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Fulltext Charles Bonnet syndrome: a precursor to Alzheimer disease

Janaki, V., Rosdinom, R., Hatta, S.

Medicine & Health, 2015;10(2):146-150.
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This case report highlights Charles Bonnet Syndrome as a precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment and the possible differential diagnoses that could be considered. We report a case of an elderly lady with no known previous medical illness, who presented for the first time to the psychiatric clinic with complex visual hallucinations consisting of well-formed images of people and inanimate objects of long standing duration of 18 months. About a year later, there was emergence of cognitive impairment which progressed gradually accompanied by other psychotic symptoms such as auditory hallucinations and persecutory delusions. There were no affective or obsessional symptoms. She had poor insight towards her illness. Ophthalmological examination revealed significant reduction in bilateral visual acuity. Otherwise, physical examination was unremarkable. She received inpatient treatment with Rivastigmine patch 4.6 mg/24 hours and Zydis 10 mg noctre. Her cognitive impairment and psychotic symptoms gradually improved over a period of 2 weeks upon commencing treatment and on subsequent follow-ups at outpatient clinic. She had also gained some insight into her illness. Charles Bonnet syndrome could be a possible precipitating factor and precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment which is often overlooked or misdiagnosed and hence under reported.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Delusions
Fulltext Amphetamine type stimulant (ATS) induced psychosis: A rising problems in Malaysia

Ahmad, H.S.

Malaysian Journal of Psychiatry, 2008;17(2):1-4.
MyJurnal

The past decade has seen a marked increase in the popularity of ATS use, particularly methamphetamine, within East Asia,and the Pacific region. In Malaysia, the National Anti Drug Agency has identified 8,870 addicts (from January till August 2008) out of which 1,126 was ATS dependence. During the same period, the police have arrested 46,388 people under the Dangerous Drug Act 1952. They also has seize 283kg of syabu, 545kg of ecstacy powder, 66194 tablets of esctacy pills and 222,376 tablets of yaba pills from Jan till August this year. The occurrence of psychosis arising from the use of ATS was first reported in the late 1930's. With growing ATS use, particularly methamphetamine, ATS-induced psychosis has become a major impact on public health.Symptoms of ATS-induced psychosis: Methamphetamine use produces a variety of effects, ranging from irritability, to physical aggression, hyperawareness, hypervigilance, and psychomotor agitation. Repeated or high-dose use of the stimulant can cause drug-induced psychosis resembling paranoid schizophrenia, characterized by hallucinations, delusions and thought disorders. When used in long term, methamphetamine may lead to development of psychiatric symptoms due to dopamine depletion in the striatum. The most common lifetime psychotic symptoms among methamphetamine psychotic patients - as reported in a cross-country study involving Australia, Japan, the Philippines and Thailand - are persecutory delusion, auditory hallucinations, strange or unusual beliefs and thought reading. Those patients were also reported to suffer from impaired speech, psychomotor retardation, depression and anxiety. An ATS psychosis can be distinguished from primary psychotic disorders by time. In ATS-induced psychosis symptoms usually resolve after the drug is discontinued. If symptoms do not resolve within 2 weeks after cessation of stimulant use, a primary psychiatric disorder should be suspected. When compared with other stimulants, such as cocaine, psychosis is induced more commonly by ATS, possibly due to the longer duration of action produced by amphetamines.For example, while smoking cocaine produces a high that lasts for 20-30 minutes, smoking methamphetamine produces a high that lasts 8-24 hours. Other symptoms of ATS-induced psychosis reported include affective blunting,(6) violent behavior, and self-mutilation and self-injurious behavior.

Matched MeSH terms: Delusions
Development of the clinical assessment scale in autoimmune encephalitis

Lim JA, Lee ST, Moon J, Jun JS, Kim TJ, Shin YW, et al.

Ann Neurol, 2019 03;85(3):352-358.
PMID: 30675918 DOI: 10.1002/ana.25421

OBJECTIVE: There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale.
METHODS: The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38).
RESULTS: A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p

Matched MeSH terms: Delusions/psychology

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