Open Access Case Study

Spinal Subarachnoid Hemorrhage Associated with Spinal Ischemic Stroke in the Thoracic Region of the Spinal Cord – A Case Report

E. Viteva, O. Chaneva

International Neuropsychiatric Disease Journal, Page 1-5
DOI: 10.9734/INDJ/2016/25903

We present a case report of a 69-year old man with spinal ischemic stroke and spinal subarachnoid hemorrhage (sSAH) in the thoracic region. The first complaint was low back pain, which was followed by retention of urine, inferior paraplegia and distal hypesthesia below Th7-8 dermatome. The diagnosis was confirmed by lumbar puncture, which showed xanthochromic cerebrospinal fluid with erythrocyte- and proteinrachia, and contrast MRI of thoracic region, the latter visualizing two lesions. The intraspinal lesion is hyperintense on Т2 and iso- to hypointense on Т1, corresponding to an ischemic spinal stroke. The extraspinal lesion is hypointense on all sequences and corresponds to a chronic sSAH. The patient denies traumatic injuries, but is with a history of a regular intake of Acenocumarol for chronic atrial fibrillation. The laboratory investigations at hospital admittance showed that the patient is in a state of hypocoagulability. The applied medications resulted in satisfactory improvement of the neurological symptoms.In our opinion the presented case report is of interest because of the extreme rarity of sSAH, moreover in association with spinal ischemic stroke. The hypocoagualability state is the most probable cause of sSAH, which is later complicated with arterial vasospasm, the latter resulting in spinal ischemic stroke.

Open Access Original Research Article

Community Services for Psychiatric Adolescents: When Planning a Residential or Semi-residential Treatment

Michela Gatta, Paola Tomadini, Lara Del Col, Paolo C. Testa, Andrea Spoto, Pier Antonio Battistella

International Neuropsychiatric Disease Journal, Page 1-19
DOI: 10.9734/INDJ/2016/23329

Background: Adolescence psychopathology often represents a challenge in regards of the way it is treated, due to the shortage of public mental health resources like Wellbeing Centers and daily Services, that differ from hospitals. From our experience in a daily Semi-residential Service for Children and Adolescents, part of the Public  Neuropsychiatry Unit in Padua - Italy, we carried out a retrospective analysis in order to identify which factors could be the best indicators for the referral of a young person to a residential or a semi-residential placement.

Scope: We aimed to identify which variables, detectable at an early stage of treatment, may be good predictors for the referral of the young person, either to a daily semi-residential facility, or to recommend a more intensive treatment in a residential unit.

Methods: The sample consists of 102 adolescents referred to the daily Semi-residential Service. It was later on divided into two groups: one group stayed in the Semi-residential Service and the second group pursued a referral in a residential child care institution. All patients were assessed using the Youth Self Report Form YSR (11-18) and the Global Assessment of Functioning Scale (GAF) with a test – retest methodology. For each patient the following data were collected: personal and family details, schooling, diagnosis, therapeutic objectives, adolescent‘s level of cooperation, their families’, and type of intervention submitted. All data were analyzed and compared to find out the most predictive factors towards the best placement for the patient.

Results: It emerged that residential child care institution was recommended for adolescents with the following features: aged under 14, living with single parent, affected by externalizing problems, displaying a poor therapeutic compliance and with non cooperative families.

Conclusions: This study showed the importance to identify which predictive factors are related to a better outcome in patients who used alternative services to hospitalization, considering these factors also necessary in terms of a better therapeutic intervention.

Open Access Original Research Article

Relevance of Brain Stem and Visual Evoked Potentials in Diagnosis of Central Demyelination in Guillain Barre Syndrome

Geetanjali Sharma

International Neuropsychiatric Disease Journal, Page 1-5
DOI: 10.9734/INDJ/2016/24399

Aims: Guillain Barre Syndrome (GBS) is an auto-immune mediated demyelination polyradiculo-neuropathy. Clinical features include progressive symmetrical ascending muscle weakness of more than two limbs, areflexia with or without sensory, autonomic and brainstem abnormalities. The purpose of this study was to determine subclinical neurological changes of CNS with GBS & to establish the presence of central demyelination in GBS.

Study Design:  A prospective study to find out early Central demyelination in clinically diagnosed patients of GBS.

Place and Duration of Study: Department of Physiology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India, between January 2014 and June 2015.

Methodology: The patients were referred from the Department of Medicine to our Department for electro-diagnostic evaluation. The study group comprised of 40 subjects (20 clinically diagnosed GBS patients and 20 healthy individuals) aged between 6-65years. Brain stem and visual evoked potentials were done in both groups using RMS EMG EP Mark II machine. BAEP parameters included the latencies of waves I to IV, inter-peak latencies I-III, III_IV & I-V while VEP included latencies of P100 waves.

Results: Statistically significant increase in absolute peak and inter-peak latency in the GBS group as compared to the control group was noted. Prolongation of latency of P100 wave latency in both the right and left eyes was also recorded in the GBS group.

Conclusion: Results of evoked potentials reflect impairment of auditory and visual pathways probably due to focal demyelination in Schwann cell derived myelin sheaths that cover the extra-medullary portion of the auditory nerves and also due to demyelination of optic pathways. Prolonged central conduction time in BAEPS & VEPS suggest the subclinical auditory and optical involvement in GBS. Early detection of the sub-clinical abnormalities is also important as timely intervention reduces morbidity and mortality.

Open Access Original Research Article

Subjective Experiences of Antipsychotic Treatment: A Comparison of First- and Second-generation Medications among Patients with Schizophrenia

Nisha Warikoo, Subho Chakrabarti, Sandeep Grover

International Neuropsychiatric Disease Journal, Page 1-12
DOI: 10.9734/INDJ/2016/24769

Aims: The patient’s perspective of antipsychotic treatment has been a relatively neglected area of research. Whether subjective experiences of antipsychotic treatment are better among patients on second-generation antipsychotics (SGAs), than those on first-generation antipsychotics (FGAs) has also evoked some controversy. This study attempted a longitudinal comparison of attitudes toward treatment, subjective well-being and quality of life (QOL) between patients on SGAs and FGAs. Socio-demographic and clinical correlates of these subjective experiences were also examined.

Methodology: Standardised ratings of insight, psychopathology, side-effects, attitudes, subjective well-being and QOL were carried out among 40 patients with schizophrenia on SGAs and 30 on FGAs, over a 6-month period.

Results: Both groups were similar in the first 3-month period, apart from the slightly greater severity of illness in the FGA group. Differences in symptom-severity and side-effects emerged between the groups over the course of follow-up. Moreover, as the study progressed, differences also became apparent in subjective experiences; patients on SGAs had significantly better attitudes, subjective well-being and QOL than those on FGAs. However, differences between individual SGAs (olanzapine and risperidone) on these indices were minimal.  The three indices of subjective experience were highly correlated with each other. Older age, being employed, greater insight, lower symptom-severity and the absence of side-effects demonstrated significant positive associations with different aspects of subjective experiences. 

Conclusions: Patients on SGAs had a more favourable profile of subjective experiences with treatment than those on FGAs. These differences seemed to be determined mainly by differences in symptom-severity and side-effects.

Open Access Original Research Article

Self Esteem and Psychological Distress among Patients with Tuberculosis and Fracture in Selected Hospitals in Enugu, Nigeria: A Comparative Study

Andrew Orovwigho, Emmanuel Olose, Richard Uwakwe, Donald Chukwujekwu, Chinyere Aguocha, Monday Igwe

International Neuropsychiatric Disease Journal, Page 1-11
DOI: 10.9734/INDJ/2016/24624

Background: Diagnosis of tuberculosis and lower limb fracture and treatment can affect a patient‘s’- psychological well being. Psychological problems can affect the overall well being of the patient and make palliation of physical symptoms more difficult. Psychological symptoms reflect on individuals self esteem and level of psychological distress.

Objectives: Aim of this study is to ascertain and compare the emotional health and self esteem in patients with tuberculosis and fracture admitted to chest units in University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, and the National Orthopaedic Hospital Enugu, Nigeria.

Methods: Study population consisted of 126 patients with pulmonary tuberculosis receiving treatment at Direct Observed Treatment Short course (DOTS) clinics and 126 patients with lower limb fracture at emergency and out – patients clinic. Socio-demographic interview schedule was used to assess the socio- demographic characteristics of the respondents. Symptom Checklist-90 was used to assess the extent of psychological symptoms in both respondents and Index of Self Esteem was used to assess self esteem.

Results: A significantly higher prevalence of psychiatric disorders was found in the tuberculosis group (25.4%) than in the orthopaedic group (7.6%). Psychiatric disorders encountered included depression, anxiety, and paranoid ideation and interpersonal sensitivity (SCL-90). Low self esteem was more prevalent among patients with tuberculosis compare to fracture.