Neuropsychiatric symptoms

One woman died after 1 week, with multiorgan failure despite intravenous dimercaptosuccinic acid chelation. The other gradually recovered from severe neuropsychiatric symptoms over several months. She had been chelated for several weeks with oral dimercaptosuccinic acid, which apparently improved her clinical condition. ... 

Mental disturbances have been reported after organophosphate exposure. Neuropsychiatric symptoms occurred in two aerial applicators, one of whom used methyl parathion as well as other insecticides. One of these pilots had high levels of exposure to a mixture containing methyl parathion, toxaphene, and Dipterex when his clothing became saturated when the tank of his aircraft accidentally overflowed. Several months after the accident, the subject complained of anxiety, dizziness, emotional lability, and frequent and severe disagreements with family members and associates. Similar observations had been... 

If the enzyme lesion occurs early in the pathway prior to the formation of porphyrinogens (eg, enzyme 3 of Figure 32-9, which is affected in acute intermittent porphyria), ALA and PBG will accumulate in body tissues and fluids (Figure 32-11). Glinically, patients complain of abdominal pain and neuropsychiatric symptoms. The precise biochemical cause of these symptoms has not been determined but may relate to elevated levels of ALA or PBG or to a deficiency of heme. 

Many of the neuropsychiatric symptoms in early hepatic encephalopathy, such as altered sleep patterns, are signs that have classically been attributed to modifications of serotoninergic neurotransmission. Serotonin turnover, as indicated by the ratio of the concentrations of the metabolite 5-hydroxyindoleacetic acid to serotonin, is increased in brain in both human and experimental hepatic encephalopathy. 

Uremic and dialysis encephalopathies. Patients with renal failure continue to manifest neuropsychiatric symptoms despite significant advances in therapeutics and management. Patients with renal failure who are not yet on dialysis develop an array of symptoms, including clouding of consciousness, disturbed sleep patterns, tremor and asterixis that may progress to coma and death. 

Parathyroid hormone (PTH) produces CNS effects in normal subjects and neuropsychiatric symptoms are frequently encountered in patients with primary hyperparathyroidism, where EEG changes resemble those described in acute renal failure. Circulating PTH is not removed by hemodialysis. In uremic patients both EEG changes and neuropsychiatric symptoms are improved by either parathyroidectomy or medical suppression of PTH. The mechanism whereby PTH causes disturbances of CNS function is not well understood, but it has been suggested that increased PTH might facilitate the entry of Ca2+ into the cell resulting in cell death. 

HE is a central nervous system disturbance with a wide range of neuropsychiatric symptoms associated with hepatic insufficiency and liver failure. 

Sink, K.M., Holden, K.F., Yaffe, K. (2005) Pharmacological treatment of neuropsychiatric symptoms of dementia. A review of the evidence. JAMA, 293, 596-608. 

Additionally, there have been postmarketing reports cognitive/neuropsychiatric symptoms, some accompanied by EEG abnormalities such as generalized spike and wave activity, that have been reported as nonconvulsant status epilepticus. 

Table 2. Core neuropsychiatric symptoms in Alzheimer s disease.

The concept of bradyphrenia overlaps with that of apathy, defined as diminished motivation not attributable to diminished level of consciousness, cognitive impairment or emotional distress (Marin, 1990). Apathy is common in neurodegenerative disorders and is associated with orbito-frontal, medial frontal and anterior temporal dysfunction in Alzheimer s disease (Craig et al., 1996). Apathy is one of the most common neuropsychiatric symptoms in PD, and correlates with executive dysfunction (Aarsland, 1999b). However, apathy is even more common in PSP patients (Aarsland et al., 2001c), possibly related to the more marked involvement of the orbitofrontal and medial frontal circuits in PSP than in PD. 

Unexpected neuropsychiatric symptoms, which are regarded as pleasurable by the patient, and particularly if they use associated with objective changes in mood or behaviour. 

Sink KM, tiolden KF, Yaffe K. Pharmacoiogicai treatment of neuropsychiatric symptoms of dementia a review of the evidence. lAMA 2005,293 596-608. 

Becker, D., Swedo, S.E., and Garvey, M.A. (2000) Abnormal motor performance during streptococcal-triggered exacerbations of neuropsychiatric symptoms [abstract]. Neurology 54 A318. 

L., Leonard, H.L., Witowski, M.E., Dubbert, B., and Swedo, S.E. (1999) A pilot study of penicillin prophylaxis for neuropsychiatric symptom exacerbations triggered by streptococcal infections. Biol Psychiatry 45 1564—1571. 

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