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Assessing Paediatric Development in Psychiatry
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
We know that damage to the limbic system (head of the caudate nucleus, anterior cingulate gyrus, the amygdala and ventral and dorsolateral aspects of the frontal lobe) and to some long fibre bundles linking areas of basic and higher cognitive functions can result in symptoms such as hallucinations, hypersexuality and general disinhibition. Depending on the exact location of damage to the limbic or other midline subcortical regions, emotional disturbance can take the form of two opposite syndromes of abnormal emotional response. First, a syndrome of complete absence of emotion and second, higher autonomic and higher emotional responses in certain situations than would be expected. This latter overstimulated emotional system, seemingly without awareness of the consequences, is seen in some congenital disorders, and the underlying pathology is presumably similar in some psychiatric diseases in which patients show similar extremes of positive emotional behaviour. Examples include William’s syndrome, Noonan syndrome, tuberous sclerosis, early childhood autism before more diagnostic features, such as failure to acquire language, become apparent, storage diseases such as abnormal glycogen metabolism or heavy metal poisoning, temporal or frontal lobe epilepsy, mood disorders, ADHD, foetal alcohol syndrome, post-radiotherapy effects and substance abuse.
Faecal incontinence 1
Published in Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy, Primary Child and Adolescent Mental Health, 2019
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy
Further referral: Those few children who deposit or smear stools may require specialist management. Often such children have other indicators of emotional disturbance, and may be known to social services. Even with this group, however, it is wisest to seek the opinion of a community paediatrician about possible constipation and/or developmental problems before referral to specialist CAMHS.
Interventions for adjustment, impaired Self-Awareness and Empathy
Published in Tom M. McMillan, Rodger Ll. Wood, Neurobehavioural Disability and Social Handicap following Traumatic Brain Injury, 2017
Hamish McLeod, Fiona Ashworth, Tom M. McMillan
The central importance of adjustment and self-awareness to a good recovery and the successful outcome of neurobehavioural interventions have long been recognised. Restoration of impaired identity of self, via compensatory strategies and adjustment, was seen as key to successful rehabilitation in early work by Goldstein (see McMillan, 2013). Sadly, these problems with psychological functioning have not stimulated the development of a coherent array of evidence-based treatment options. This makes it hard to specify effective treatment strategies and to develop new, more efficient, effective, and scalable complex interventions (Craig et al., 2008; Moore et al., 2015b). As an example, the data to guide psychological treatment of depression following TBI is so limited that treatment guidelines have not been able to stipulate an empirically supported approach (SIGN, 2013). The evidence for managing anxiety disorders after brain injury is not much better except for limited evidence that CBT is indicated for acute stress disorder and the recommendation that CBT should be part of a holistic rehabilitation programme (SIGN, 2013; Soo & Tate, 2007). These are substantial limitations as lower levels of emotional distress are a particularly strong predictor of favourable post-injury outcome (Schonberger et al., 2014). If this association between adjustment, awareness, emotional disturbance and recovery is modifiable by psychological therapy, then there is great potential for improving outcomes for a currently neglected group.
Acute parkinsonism in patients with systemic lupus erythematosus: a case report and review of the literature
Published in International Journal of Neuroscience, 2022
Chayasak Wantaneeyawong, Nuntana Kasitanon, Kullanit Kumchana, Worawit Louthrenoo
The main clinical features of parkinsonism, including masked face, resting tremor, rigidity, bradykinesia or akinesia, postural instability and gait difficulty were reported in 13, 20, 25, 22, 10 and 18 patients, respectively. Asymmetrical involvement was noted in 10 patients. Alteration of consciousness, cognitive dysfunction, headache, abnormal speech and dystonia were noted in 14, 7, 6, 14 and 3 patients, respectively. Mutism was noted in six patients, of which all were juvenile SLE. Emotional disturbance (restlessness, agitation, anxiety, depression and self-injury) and focal neurological deficits (ptosis, diplopia, hemiparesis and facial weakness) have been mentioned occasionally. Brisk deep tendon reflex and positive extensor plantar response (Babinski’s sign) were noted in 8 of 14 and 7 of 12 patients, respectively (Supplementary Table 2).
Subjective experience of aberrant salience in young people at Ultra-High Risk (UHR) for psychosis: a cross-sectional study
Published in Nordic Journal of Psychiatry, 2022
Michele Poletti, Lorenzo Pelizza, Silvia Azzali, Sara Garlassi, Ilaria Scazza, Federica Paterlini, Luigi Rocco Chiri, Simona Pupo, Andrea Raballo
The CAARMS is a clinical interview specifically assessing different symptoms of attenuated psychopathology, together with daily functioning (using the integrated ‘Social and Occupational Functioning Assessment Scale’ [SOFAS]) [17]. The 27 CAARMS items (rated according to intensity [0–6] and frequency/duration [0–6]) are usually clustered in 7 main subscales: (a) ‘Positive Symptoms’, (b) ‘Cognitive Change’, (c) ‘Emotional Disturbance’, (d) ‘Negative Symptoms’, (e) ‘Behavioral Change’, (f) ‘Motor/Physical Changes’ and (g) ‘General Psychopathology’. The CAARMS ‘Positive Symptoms’ subscale, which covers disorganized speech, delusions and hallucinations, is used to define both UHR and FEP criteria [17,23]. CAARMS interviews are conducted by trained psychiatrists and clinical psychologists using the approved Italian version (CAARMS-ITA) [24]. Regular CAARMS scoring workshops and supervision sessions ensured a good to excellent inter-rater reliability (specifically, the k coefficient for the agreement on the CAARMS criteria was above 0.85) [25]. As the CAARMS considers both intensity and frequency, we computed composite scores to weight intensity symptoms by their frequencies in accordance with Yung et al. [17].
Subjective experience of social cognition in young people at Ultra-High Risk of psychosis: a 2-year longitudinal study
Published in Nordic Journal of Psychiatry, 2021
Lorenzo Pelizza, Michele Poletti, Silvia Azzali, Sara Garlassi, Ilaria Scazza, Federica Paterlini, Luigi Rocco Chiri, Simona Pupo, Andrea Raballo
The CAARMS is a clinical interview developed to examine different aspects of attenuated psychopathology as well as functioning (via the integrated SOFAS [‘Social and Occupational Functioning Assessment Scale’] instrument) [32]. It consists of 27 items (each one rated in terms of frequency/duration [0–6] and intensity [0–6]), which can be clustered in seven main dimensions: (a) ‘Positive Symptoms’; (b) ‘Cognitive Change, Attention and Concentration’; (c) ‘Emotional Disturbance’; (d) ‘Negative Symptoms’; (e) ‘Behavioral Change’; (f) ‘Motor/Physical Changes’; and (g) ‘General Psychopathology’. The CAARMS ‘Positive Symptoms’ subscale (which covers hallucinations, delusions, and thought disorder) determines both the FEP and the UHR criteria. CAARMS interviews were conducted by four trained ReARMS team members (one psychiatrist and three psychologists: i.e. the same group for which CAARMS inter-rater reliability have been published) [39]. In this respect, the CAARMS-ITA showed excellent inter-rater reliability [39,40].