Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
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
A meta-analysis of 37 studies on cognitive differences between those presenting ADHD-Predominantly Inattentive presentations and ADHD-Combined type found that "the ADHD-C presenting performed better than the ADHD-PI presenting in the areas of processing speed, attention, performance IQ, memory, and fluency. The ADHD-PI presenting performed better than the ADHD-C group on measures of flexibility, working memory, visual/spatial ability, non-verbal IQ, motor ability, and language. Both the ADHD-C and ADHD-PI groups were found to perform more poorly than the control group on measures of inhibition, however, there was no difference found between the two groups. Furthermore, the ADHD-C and ADHD-PI presenting did not differ on measures of sustained attention."
SCT is currently not an official diagnosis in DSM-5. But there are rating scales that can be used to screen for SCT symptoms such as the "Concentration Inventory" (for children and adults) or the "Barkley Sluggish Cognitive Tempo Scale-Children and Adolescents (BSCTS-CA)". The "Comprehensive Behaviour Rating Scale for Children" (CBRSC), an older scale, can also be used for SCT as this case study shows.
Although having no diagnosic code either, ICD-10 mentions the SCT group as a reason for why it did not replace the term ""Hyperkinetic Disorder"" with ""ADHD"."
Other mental disorders may produce similar symptoms to SCT (e.g. excessive daydreaming or "staring blankly") and should not be confused with it. Examples might be conditions like depersonalization disorder, dysthymia, thyroid problems, absence seizures, Bipolar II disorder, Kleine–Levin syndrome, forms of autism or schizoid personality disorder. However, the prevalence of SCT in these clinical populations has yet to be empirically and systematically investigated.
Although ADHD has most often been treated with medication, medications do not cure ADHD. They are used solely to treat the symptoms associated with this disorder and the symptoms will come back once the medication stops.
The prognosis of SCT is unknown. In contrast, much is known about the adolescent and adult outcomes of children having ADHD. Those with SCT symptoms typically show a later onset of their symptoms than do those with ADHD, perhaps by as much as a year or two later on average. They have as much or more difficulty with academic tasks and far fewer social difficulties than do people having ADHD. They do not have the same risks for oppositional defiant disorder, conduct disorder, or social aggression and thus may have different life course outcomes compared to children with ADHD-HI and Combined subtypes who have far higher risks for these other "externalizing" disorders.
However, unlike ADHD, there are no longitudinal studies of children with SCT that can shed light on the developmental course and adolescent or adult outcomes of these individuals.
Routine medical assessments are often prescribed to rule-out or identify a somatic cause for bipolar I symptoms. These tests can include ultrasounds of the head, x-ray computed tomography (CAT scan), electroencephalogram, HIV test, full blood count, thyroid function test, liver function test, urea and creatinine levels and if patient is on lithium, lithium levels are taken. Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins.
Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance of compliance with medication as prescribed. Behavior modification through counseling can have positive influence to help reduce the effects of risky behavior during the manic phase. Additionally, the lifetime prevalence for bipolar I disorder is estimated to be 1%.
People with hypersexual disorder experience multiple, unsuccessful attempts to control or diminish the amount of time spent engaging in sexual fantasies, urges, and behaviors in response to dysphoric mood states or stressful life events.
For a valid diagnosis of hypersexual disorder to be established, symptoms must persist for a period of at least 6 months and occur independently of a use mania or a medical condition.
According to Michael First of the DSM-5 working committee the focus of a relational disorder, in contrast to other DSM-IV disorders, "is on the relationship rather than on any one individual in the relationship".
Relational disorders involve two or more individuals and a disordered "juncture", whereas typical Axis I psychopathology describes a disorder at the individual level. An additional criterion for a relational disorder is that the disorder cannot be due solely to a problem in one member of the relationship, but requires pathological interaction from each of the individuals involved in the relationship.
For example, if a parent is withdrawn from one child but not another, the could be attributed to a relational disorder. In contrast, if a parent is withdrawn from both children, the dysfunction may be more appropriately attributable to a disorder at the individual level.
First states that "relational disorders share many elements in common with other disorders: there are distinctive features for classification; they can cause clinically significant impairment; there are recognizable clinical courses and patterns of comorbidity; they respond to specific treatments; and they can be prevented with early interventions. Specific tasks in a proposed research agenda: develop assessment modules; determine the clinical utility of relational disorders; determine the role of relational disorders in the etiology and maintenance of individual disorders; and consider aspects of relational disorders that might be modulated by individual disorders."
The proposed new diagnosis defines a relational disorder as "persistent and painful patterns of feelings, behaviors, and perceptions" among two or more people in an important personal relationship, such a husband and wife, or a parent and children.
According to psychiatrist Darrel Regier, MD, some psychiatrists and other therapists involved in couples and marital counseling have recommended that the new diagnosis be considered for possible incorporation into the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).
Glucocorticoid medications have been known to be associated with significant side effects involving behavior and mood, regardless of previous psychiatric or cognitive condition, since the early 1950s. But cognitive side effects of steroid medications involving memory and attention are not as widely publicized and may be misdiagnosed as separate conditions, such as attention deficit disorder (ADHD or ADD) in children or early Alzheimer's disease in elderly patients.
Hypersexual disorder is a pattern of behavior involving intense preoccupation with sexual fantasies, urges and activities, leading to adverse consequences and clinically significant distress or impairment in social, occupational or other important functions. It was proposed in 2010 for inclusion in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) of the American Psychiatric Association (APA).
SMS is usually confirmed by blood tests called chromosome (cytogenetic) analysis and utilize a technique called FISH (fluorescent in situ hybridization). The characteristic micro-deletion was sometimes overlooked in a standard FISH test, leading to a number of people with the symptoms of SMS with negative results.
The recent development of the FISH for 17p11.2 deletion test has allowed more accurate detection of this deletion. However, further testing is required for variations of Smith–Magenis syndrome that are caused by a mutation of the "RAI1" gene as opposed to a deletion.
Children with SMS are often given psychiatric diagnoses such as autism, attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), attention deficit disorder (ADD) and/or mood disorders.
Aside from discontinuation of glucocorticoid medication, potential treatments discussed in the research literature include:
- anti-glucocorticoids
- psychoactive drugs that up-regulate the GRII glucocorticoid receptor:
- tricyclic antidepressants: Desipramine, Imipramine, and Amitriptyline (SSRIs do not )
- serotonin antagonists: Ketanserin
- mood stabilizers: Lithium
- corticotropin-releasing hormone (CRH) antagonists
- glutamate antagonists
- dehydroepiandrosterone (DHEA)
- small molecule brain-derived neurotrophic factor (BDNF) analogs
- stress reduction therapies and exercise.
Hypersexuality is a clinical diagnosis used by mental healthcare professionals to describe extremely frequent or suddenly increased libido. The terms nymphomania and satyriasis were once used to describe the condition, in women and men respectively, but are no longer in general medical use, although the former is still used colloquially.
Hypersexuality may be a primary condition, or the symptom of another medical disease or condition, for example Klüver-Bucy syndrome or bipolar disorder. Hypersexuality may also present as a side effect of medication such as drugs used to treat Parkinson's disease, or through the administering of hormones such as testosterone and estrogen during hormone therapy.
Clinicians have yet to reach a consensus over how best to describe hypersexuality as a primary condition, or to determine the appropriateness of describing such behaviors and impulses as a separate pathology.
Hypersexual behaviours are viewed variously by clinicians and therapists as an addiction, a type of obsessive-compulsive disorder (OCD) or “OCD-spectrum disorder", or a disorder of impulsivity. A number of authors do not acknowledge such a pathology and instead assert that the condition merely reflects a cultural dislike of exceptional sexual behavior.
Consistent with there not being any consensus over what causes hypersexuality, authors have used many different labels to refer to it, sometimes interchangeably, but often depending on which theory they favor or which specific behavior they were studying. Contemporary names include compulsive masturbation, compulsive sexual behavior, cybersex addiction, erotomania, “excessive sexual drive”, hyperphilia, hypersexuality, hypersexual disorder, problematic hypersexuality, sexual addiction, sexual compulsivity, sexual dependency, sexual impulsivity, “out of control sexual behavior”, and paraphilia-related disorder.
Hypersexuality may negatively impact an individual. The concept of hypersexuality as an addiction was started in the 1970s by former members of Alcoholics Anonymous who felt they experienced a similar lack of control and compulsivity with sexual behaviors as with alcohol. Multiple 12-step style self-help groups now exist for people who identify as sex addicts, including Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous. Some hypersexuals may treat their condition with the usage of medication or any foods considered to be anaphrodisiacs. Other hypersexuals may choose a route of consultation, such as psychotherapy, self-help groups or counselling.
Research on parent–child abuse bears similarities to that on marital violence, with the defining characteristic of the disorder being physical aggression by a parent toward a child. The disorder is frequently concealed by parent and child, but may come to the attention of the clinician in several ways, from emergency room medical staff to reports from child protection services.
Some features of abusive parent–child relationships that serve as a starting point for classification include: (a) the parent is physically aggressive with a child, often producing physical injury, (b) parent–child interaction is coercive, and parents are quick to react to provocations with aggressive responses, and children often reciprocate aggression, (c) parents do not respond effectively to positive or prosocial behavior in the child, (d) parents do not engage in discussion about emotions, (e) parent engages in deficient play behavior, ignores the child, rarely initiates play, and does little teaching, (f) children are insecurely attached and, where mothers have a history of physical abuse, show distinctive patterns of disorganized attachment, and (g) parents relationship shows coercive marital interaction patterns.
Defining the relational aspects of these disorders can have important consequences. For example, in the case of early appearing feeding disorders, attention to relational problems may help delineate different types of clinical problems within an otherwise broad category. In the case of conduct disorder, the relational problems may be so central to the maintenance, if not the etiology, of the disorder that effective treatment may be impossible without recognizing and delineating it.
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.
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.
Treatment-resistant depression is associated with more instances of relapse than depression that is responsive to treatment. One study showed that as many as 80% of patients who needed more than one course of treatment relapsed within a year. Treatment-resistant depression has also been associated with lower long term quality of life.
Treatment-resistant depression (TRD) or treatment-refractory depression is a term used in clinical psychiatry to describe cases of major depressive disorder (MDD) that do not respond adequately to appropriate courses of at least two antidepressants. The term was first coined with the development of the concept in 1974. Inadequate response has traditionally been defined as no response whatsoever. However, many clinicians consider a response inadequate if the patient does not achieve full remission of symptoms. Cases of treatment-resistant depression in which the course of treatment was not adequate are sometimes referred to as pseudoresistant. Some factors that contribute to inadequate treatment are: early discontinuation of treatment, insufficient dosage of medication, patient noncompliance, misdiagnosis, and concurrent psychiatric disorders. Cases of treatment-resistant depression may also be referred to by which medications they are resistant to (i.e.: SSRI-resistant).
Initial testing for adipsia involves electrolyte, blood urea nitrogen and creatinine levels, serum and urine osmolality, blood hormone levels, like vasopressin. In patients who have defects in thirst regulation and vasopresin secretion, serum vassopresin levels are low or absent. Measurements of urine electrolytes and osmolality are critical in determining the central, rather than renal, nature of the defect in water homeostasis. In adipsia, the fractional excretion of sodium is less than 1%, unless a coexisting defect in AVP secretion is present. In salt intoxication, the urine sodium concentrations are very high and fractional excretion of sodium is greater than 1%. Initial test results may be suggestive of diabetes insipidus. The circulating AVP levels tend to be high, which indicate an appropriate response of the pituitary to hyperosmolality. Patients may have mild stable elevations of serum sodium concentrations, along with elevations in both BUN and creatinine levels and in the BUN/creatinine ratio.
Type D is the least commonly diagnosed and researched type of adipsia. The AVP release in this subtype occurs with normally functioning levels of osmoregulation.
Treatment for Smith–Magenis syndrome relies on managing its symptoms. Children with SMS often require several forms of support, including physical therapy, occupational therapy and speech therapy. Support is often required throughout an affected person's lifetime.
Medication is often used to address some symptoms. Melatonin supplements and trazodone are commonly used to regulate sleep disturbances. In combination with exogenous melatonin, blockade of endogenous melatonin production during the day by the adrenergic antagonist acebutolol can increase concentration, improve sleep and sleep timing and aid in improvement of behaviour. Other medications (such as risperdal) are sometimes used to regulate violent behavior.
Human findings provide insufficient data for developing treatments due to differences in the patients physiological and metabolic disorders thus, a suitable alternative animal model is essential in obtaining a better understanding of the SR deficiency. In this particular case, researchers used silkworms to identify and characterize mutations relating to SPR activity from an initial purified state created in the larvae of the silkworm. The researchers used genetic and biochemical approaches to demonstrate oral administration of BH and dopamine which increased the survival rates of the silkworm larvae. The results indicate that BH deficiency in silkworms leads to death in response to the lack of dopamine. This shows that silkworms can be useful insect models in additional SR deficiency research and study.
The diagnosis of SR deficiency is based on the analysis of the pterins and biogenic amines found in the cerebrospinal fluid (CSF) of the brain. The pterin compound functions as a cofactor in enzyme catalysis and biogenic amines which include adrenaline, dopamine, and serotonin have functions that vary from the control of homeostasis to the management of cognitive tasks. This analysis reveals decreased concentrations of homovanillic acid (HVA), 5-hydroxyindolacetic acid (HIAA), and elevated levels of 7,8-dihydrobiopterin, a compound produced in the synthesis of neurotransmitters. Sepiapterin is not detected by the regularly used methods applied in the investigation of biogenic monoamines metabolites in the cerebrospinal fluid. It must be determined by specialized methods that work by indicating a marked and abnormal increase of sepiapterin in cerebrospinal fluid. Confirmation of the diagnosis occurs by demonstrating high levels of CSF sepiapterin and a marked decrease of SR activity of the fibroblasts along with SPR gene molecular analysis.
A physician specializing in sleep medicine may ask patients about their medical history; for example: neurological problems, prescription or non-prescription medications taken, alcohol use, family history, and any other sleep problems. A thorough medical and neurological exam is indicated. The patient will be asked to complete a sleep diary, recording natural sleep and wake up times, over several weeks. Sleep rating with the Epworth Sleepiness Scale may be used.