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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Treatment consists of high-dose lorazepam or in some cases ECT. The response to the treatment is usually good, especially if detected early
Autistic catatonia is a rare type of disorder that affects roughly 10 percent of all adults with autism spectrum disorder. Most of them are not severely affected but a few exhibit stupor and severe excitement, which is the most extreme form of the disorder. Full expression of excitement could be a sign of comorbid Bipolar disorder but more research is needed.
More than 40 symptoms has been identified to be a result of the disorder, but some of the symptoms overlap with those of autism spectrum disorder, making diagnosing difficult even for a seasoned professional. In a few cases stupor and hyperactivity can continue for weeks or even months.
During the excitement phase individuals show combativeness and can have delusions and hallucinations and can also pose a danger to themselves or others and can make marked destruction of property..In the later stages of medium and even more in the severe and if left untreatead lethal state they will also experience autonomic instability! (Behav Sci (Basel). 2015 Dec; 5(4): 576–588.
Published online 2015 Dec 9. doi: 10.3390/bs5040576
Childhood schizophrenia increases the risk for autistic catatonia later in life dramatically. There seems to be a common font of brain pathology for psychosis, catatonia and autism.
Although not necessary for the diagnosis, individuals with intellectual disability are at higher risk for SMD. It is more common in boys, and can occur at any age.
Individuals suffering from Diogenes syndrome generally display signs of collectionism, hoarding, or compulsive disorder. Individuals who have suffered damage to the brain, particularly the frontal lobe, may be at more risk to developing the syndrome. The frontal lobes are of particular interest, because they are known to be involved in higher order cognitive processes, such as reasoning, decision-making and conflict monitoring.
Diogenes Syndrome tends to occur among the elderly. The behavioural patterns that is usually reflected by those living with this disorder are suffering from significant functional problem that is correlated with morbidity and mortality.
Waxy flexibility is a psychomotor symptom of catatonia as associated with schizophrenia, bipolar disorder, or other mental disorders which leads to a decreased response to stimuli and a tendency to remain in an immobile posture. Attempts to reposition the patient are met by "slight, even resistance", and after being repositioned the patient will typically remain in the new position. Waxy flexibility rarely occurs in cases of delirium. The presence of waxy flexibility along with at least two other catatonic symptoms such as stupor or negativism are enough to warrant a diagnosis of catatonia.
For instance, if one were to move the arm of someone with waxy flexibility, they would keep their arm where one moved it until it was moved again, as if it were made from wax. Further alteration of an individual's posture is similar to bending a candle. Although waxy flexibility has historically been linked to schizophrenia, there are also other disorders which it may be associated with, for example, mood disorder with catatonic behaviour.
Electroconvulsive therapy is often used as a treatment for catatonia. A study has found that catatonic patients suffering from waxy flexibility responded faster to electroconvulsive therapy, compared to patients with different catatonic symptoms.
Prognosis depends on the severity of the disorder. Recognizing symptoms early can help reduce the risk of self-injury, which can be lessened with meditations. Stereotypic movement disorder due to head trauma may be permanent.
The number of events that can lead to the development of PSH symptoms is many. The exact pathways or causes for the development of the syndrome are not known. Traumatic brain injury, hypoxia, stroke, anti-NMDA receptor encephalitis (although further associations are being explored), injury of the spinal cord, and many other forms of brain injury can cause onset of PSH. Even more obscure diseases such as intracranial tuberculoma have been seen to cause onset of paroxysmal sympathetic hyperactivity. It is observed that these injuries lead to the development of PSH or are seen in conjunction with PSH, but the pathophysiology behind these diseases and the syndrome is not well understood.
Diogenes syndrome is a disorder that involves hoarding of rubbish and severe self-neglect. In addition, the syndrome is characterized by domestic squalor, syllogomania, social alienation, and refusal of help. It has been shown that the syndrome is caused as a reaction to stress that was experienced by the patient. The time span in which the syndrome develops is undefined, though it is most accurately distinguished as a reaction to stress that occurs late in life.
In most instances, patients were observed to have an abnormal possessiveness and patterns of compilation in a disordered manner. These symptoms suggest damages on the prefrontal areas of the brain, due to its relation to decision making. Although in contrast, there have been some cases where the hoarded objects were arranged in a methodical manner, which may suggest a cause other than brain damage.
Although most patients have been observed to come from homes with poor conditions, and many had been faced with poverty for a long period of time, these similarities are not considered as a definite cause to the syndrome. Research showed that some of the participants with the condition had solid family backgrounds as well successful professional lives. Half of the patients were of higher intelligence level. This indicates the "Diogenes syndrome" does not exclusively affect those experiencing poverty or those who had traumatic childhood experiences.
The severe neglect that they bring on themselves usually results in physical collapse or mental breakdown. Most individuals who suffer from the syndrome do not get identified until they face this stage of collapse, due to their predilection to refuse help from others.
The patients are generally highly intelligent, and the personality traits that can be seen frequently in patients diagnosed with Diogenes syndrome are aggressiveness, stubbornness, suspicion of others, unpredictable mood swings, emotional instability and deformed perception of reality. Secondary DS is related to mental disorders. The direct relation of the patients' personalities to the syndrome is unclear, though the similarities in character suggest potential avenues for investigation.
Circumstantial speech (also referred to as circumstantiality) is the result of a so called "non-linear thought pattern" and occurs when the focus of a conversation drifts, but often comes back to the point. In circumstantiality, apparently unnecessary details and seemingly irrelevant remarks cause a delay in getting to the point.
If someone exhibits circumstantial speech during a conversation, they will often seem to "talk the long way around" to their point, which may be an attempt by the speaker to include pertinent hyperspatial details, that may contrast with linear speech, which is more direct, succinct, and to the point (the gist) even at the expense of more precise, accurate communication. Some individuals with autistic tendencies may prefer highly precise speech, and this may seem circumstantial, but in fact it is a choice that posits that more details are necessary to communicate a precise meaning, and preempt more disastrous ambiguous communication.
Circumstantial speech is more direct than tangential speech in which the speaker wanders and drifts (in order to add more thought vectors in unrelated hyperplanes) and usually never returns to the original topic, and is far less severe than logorrhea. A helpful metaphor is traveling to a destination. If someone is thinking and speaking linearly, then they will go directly to the point. Circumstantial speech is more like taking "unnecessary" detours, according to some, but the speaker eventually arrives at the intended destination. In tangential speech, the speaker simply gets lost along the way, never returning to the original topic of conversation. With logorrhea, which is closer to word salad, it may not even be clear that the speaker had a particular idea or point in the first place.
Catalepsy is a symptom of certain nervous disorders or conditions such as Parkinson's disease and epilepsy. It is also a characteristic symptom of cocaine withdrawal, as well as one of the features of catatonia. It can be caused by schizophrenia treatment with anti-psychotics, such as haloperidol, and by the anesthetic ketamine. Protein kinase A has been suggested as a mediator of cataleptic behavior.
A person afflicted with circumstantiality has slowed thinking and invariably talks at length about irrelevant and trivial details (i.e. circumstances). Eliciting information from such a person can be difficult since circumstantiality makes it hard for the individual to stay on topic. In most instances however, the relevant details are eventually achieved.
The disorder is often associated with schizophrenia and obsessive-compulsive disorder.
Catatonia is a state of psycho-motor immobility and behavioral abnormality manifested by stupor. It was first described in 1874 by Karl Ludwig Kahlbaum, in ("Catatonia or Tension Insanity").
Though catatonia has historically been related to schizophrenia (catatonic schizophrenia), it is now known that catatonic symptoms are nonspecific and may be observed in other mental disorders and neurological conditions. In the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM), catatonia is not recognized as a separate disorder, but is associated with psychiatric conditions such as schizophrenia (catatonic type), bipolar disorder, post-traumatic stress disorder, depression and other mental disorders, narcolepsy, as well as drug abuse or overdose (or both). It may also be seen in many medical disorders including infections (such as encephalitis), autoimmune disorders, focal neurologic lesions (including strokes), metabolic disturbances, alcohol withdrawal and abrupt or overly rapid benzodiazepine withdrawal. In the fifth edition of the DSM, it is written that a variety of medical conditions may cause catatonia, especially neurological conditions: encephalitis, cerebrovascular disease, neoplasms, head injury. Moreover, metabolic conditions: homocystinuria, diabetic ketoacidosis, hepatic encephalopathy, hypercalcaemia.
It can be an adverse reaction to prescribed medication. It bears similarity to conditions such as encephalitis lethargica and neuroleptic malignant syndrome. There are a variety of treatments available; benzodiazepines are a first-line treatment strategy. Electroconvulsive therapy is also sometimes used. There is growing evidence for the effectiveness of NMDA receptor antagonists for benzodiazepine-resistant catatonia. Antipsychotics are sometimes employed but require caution as they can worsen symptoms and have serious adverse effects.
All of the causes of childhood disintegrative disorder are still unknown. Sometimes CDD surfaces abruptly within days or weeks, while in other cases it develops over a longer period of time. A Mayo Clinic report indicates: "Comprehensive medical and neurological examinations in children diagnosed with childhood disintegrative disorder seldom uncover an underlying medical or neurological cause. Although the occurrence of epilepsy is higher in children with childhood disintegrative disorder, experts don't know whether epilepsy plays a role in causing the disorder."
CDD, especially in cases of later age of onset, has also been associated with certain other conditions, particularly the following:
- Lipid storage diseases: In this condition, a toxic buildup of excess fats (lipids) takes place in the brain and nervous system.
- Subacute sclerosing panencephalitis: Chronic infection of the brain by a form of the measles virus causes subacute sclerosing panencephalitis. This condition leads to brain inflammation and the death of nerve cells.
- Tuberous sclerosis (TSC): TSC is a genetic disorder. In this disorder, tumors may grow in the brain and other vital organs like kidneys, heart, eyes, lungs, and skin. In this condition, noncancerous (benign) tumors, hamartomas, grow in the brain.
- Leukodystrophy: In this condition, the myelin sheath does not develop in a normal way causing white matter in the brain to disintegrate.
Patients who develop PSH after traumatic injury have longer hospitalization and longer durations in intensive care in cases where ICU treatment is necessary. Patients often are more vulnerable to infections and spend longer times on ventilators, which can lead to an increased risk of various lung diseases. PSH does not affect mortality rate, but it increases the amount of time it takes a patient to recover from injury, compared to patients with similar injuries who do not develop PSH episodes. It often takes patients who develop PSH longer to reach similar levels of the brain activity seen in patients who do not develop PSH, although PSH patients do eventually reach these same levels.
There is no known single cause or causes of schizophrenia, however, it is a heritable disorder.
Several environmental factors, including perinatal complications and prenatal maternal infections could cause schizophrenia. These factors in a greater severity or frequency could result in an earlier onset of schizophrenia. Maybe a genetic predisposition is a important factor too, familial illness reported for childhood-onset schizophrenic patients.
Pooled data suggest the incidence of NMS is between 0.2%–3.23%. However, more physician awareness coupled with increased use of atypical anti-psychotics have likely reduced the prevalence of NMS. Additionally, young males are particularly susceptible and the male:female ratio has been reported to be as high as 2:1.
The prognosis is best when identified early and treated aggressively. In these cases NMS is not usually fatal. In previous studies the mortality rates from NMS have ranged from 20%–38%; however, in the last two decades, mortality rates have fallen below 10% due to early recognition and improved management. Re-introduction to the drug that originally caused NMS to develop may also trigger a recurrence, although in most cases it does not.
Memory impairment is a consistent feature of recovery from NMS, and usually temporary, though in some cases, may become persistent.
Schizophrenia disorders in children are rare. Boys are twice as likely to be diagnosed with childhood schizophrenia. There is often an disproportionately large number of males with childhood schizophrenia, because the age of onset of the disorder is earlier in males than females by about 5 years. People have been and still are reluctant to diagnose schizophrenia early on, primarily due to the stigma attached to it.
While very early-onset schizophrenia is a rare event, with prevalence of about 1:10,000, early-onset schizophrenia is manifests more often with an estimated prevalence of 0.5 %.
Multiple complex developmental disorder is likely to be caused by a number of different various genetic factors. Each individual with MCDD is unique from one another and displays different symptoms. Various neuropsychological disorders can also be found in family members of people with MCDD.
Initial treatment is aimed at providing symptomatic relief. Benzodiazepines are the first line of treatment, and high doses are often required. A test dose of intramuscular lorazepam will often result in marked improvement within half an hour. In France, zolpidem has also been used in diagnosis, and response may occur within the same time period. Ultimately the underlying cause needs to be treated.
Electroconvulsive therapy (ECT) is an effective treatment for catatonia. Antipsychotics should be used with care as they can worsen catatonia and are the cause of neuroleptic malignant syndrome, a dangerous condition that can mimic catatonia and requires immediate discontinuation of the antipsychotic.
Excessive glutamate activity is believed to be involved in catatonia; when first-line treatment options fail, NMDA antagonists such as amantadine or memantine are used. Amantadine may have an increased incidence of tolerance with prolonged use and can cause psychosis, due to its additional effects on the dopamine system. Memantine has a more targeted pharmacological profile for the glutamate system, reduced incidence of psychosis and may therefore be preferred for individuals who cannot tolerate amantadine. Topiramate is another treatment option for resistant catatonia; it produces its therapeutic effects by producing glutamate antagonism via modulation of AMPA receptors.
It is estimated that up to 16.5% of elementary school aged children present elevated SOR behaviors in the tactile or auditory modalities. However, this figure might represent an underestimation of Sensory Over Responsivity prevalence, since this study did not include children with developmental disorders or those delivered preterm, who are more likely to present it.
This figure is, nonetheless, larger than what previous studies with smaller samples had shown: an estimate of 5–13% of elementary school aged children.
Incidence for the remaining subtypes is currently unknown.
Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of autistic spectrum disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term "multiplex developmental disorder" was coined by Donald J. Cohen in 1986.
The prevalence rate has been estimated to be less than 1/1,000,000 worldwide. However, it is much more common in the French-Canadian population of the Saguenay and Lac-St-Jean regions of Quebec, Canada, where it has a frequency of about 1 in 2100 in live births, and a carrier rate of 1 in 23.
Symptoms include: rigid body, rigid limbs, limbs staying in same position when moved (waxy flexibility), no response, loss of muscle control, and slowing down of bodily functions, such as breathing.
Because comorbid conditions are common with sensory integration issues, a person may have other conditions as well. People who receive the diagnosis of sensory processing disorder may also have signs of anxiety problems, ADHD, food intolerances, behavioral disorders and other disorders.