The Journal of neuropsychiatry and clinical neurosciences
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J Neuropsychiatry Clin Neurosci · Jan 2005
Comparative StudyCognitive impairment associated with major depression following mild and moderate traumatic brain injury.
Traumatic brain injury (TBI) and major depression are neuropsychiatric conditions that have been associated with cognitive dysfunction. The aim of this study was to explore the relationship between major depression and cognitive impairment following mild and moderate TBI. ⋯ Subjects with major depression (28.4%), compared to those without, were found to have significantly lower scores on measures of working memory, processing speed, verbal memory and executive function. Potential mechanisms and implications for treatment are discussed.
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J Neuropsychiatry Clin Neurosci · Jan 2005
Case ReportsAdjunctive valproic acid for delirium and/or agitation on a consultation-liaison service: a report of six cases.
The authors present six cases in which valproate was used in patients seen by a consultation-liaison service (CLS) to manage delirium and/or psychotic agitation. The intravenous (IV) preparation (Depacon, Abbott Laboratories) was used in two nothing by mouth (NPO) patients, while the liquid oral preparation (Depakene, Abbott Laboratories) was used via nasogastric tube (NGT) in the other patients. All of these cases had suboptimal responses and/or concerning side effects from conventional therapy with benzodiazepines and/or antipsychotics. ⋯ Consultation-liaison psychiatrists should consider the addition of valproic acid to control behavioral symptoms of delirium when conventional therapy is inadequate. This may be especially advisable when problematic side effects result from more conventional psychopharmacological management. Specifically, intravenous valproate sodium may be a viable option for NPO patients.
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J Neuropsychiatry Clin Neurosci · Jan 2005
Comparative StudyHigh-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD.
Eye movement desensitization and reprocessing (EMDR) has been shown to be an effective treatment for posttraumatic stress disorder (PTSD). In this study, the authors evaluated the effectiveness and physiological effects of EMDR in police officers involved with on-duty shootings and who had PTSD. ⋯ In addition, there were decreases in the left and right occipital lobe, left parietal lobe, and right precentral frontal lobe as well as significant increased perfusion in the left inferior frontal gyrus. In our study EMDR was an effective treatment for PTSD in this police officer group, showing both clinical and brain imaging changes.
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Rarely reported in pediatric patients, the characteristic symptoms and course of delirium are well known in adults. This retrospective study was undertaken to describe the clinical presentation, symptoms, and outcome of delirium in children and adolescents. ⋯ Mortality was high (20%), and length of stay was prolonged. Symptoms of psychosis and disorientation were less characteristic, but overall the presentation and course of delirium were similar to adults, and the current Diagnostic and Standard Manual of Mental Disorders (DSM) criteria were found applicable in the pediatric population.
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J Neuropsychiatry Clin Neurosci · Jan 2003
Comparative StudyAn empirical study of different diagnostic criteria for delirium among elderly medical inpatients.
This study compared the sensitivity and specificity of DSM-IV criteria for delirium with the sensitivity and specificity of DSM-III and ICD-10 criteria among elderly medical inpatients with or without dementia. Secondary objectives were to examine the effect of changing the definition of criterion A on sensitivity and specificity and to compare the sensitivity and specificity of different numbers of symptoms of delirium. A total of 322 elderly patients who had been admitted from the emergency department to the medical services were classified into one of four groups using DSM-III-R criteria: delirium and dementia (n = 128), delirium only (n = 40), dementia only (n = 94), and neither (n = 60). ⋯ The results were similar among patients with or without dementia. The lower specificity of DSM-IV was accounted for by its inclusion of patients who did not show disorganized thinking. DSM-IV criteria for delirium are the most inclusive criteria to date for elderly medical patients with or without dementia.