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2 results

  • Chapter 11 - Psychotic Disorders in Prader-Willi Syndrome

  • Edited by Deepan Singh
  • Book:
    Neuro-behavioral Manifestations of Prader-Willi Syndrome
    Published online:
    26 May 2022
    Print publication:
    16 June 2022, pp 103-115

  • Summary

    This chapter describes the phenomenon of psychosis and how it presents in patients with PWS. Characteristics of psychosis, including delusions, hallucinations, disorganized thinking, abnormal motor behavior, or negative symptoms are described. Although the classical presentation of schizophrenia, schizophreniform, and other schizoid disorders is uncommon in PWS, there are other less-recognized psychotic presentations that are explained in the text. Delirium, despite not being considered a psychotic disorder, is important to recognize due to its association with medications patients with PWS are prescribed. Cycloid psychosis is another phenomenon that, although not formally recognized in the DSM-5, is frequently seen in PWS. The sudden onset and cycling between normalcy and psychosis makes it difficult to diagnose for providers who are unfamiliar with it. We emphasize the need for immediate medical attention and treatment in the case of suspected psychosis. Some commonly used strategies for management are discussed. Continued monitoring by mental healthcare providers and need for maintenance treatment is discussed.

  • Performance on bedside tests of attention and organized thinking in patients with dementia free from delirium

  • Letty Oudewortel, Karlijn J. Joling, Cees M. P. M. Hertogh, Viona J. M. Wijnen, Anne A. M. van der Brug, Willem A. van Gool
  • Journal:
    International Psychogeriatrics / Volume 31 / Issue 1 / January 2019
    Published online by Cambridge University Press:
    23 July 2018, pp. 73-81
    • Article
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      • Open access
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  • Objectives:

    Bedside tests of attention and organized thinking were performed in patients with cognitive impairment or dementia but without delirium, to provide estimates of false positive rates for detecting delirium superimposed on dementia (DSD).

    Design and Setting:

    This cross-sectional study was conducted in outpatients and institutionalized patients without delirium representing a wide spectrum of severity of cognitive impairments.

    Participants:

    Patients with dementia or a cognitive disorder according to DSM IV criteria, after exclusion of (suspected) delirium according to DSM IV criteria.

    Measurements:

    Tests for inattention and disorganized thinking from the CAM-ICU were assessed.

    Results:

    The sample included 163 patients (mean age 83 years (SD 6; 64% women)), with Alzheimer's disease as most prevalent (45%) diagnosis and a mean MMSE-score of 16.8 (SD 7.5). False positive rates of the test of attention varied from 0.04 in patients with normal to borderline cognitive function to 0.8 in those with severe dementia. The false positive rate of the test of disorganized thinking was zero in the normal to borderline group, increasing to 0.67 in patients with severe dementia. When combining test results false positive rates decreased to 0.03 in patients with MMSE scores above 9.

    Conclusion:

    Use of simple bedside tests of attention and organized thinking for the clinical diagnosis of DSD will result in high rates of false positive observations if used regardless of the severity of dementia. However, if test results are combined they may be useful to exclude DSD in patients with minimal to moderate degrees of dementia, but not in the severe group.