• Title/Summary/Keyword: neuropsychiatric disease

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Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review

  • Chun Geun Lim;Myong Hun Hahm;Hui Joong Lee
    • Journal of Yeungnam Medical Science
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    • v.40 no.2
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    • pp.136-145
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    • 2023
  • Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as "acute-on-chronic liver failure (ACLF)," a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.

The Effect of Adding Kami-guibi-tang to Acetylcholinesterase Inhibitor Treatment on the Cognitive Function of Mild Alzheimer's Disease Patients: Study Protocol of a Randomized, Placebo-Controlled, Double-Blind Pilot Trial

  • Yang, Seung-bo;Kim, Ha-ri;Shin, Hee-yeon;Kim, Jeong-hwa;Lee, Chang-woo;Jahng, Geon-ho;Park, Seong-uk;Ko, Chang-nam;Park, Jung-mi
    • The Journal of Internal Korean Medicine
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    • v.41 no.3
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    • pp.326-338
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    • 2020
  • Background: Alzheimer's disease (AD) is a chronic neurodegenerative disease that causes disorientation, mood swings, problems with language, and difficulty remembering recent events. Acetylcholinesterase inhibitors (AchEIs) and memantine have been used to slow the course of the disease, but they can neither modify its progression nor prevent disease onset. Previous studies have suggested that Kami-guibi-tang (KGT) could be beneficial for supporting cognitive function in AD patients, but few clinical trials have been published. This pilot study aimed to evaluate the effect of KGT in improving cognitive function in AD patients. Methods: The study will be a randomized, placebo-controlled, double-blind, single-center trial conducted using subjects diagnosed with mild AD by neurologists. Study subjects will be randomly assigned to either a treatment or control group. The treatment group will receive KGT granules for 24 weeks, while the control group will receive placebo granules. AchEI administration will be maintained in both groups during the entirety of the study. Subjects will be assessed using the following exams: the Seoul Neuropsychologic Screening Battery (SNSB) for cognitive function; brain magnetic resonance imaging (MRI) for brain metabolite, neurotransmitter, and cerebral blood flow (CBF) measurements; the Korean version of Quality of Life-Alzheimer's Disease (KQol-AD) for quality of life; the Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI) for neurobehavioral symptoms; blood tests for amyloid and tau proteins and general blood parameters; and electrocardiography (ECG) before and after taking the medication. Discussion: Our findings will provide insight into the feasibility of large-scale trials to consolidate evidence for the efficacy of KGT for dementia treatment. Registration ID in CRIS: KCT0002904 (Clinical Research Information Service of the Republic of Korea).

Imaging Neuroreceptors in the Living Human Brain

  • Wagner Jr Henry N.;Dannals Robert F.;Frost J. James;Wong Dean F.;Ravert Hayden T.;Wilson Alan A.;Links Jonathan M.;Burns H. Donald;Kuhar Michael J.;Snyder Solomon H.
    • The Korean Journal of Nuclear Medicine
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    • v.18 no.2
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    • pp.17-23
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    • 1984
  • For nearly a century it has been known that chemical activity accompanies mental activity, but only recently has it been possible to begin to examine its exact nature. Positron-emitting radioactive tracers have made it possible to study the chemistry of the human mind in health and disease, using chiefly cyclotron-produced radionuclides, carbon-11, fluorine-18 and oxygen-15. It is now well established that measurable increases in regional cerebral blood flow, glucose and oxygen metabolism accompany the mental functions of perception, cognition, emotion and motion. On May 25, 1983 the first imaging of a neuroreceptor in the human brain was accomplished with carbon-11 methyl spiperone, a ligand that binds preferentially to dopamine-2 receptors, 80% of which are located in the caudate nucleus and putamen. Quantitative imaging of serotonin-2, opiate, benzodiazapine and muscarinic cholinergic receptors has subsequently been accomplished. In studies of normal men and women, it has been found that dopamine and serotonin receptor activity decreases dramatically with age, such a decrease being more pronounced in men than in women and greater in the case of dopamine receptors than serotonin-2 receptors. Preliminary studies in patients with neuropsychiatric disorders suggests that dopamine-2 receptor activity is diminished in the caudate nucleus of patients with Huntington's disease. Positron tomography permits quantitative assay of picomolar quantities of neuro-receptors within the living human brain. Studies of patients with Parkinson's disease, Alzheimer's disease, depression, anxiety, schizophrenia, acute and chronic pain states and drug addiction are now in progress. The growth of any scientific field is based on a paradigm or set of ideas that the community of scientists accepts. The unifying principle of nuclear medicine is the tracer principle applied to the study of human disease. Nineteen hundred and sixty-three was a landmark year in which technetium-99m and the Anger camera combined to move the field from its latent stage into a second stage characterized by exponential growth within the framework of the paradigm. The third stage, characterized by gradually declining growth, began in 1973. Faced with competing advances, such as computed tomography and ultrasonography, proponents and participants in the field of nuclear medicine began to search for greener pastures or to pursue narrow sub-specialties. Research became characterized by refinements of existing techniques. In 1983 nuclear medicine experienced what could be a profound change. A new paradigm was born when it was demonstrated that, despite their extremely low chemical concentrations, in the picomolar range, it was possible to image and quantify the distribution of receptors in the human body. Thus, nuclear medicine was able to move beyond physiology into biochemistry and pharmacology. Fundamental to the science of pharmacology is the concept that many drugs and endogenous substances, such as neurotransmitters, react with specific macromolecules that mediate their pharmacologic actions. Such receptors are usually identified in the study of excised tissues, cells or cell membranes, or in autoradiographic studies in animals. The first imaging and quantification of a neuroreceptor in a living human being was performed on May 25, 1983 and reported in the September 23, 1983 issue of SCIENCE. The study involved the development and use of carbon-11 N-methyl spiperone (NMSP), a drug with a high affinity for dopamine receptors. Since then, studies of dopamine and serotonin receptors have been carried out in over 100 normal persons or patients with various neuropsychiatric disorders. Exactly one year later, the first imaging of opitate receptors in a living human being was performed [1].

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A Study on the Disease induced by Emotional Problem and the Psychotherapeutic Medical Records in Mingyi-leian (Classified Medical Records of Famous Doctors) (<명의류안(名醫類案)>에 나타난 감정으로 유발된 질환 및 심리치료 의안(醫案)에 관(關)한 연구(硏究))

  • Kim, Sung-Wook;Han, Yoon-Seoung;Kim, Geun-Woo;Koo, Byung-Soo;Kim, Joo-Ho
    • Journal of Oriental Neuropsychiatry
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    • v.17 no.1
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    • pp.17-35
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    • 2006
  • Objects : In the present study, we translated Mingyi-leian into modern Korean, and studied the medical records about the disease induced by emotional problem and the psychotherapy in Mingyi-leian for find the possibility of application that established researches did not studied. Methods : It was 197 cases that related to psychotherapy and emotional problem called Seven Passions(七情). We studied these records by statistical methods. Results : The anger(怒) was the most numerous cause into classified to Seven Passions in 197 cases. In the order of frequency of emotional causes, it was worry(憂), surprise(驚), lust(思), fear(恐), sorrow(悲), joy(喜) that classified into Seven Passions. The most disease induced by emotional problem was internal trauma(內傷), 11 cases. There was very numerous diseases induced by emotional problem except internal trauma. In ratio of the sexes, it was 104 cases in female and 93 cases in male from 197 cases. But the number of all case records about male were more than about female in Mingyi-leian, so female ratio was two times to male ratio. Specially, the percentage of cases about disease due to anger high in female. In ratio of the Seven Passions, the anger was most frequent cause of diseases due to emotional problem in 197 cases, and mostly caused bleeder's diseases. In oral medical treatments, various prescriptions were used. On the whole, the ratio of prescriptions about venting grudges(解鬱) records are mostly application of compatibility and incompatibility with the and warmly strengthening(溫補) were high. Psychotherapeutic medical Five Elements(五行) relation. But it also has psychotherapeutic medical record made by detailed and correct analysis can equal to modern psychotherapy, it is worth refer to clinic. Conclusions : Mingyi-leian and its medical records about the disease induced by emotional problem and the psychotherapeutic records have sufficient meaning to not only modern neuropsychiatric physicians but also physicians of all medical fields to treat disease of this kind.

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Association between Cognitive Function, Behavioral and Psychological Symptoms of Dementia and White Matter Hyperintensities in Patients with Alzheimer's Disease and Mild Cognitive Impairment (알츠하이머병 및 경도인지장애 환자에서 인지기능 및 행동심리증상과 백질고강도신호와의 연관성)

  • Kwon, Ji Woong;Kim, Hyun;Lee, Kang Joon
    • Korean Journal of Psychosomatic Medicine
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    • v.26 no.2
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    • pp.119-126
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    • 2018
  • Objectives : The aim of this study is to investigate correlation between degree of white matter hyperintensities (WMH) and neurocognitive function along with behavioral and psychological symptoms of dementia (BPSD) in Korean patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods : Participants were 115 elderly subjects diagnosed with Alzheimer's disease or mild cognitive impairment in this retrospective study. WMH in brain MRI were rated with standardized visual rating scales (Fazekas scales) and the subjects were divided into two groups according to Fazekas scale. Cognitive function was evaluated with Korean version of the consortium to establish a registry for Alzheimer's Disease (CERAD-K), and BPSD was evaluated with Korean neuropsychiatric inventory (K-NPI). Independent t-test was performed to analyze the relationship between the degree of WMH and neurocognitive functions & BPSD. Results : Especially, the group with high severity of WMH showed significantly lower language fluency (p<0.05). In addition, the group with high severity of WMH showed significantly higher score in K-NPI. Conclusions : There was a significant association between WMH and neurocognitive test related with executive function. Moreover, WMH seems to affect BPSD severity. Evaluation of WMH would provide useful information in clinical settings.

Analysis of Health Conditions Influencing on Industrial Accidents by Cornell Medical Index (Cornell Medical Index에 의(依)한 산업재해(産業災害) 요인(要因)의 분석(分析))

  • Chang, Im-Won
    • Journal of Preventive Medicine and Public Health
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    • v.12 no.1
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    • pp.31-37
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    • 1979
  • By evaluating the health status of 152 male workers engaged in a metal-product factory by Cornell Medical Index in conjunction with their experience of industrial accident, I attempted to find out whether any health condition may effect on the occurence of industrial accident. Differences in frequency of complaints in each section of CMI between control workers and accident workers were statistically tested by T-test. On the other hand, influence of neuropsychiatric factors (section M-R) on the occurence of accidents was analyzed by $X^2-test$ with Fukamachi's classification. The followings were the results obtained in this study. 1. The average number (26.42) of physical complaints in accident group is significantly more than in control group (18.70). 2. The average number (17.70) of mental complaints in accident group is very significantly more than in control group (11.70). 3. Differences in frequencies of complaints by sections between accident group and control group was all significant except C (cardiovascular system), H (genitourinary system), I (fatigue) & J (frequency of disease). 4. frequency rate of neurotic workers who were identified by Fukamachi's classification was significantly higher in accident group (72%) than in control group (51%).

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A case of Hashimoto's encephalopathy presenting with seizures and psychosis

  • Lee, Min-Joo;Lee, Hae-Sang;Hwang, Jin-Soon;Jung, Da-Eun
    • Clinical and Experimental Pediatrics
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    • v.55 no.3
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    • pp.111-113
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    • 2012
  • Hashimoto's encephalopathy (HE) is a rare, poorly understood, autoimmune disease characterized by symptoms of acute or subacute encephalopathy associated with increased anti-thyroid antibody levels. Here, we report a case of a 14-year-old girl with HE and briefly review the literature. The patient presented with acute mental changes and seizures, but no evidence of infectious encephalitis. In the acute stage, the seizures did not respond to conventional antiepileptic drugs, including valproic acid, phenytoin, and topiramate. The clinical course was complicated by the development of acute psychosis, including bipolar mood, insomnia, agitation, and hallucinations. The diagnosis of HE was supported by positive results for antithyroperoxidase and antithyroglobulin antibodies. Treatment with methylprednisolone was effective; her psychosis improved and the number of seizures decreased. HE is a serious but curable, condition, which might be underdiagnosed if not suspected. Anti-thyroid antibodies must be measured for the diagnosis. HE should be considered in patients with diverse neuropsychiatric manifestations.

A Meta-analysis of the Risk Factors related to Falls among Elderly Patients with Dementia (치매노인의 낙상위험요인에 관한 메타분석)

  • Hong, SunYoung;Park, Heeok
    • Korean Journal of Adult Nursing
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    • v.29 no.1
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    • pp.51-62
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    • 2017
  • Purpose: The purpose of this study was to provide data about the risk factors related to falls among elderly patients with dementia using meta-analysis. Methods: Key words used for search through electronic database (CINAHL, PubMed, Ovid-MEDLINE, RISS, KISS, DBPIA, National Assembly Library) included 'dementia', 'Alzheimer', 'fall'. Twenty studies met the inclusion criteria for the meta-analysis and 'R' version 3.2.2 was used to analyze the correlated effect size. Results: Study results showed that risk factors related to falls were identified as the demographic (age, gender, education), dementia-related (disease duration, cognition), physical (body mass index, walking, balance, activity of daily living, use of walking aids, number of medications including psychotropic drugs, musculoskeletal problems, parkinsonism, comorbidity), psychological (neuropsychiatric symptom, depression), environmental (Physical environment), and fall-related (fall history, high risk group of fall) factors. The effect size of risk factors such as high risk group of fall (r=.35), use of walking aids (r=.33), depression (r=.31), psychotropic drugs (r=.27), Musculoskeletal problems (r=.25) were higher than the other risk factors. Conclusion: Based on the findings of this study, strategies to improve elderly patient's depression, intensive care for high risk group of fall, and adequate training with walking aids are needed for prevention of falls in elderly patients with dementia.

A Conceptual Study of "Pyo (表)" in Gangpyeong-Shanghanlun Based on Two Cases of Bipolar Disorder Improved with Mahwang-tang (『강평상한론(康平傷寒論)』 '표(表)'에 대한 고찰 : 마황탕(麻黃湯)으로 호전된 양극성 장애 2례를 바탕으로)

  • Choi, Woon-yong;Lee, Sung-jun
    • 대한상한금궤의학회지
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    • v.13 no.1
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    • pp.81-98
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    • 2021
  • Objective : We explored the meaning of "Pyo (表)" in Gangpyeong-Shanghanlun through two cases. Methods : We analyzed the original form of 表 and its context in Shanghanlun. We also analyzed 2 clinical cases of bipolar disorder treated with Mahwang-tang (麻黃湯) according to the newly deduced definition of 表. Results : 表 can be interpreted as "pursuing something high-class seen from the outside." Both cases had various psychological symptoms including insomnia, mood swings, anxiety, and depression. We determined that the diseases in both cases occurred when 表 had not been achieved. We also found that 麻黃湯 can improve psychological status. Conclusions : 表 is different from "surface," which is the most widely used definition. After diagnosing these two patients with bipolar disorder using the Diagnostic and Statistical Manual of Mental Disorders (5th edition), we found that symptoms could be improved by administration of 麻黃湯 (46條). Although its potential for neuropsychiatric diagnosis has been suggested through etymological interpretation of 表 and analysis of two cases, more advanced clinical studies are needed in the future.

An Infant Case of Citrin Deficiency with Corresponding Biochemical Features and a Heterozygous SLC25A13 Mutation (SLC25A13 이형접합 유전자 변이와 부합하는 생화학적 소견을 가진 영아 시트린 결핍증 1례)

  • Kang, Su Min;Chi, Yang Hyun;Lee, Jun Hwa
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.15 no.3
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    • pp.155-159
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    • 2015
  • Citrin deficiency (OMIN #605814) is an autosomal recessive disorder caused by the SLC25A13 gene mutation with abnormal biochemical findings, including increased serum ammonia, citrulline, arginine, galactose, serum threonine-to-serine ratio, serum pancreatic secretory trypsin inhibitor, and alpha-fetoprotein. Citrin deficiency can manifest in three ways: in newborns as neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD), in older children as failure to thrive and dyslipidemia caused by citrin deficiency (FTTDCD), and in adults as citrullinemia type 2 (CTLN2) with recurrent hyperammonemia and neuropsychiatric symptoms. We report a 35-day-old asymptomatic patient with citrin deficiency who had abnormal biochemical findings.