Journal of psychosomatic research
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The purpose of this study was to collate all works relating to delirium and probable delirium in children and adolescents published since 1980. ⋯ Delirium is an important but neglected disorder of childhood associated with significant morbidity and high mortality. Current clinical practice for management is based on slim empirical evidence.
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Despite the availability of both pharmacological and behavioral therapies for Gilles de la Tourette Syndrome (GTS), a subgroup of patients suffer intractable disease and require treatment through non-conservative means. Since 1955, various neurosurgical procedures have been considered as a potential resort for this severely affected sub-group; this article reviews the neurosurgical treatment for GTS, with in-depth discussion on deep brain stimulation (DBS). Internationally, 39 cases of GTS undergoing DBS treatment have been published. ⋯ Patients resorting to surgical measures often carry the additional burden of a diverse range of behavioral disturbances found to significantly impair health-related quality of life; comorbid psychopathologies must be considered when postoperatively evaluating the benefits of DBS. The authors acknowledge that out of the 39 documented cases of GTS treated with DBS, 18 cases originate from Italy; thus, it seems both relevant and pertinent to recount and present the lived Italian experience of that subgroup of GTS treated by DBS, for the first time. Recommendations from such experience are presented.
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Tourette syndrome (TS) is a neurodevelopmental disorder with a rich phenomenology that includes simple and complex motor and vocal tics as well as multiple comorbidities. From a nosological perspective, it is evident that a continuum of tic severity exists, of which TS is the most severe and rare form, while transient tics and chronic tics represent milder forms. ⋯ Data reduction techniques have been used more recently to define a "simple" and "complex" tic symptom clusters or factors. Phenomenologic approaches can be used in TS to guide future pathophysiologic research.
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Fatigue is a frequent and disabling symptom in patients with multiple sclerosis (MS), but it is difficult to define and measure. Today, MS-related fatigue is not fully understood, and evidence related to explanatory pathophysiological factors are conflicting. ⋯ Insight into the possible underlying psychological mechanisms might help us to develop adequate psychological interventions and to improve the overall management of fatigue. Conceptual issues and the relationships between MS-related fatigue and mood, anxiety, cognition, personality, and cognitive-behavioral factors are discussed, and the implications for clinical practice and research are presented.
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The objective of this study is to provide an expert review of delirium in the context of palliative care. ⋯ Further research is needed regarding delirium recognition, phenomenology, the development of low-burden instruments for assessment, family education, predictive models for reversibility, and evidence-based guidelines on the appropriate use of palliative sedation.