturbances of health on behalf of drivers, being supported by the police of Upper Austria and Salzburg. Only 26 out of a total amount of 53.530 road accidents were made known but the cooperation with the police did not always seem to work too well. Only in the province of Salzburg did the number of these accidents correspond with the expected frequencies of 1.3%. Most of the drivers were internally sick, cardiovascular diseases prevailing. The danger of epilepsy is generally overestimated, that of diabetes and other internal diseases rather underrated. People in general good health were also seen causing accidents due to nausea. In such cases self-endangering is twice as common as the exposure of others to danger. In the majority of the incidents only damage to property resulted. In addition it became apparent, that accidents with damage to people occurred more often in the city than in rural areas, whereas fatalities and severe injuries were more common in the country than in cities.

Accidents, Traffic↗
PubMed2001

New-onset delusions and hallucinations in patients infected with HIV.

OBJECTIVE: To assess the relationship between HIV-associated psychotic symptoms (i.e., delusions, hallucinations) and demographic, psychopathological and medical variables by comparing patients with and without cerebral opportunistic infections or metabolic encephalopathy. DESIGN: Cross-sectional study. PATIENTS: 26 patients admitted to hospital with HIV and new-onset psychotic symptoms, defined according to DSM-III-R criteria. OUTCOME MEASURES: A semistructured psychiatric interview using the Psychopathology Assessment Scale (AMDP-4) of the Association for Methodology and Documentation in Psychiatry system. Comprehensive medical assessments, including laboratory tests and computed tomographic scans, were also performed. RESULTS: Patients with cerebral opportunistic infections or metabolic encephalopathy (i.e., "secondary" psychosis, n = 13) were more likely to show disorders of consciousness, disorders of orientation and disturbances of attention and memory than those with no evidence of HIV-related cerebral disease (i.e., "primary" psychosis, n = 13); 10 patients (77%) with cerebral opportunistic infections or metabolic encephalopathy and only 1 (8%) patient without (p < 0.001) were diagnosed with delirium. These associations were stronger for the "secondary" patients with no focal brain lesions than for those with lesions. CONCLUSIONS: These findings suggest that "organic" symptoms of psychosis in those infected with HIV are related to the systemic and cerebral complications of HIV infection rather than to the psychotic process itself.

AIDS Dementia Complex↗
PubMed1983

[Psychopathologic onset of brain tumors].

The pattern of the psychopathological syndromes that marked the onset of brain tumors was examined using the materials of 99 cases of brain tumors seen at the Kostroma region psychiatric hospital. Of the 75 supratentorial tumors, 48 were localized in the left and 27 in the right hemisphere. In 38 cases the debut of the disease was marked by the epileptic syndrome, while in 19 cases by the syndromes of disordered consciousness. The other syndromes were encountered less frequently. As regards the histological structure there prevailed glial type tumors. Analysis of the pattern of the psychopathological syndromes made it possible to reduce over the past 10 years the percentage of diagnostic errors from 43 to 19 and to provide timely delivery of the neurosurgical care.

Adolescent↗