1/15. "Herbal Ecstasy": a case series of adverse reactions.AIMS: To report five cases of adverse effects associated with the ingestion of "Herbal Ecstasy" tablets and discuss possible mechanisms of toxicity. METHOD: Composition of the "Herbal Ecstasy" tablets was determined by discussions with distributors and with MEDSAFE: Reference to relevant texts and an internet and medline literature search was used to identify articles of interest RESULTS: Three patients complained of minor symptoms such as perceptual disturbances, anorexia, inability to sleep, dizziness, palpitations and paresthesia. A fourth patient presented with palpitations and ventricular bigeminy, and a fifth patient presented with headache, vomiting, and a hypertensive crisis. Different brands of "Herbal Ecstasy" have different compositions, some containing caffeine and kava, and one contained ephedrine. CONCLUSION: These five patients presented with adverse reactions to "Herbal Ecstasy" ranging from minor to major. knowledge of the possible mechanisms of toxicity will help plan therapy in cases of major toxicity.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
2/15. Treatment of agitation and aggression in four demented patients using ECT.electroconvulsive therapy (ECT) has been shown to be effective in treating the behavioral symptoms associated with psychiatric disorders in demented patients. Four case studies are presented that show its efficacy in treating behavioral symptoms in demented patients. We suggest that ECT is beneficial in these potentially life-threatening behavioral disturbances.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
3/15. dementia with lewy bodies treated with rivastigmine: effects on cognition, neuropsychiatric symptoms, and sleep.dementia with lewy bodies (DLB) is a common cause of the dementia syndrome. Symptomatic treatment of the fluctuating cognition, visual hallucinations, and sleep disturbance that characterize this condition is challenging; neuroleptics are relatively contraindicated. We describe eight patients fulfilling the consensus diagnostic criteria for probable DLB who were treated with rivastigmine. Clinical features rated were: cognition by the Modified Mini-Mental State Examination (3MS); and behavioral and psychiatric symptoms by the Neuropsychiatric Inventory (NPI). Additional information was obtained from family and nursing reports. Seven patients showed resolution or improvement in cognition and neuropsychiatric symptoms as demonstrated by improvement in their 3MS and NPI scores. They also became more independent in mobility and activities of daily living, and the majority returned to live in their own home. Of the seven patients with sleep disruption, six improved. One case had no improvement in his symptomatology and the rivastigmine was stopped. Outcomes in this case series suggest that rivastigmine is well tolerated in clinical practice.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
4/15. Agitation assessment in severe traumatic brain injury: methodological and clinical issues.The aim of this single case study was to evaluate the applicability of a graphic and statistical time-series analyses in the observation of an agitation disturbance in a 16-year-old patient who had sustained a severe traumatic brain injury. The agitation was measured using the Agitated Behaviour Scale. The experimental model was of the A-B type: phase A corresponded to the period of vegetative state, and phase B to the period following the reawakening from coma. The data were submitted to visual and statistical analysis by the split-middle trend line method, function of autocorrelation, and C statistic. The results show the different nature and frequency of the agitated behaviour during the vegetative state and after reawakening from coma. The application of a statistical analysis to establish whether the behavioural disturbance is random or a response to the environment allows the adoption of specific and potentially more efficacious treatments.- - - - - - - - - - ranking = 2keywords = disturbance (Clic here for more details about this article) |
5/15. arm restlessness as the initial symptom in restless legs syndrome.BACKGROUND: upper extremity symptoms can develop in restless legs syndrome, but are rarely the initial symptom. OBJECTIVES: To report a case of restless legs syndrome with restless arms as the initial symptom, and to review the literature. DESIGN: Case report and literature review. PATIENT: A 78-year-old man had arm restlessness and sleep disturbance. A polysomnogram demonstrated subclinical periodic leg movements 1 year after the onset of his symptoms. RESULTS: Two years later, he developed lower extremity symptoms that fit the criteria for restless legs syndrome. To our knowledge, this is the first case of restless legs syndrome with arm restlessness as the initial symptom in an otherwise neurologically normal person. CONCLUSION: restless legs syndrome may initially exhibit upper extremity symptoms.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
6/15. Behavioural disturbances in the demented elderly: phenomenology, pharmacotherapy and behavioural management.Behavioural disturbances in the demented elderly cause a significant amount of distress both to the patients and their caregivers. This article first summarizes the phenomenology associated with these disturbances. It then deals with the pharmacological methods of reducing these disturbances. Finally, it deals with some of the more recent advances in combining the insights of behavioural modification with those of neuropsychology in finding non pharmacological methods of reducing problematic behaviours. It is stressed that a combination of the two approaches is most likely to be required, and most likely to be successful, in the individual case.- - - - - - - - - - ranking = 7keywords = disturbance (Clic here for more details about this article) |
7/15. Alcohol withdrawal as an underrated cause of agitated delirium and terminal restlessness in patients with advanced malignancy.A significant number of patients with terminal cancer experience terminal restlessness or an agitated delirium in the final days of life. Multifactorial etiologies may contribute to agitation and restlessness for any one patient; alcohol withdrawal may be underrated as a contributing factor. The symptoms and signs of alcohol withdrawal--autonomic dysfunction, tremor, anxiety, sleep disturbances, insomnia, and abnormal vital signs--may continue for 6 to 12 months after the cessation of alcohol. We report four patients with terminal restlessness in whom we believe alcohol withdrawal to be a significant causal factor and a fifth patient who subsequently benefited from our team's increased awareness of this clinical problem. Formal assessment of alcohol withdrawal may be of more value in the palliative setting than using the currently accepted assessment instruments. Many of the medications utilized for the treatment of agitated delirium and terminal restlessness in the palliative care setting are effective therapies for alcohol withdrawal.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
8/15. Quetiapine in the treatment of behavioral disturbances in patients with Huntington's disease.The effect of quetiapine (an atypical antipsychotic with minimal extrapyramidal side effects) on motor as well as behavioral symptoms was studied in five consecutive patients with Huntington's disease in a long-term facility. Improvement of behavioral symptoms (i.e., psychotic symptoms, agitation, irritability, and insomnia) without worsening of motor functioning were noted.- - - - - - - - - - ranking = 4keywords = disturbance (Clic here for more details about this article) |
9/15. Adrenocortical suppression presenting with agitated depression, morbid jealousy, and a dementia-like state.A 66-year-old woman showed profound neuropsychiatric disturbance after withdrawal from prolonged corticosteroid treatment. Reintroduction of an alternative corticosteroid, at low dose, produced a return to premorbid mental state.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
10/15. The psychiatry of vertebro-basilar insufficiency with the report of a case.Vertebro-basilar insufficiency produces a rich spectrum of psychological and neurological symptoms. Where psychological symptoms dominate the picture, the patient may be presented first to a psychiatrist. The phenomenology of vertebro-basilar insufficiency is discussed with special reference to hallucinatory syndromes, memory disturbance, affective disorders, akinetic mutism, 'unusual reports', cortical blindness, agitated delirium, the capgras syndrome and normal pressure hydrocephalus. Finally, the case of a 61-year-old man illustrating a variety of the neurological and psychological features described in this paper is presented.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
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