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PubMed1980

[Disorders of memory and consciousness in endogenous--depressed patients during antidepressive drug treatment (author's transl)].

Besides the well known somnolent and almost delirious states which always imply different mnestic and gnostic disorders also other drug-induced side-effects and complications can be observed during antidepressive treatment. Mnestic blackouts which clinically are more or less inconspicuous but which are always discovered retrospectively occur more often than they are documented. They are rather related to disturbances of engrammation depending on psychotropic drugs than to a disturbance and narrowing of the state of vigilance and consciousness. In order to exemplify a serious psychopathological complication of the altogether rare amential-amnestical syndrom, a casuistic report is presented of a case of a regulated semiconscious state during two weeks, a case of an amential-amnestical attack, and a case of ictal amnestical episode (Ictus amnesticus). The possible etiology and the observed disorders of memory and consciousness are discussed. The following common pathogenetic factors should be considered though the presented three cases have a different psychopathology and probably a different etiology: (1) The specific pharmacodynamics of the individual antidepressive drug, (2) disease related factors inclusing an alteration of the ability of conceiving and of the process of engrammation, (3) an individual vulnerability of neuronal synaptic systems.

Adult↗
PubMed2001

[A case of multiple sclerosis with recurrent episodes of psychiatric symptoms].

We reported a 19-year-old woman with multiple sclerosis (MS) with recurrent episodes of psychiatric symptoms at the age of 10 and 19, as the first and 11th relapse, respectively. Her first episode of MS resembled acute encephalitis at the age of 9 and she relapsed 12 times. The psychiatric symptoms were not mood disorders but altered states of consciousness, such as the delirous state. She was treated with high doses of intravenous methylpredonisolone and her symptoms were almost resolved, but her anxiety neurosis remained. Her MRI showed demyelination in the white matter of the frontal lobe and the hippocampus, which suggested that psychiatric symptoms of MS would be related to the frontal lobe lesion.

Adult↗
PubMedDate not supplied

Delirium in elderly patients.

Delirium is a mental disorder characterized by disturbances in consciousness, orientation, memory, thought, perception, and behavior, of acute onset and fluctuating course. It occurs in hyperactive, hypoactive, or mixed forms, in up to 50% of elderly hospital inpatients, many with pre-existing dementia, and appears to be independently associated with significant increases in functional disability, length of hospital stay, rates of admission to long-term care institutions, rates of death, and healthcare costs. Despite its clinical importance, delirium is often not detected or it is misdiagnosed as dementia or other psychiatric illness even though there are potential strategies (e.g., screening by nurses, risk-factor assessment) and instruments that can improve detection and diagnosis. Although there has been limited progress in understanding the etiology, pathogenesis, assessment, and specific treatment of delirium, systematic detection and treatment programs appear to be beneficial for elderly surgical patients, as are preventive programs for elderly medical and surgical patients. Even now, there is probably enough evidence to recommend implementation of these two types of programs in acute-care hospitals.

Acute Disease↗
PubMed1977

[Attempt at explaining decompensation of hydrocephalus by modifications of reticular activity].

A correlative study is done between observation of cases of shunted hydrocephalus with mesencephalic signs such as Parinaud's syndrome and a multiunitary recording of mesencephalic and bulbar reticular formation activities during acute and chronic intracranial hypertension in cats. Clinical and experimental data are first separately analysed and then superimposed. This results in analysing the evolution of such intracranial hypertension in three stages: first stage of "tolerance" with minimal clinical signs and no change of reticular activity; second stage of "uncompensation" when mesencephalic signs appear and with increased mesencephalic activity and unchanged bulbar activity; third stage of "exhaustion" where can be noted disorders of consciousness, decerebration fits, and cardiorespiratory disorders; mesencephalic activity falls down to lower levels than basal ones, bulbar activity increases first and then also decreases rapidly. This suggests a mechanism of exhausting stocks of monoamines but also of change of the local cerebral blood flow. Increase and then fall of the reticular activity may be the general way, even without any herniation, of evolution of any intracranial hypertension of traumatic or tumoral origin.

Cerebrospinal Fluid Shunts↗
PubMedDate not supplied

Diagnostic and prognostic guidelines for the vegetative and minimally conscious states.

Many individuals who sustain severe brain injury experience prolonged or permanent disorders of consciousness. While these disorders may appear homogeneous, important distinctions exist in prognosis and clinical management. Studies suggest, however, that the incidence of diagnostic inaccuracy is high in both acute care and rehabilitation settings. In this paper, we review consensus-based diagnostic and prognostic criteria for the vegetative and minimally conscious states. We also discuss recent developments and future directions for research in this area.

Diagnosis, Differential↗