RESUMEN
OBJECTIVE: This study was an investigation of the role of Alzheimer-type senile degenerative abnormalities in the cognitive impairment of chronic schizophrenia. METHOD: The study group comprised 145 deceased elderly institutionalized psychiatric patients: 66 with schizophrenia, 26 with mood disorders, 36 with dementia, and 17 with other psychiatric diagnoses. The comparison group included 16 deceased elderly individuals without neurologic or psychiatric disease. Psychiatric diagnoses and cognitive status were established by standardized review of medical records. Neuritic senile plaques and neurofibrillary tangles were identified immunohistochemically and counted, by investigators blind to clinical information, in standardized regions of each brain. RESULTS: Of the subjects with schizophrenia, 68% had definite cognitive impairment, but only 8% satisfied neuropathological criteria for Alzheimer's disease. Among the schizophrenia subjects without Alzheimer's disease, definite cognitive impairment was associated with higher levels of plaques and tangles. The schizophrenia subjects without definite cognitive impairment had fewer plaques and tangles than the unimpaired nonpsychiatric subjects. CONCLUSIONS: Most cases of cognitive impairment in schizophrenia could not be attributed to Alzheimer's disease. An association of mild Alzheimer-type pathology with definite cognitive impairment was unique to schizophrenia. Enhanced sensitivity to the effects of aging on the brain may be a manifestation of diminished cognitive reserve in schizophrenia.
Asunto(s)
Trastornos del Conocimiento/diagnóstico , Enfermedades Neurodegenerativas/diagnóstico , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/patología , Encéfalo/patología , Enfermedad Crónica , Trastornos del Conocimiento/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/patología , Ovillos Neurofibrilares/patología , Placa Amiloide/patología , Esquizofrenia/patologíaRESUMEN
OBJECTIVE: The authors examined HIV infection among young adults with newly diagnosed psychotic disorders. METHODS: The study was based on a research cohort of 320 first-admission patients aged 20-39 years in a semirural-suburban county. Research assessments and medical records were systematically reviewed for information about HIV status. RESULTS: Despite the fact that few patients were tested for HIV, 12 (3.8%) of the 320 patients had a known HIV infection. In all 12 cases, the HIV infection was contracted before the onset of psychosis. AIDS was the leading cause of mortality in the 320 patients. CONCLUSIONS: The HIV epidemic may be having an important effect on the etiology and the course of psychotic disorders.
Asunto(s)
Infecciones por VIH/epidemiología , Trastornos Psicóticos/epidemiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adulto , Factores de Edad , Causas de Muerte , Estudios de Cohortes , Comorbilidad , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Prevalencia , Trastornos Psicóticos/etiologíaRESUMEN
The reliability of psychiatric diagnosis has a direct effect on the validity of post-mortem analyses of neuropathological data, yet little is known about the reliability of retrospective diagnostic procedures which rely on review of medical records. In this paper, we report on the reliability of DSM-III-R psychiatric diagnoses assigned by a pool of 8 raters to a set of 106 state hospital charts of elderly, chronic patients who had died while institutionalized and were autopsied. Diagnoses were grouped by general diagnostic class, and Kappa coefficients computed for agreement among raters, as well as for agreement between ultimate consensus diagnoses and those made while subjects were living. Interrater agreement for those diagnoses that occurred most frequently in this sample (e.g. Schizophrenia and Dementia) was excellent, and comparable to the the agreement observed for ratings of live patients. Interrater agreement for less frequently occurring diagnoses (e.g. Mental Retardation, Mood Disorders, other non-Schizophrenic Psychoses) ranged from excellent to poor. We found high agreement between our rates diagnoses and those assigned by state hospital personnel while patients were living, although post-mortem review produced lower rates of diagnosis of both schizophrenia and Alzheimer-type dementias. Overall, results suggest that the reliability of chart review diagnosis is comparable to that obtained from interviews of live patients when experienced raters are used and diagnostic base rates are high enough to produce stable estimates of reliability.
Asunto(s)
Demencia/diagnóstico , Registros Médicos/estadística & datos numéricos , Esquizofrenia/diagnóstico , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Demencia/clasificación , Demencia/psicología , Femenino , Hospitales Psiquiátricos , Hospitales Provinciales , Humanos , Masculino , Persona de Mediana Edad , New York , Variaciones Dependientes del Observador , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Reproducibilidad de los Resultados , Esquizofrenia/clasificación , Psicología del EsquizofrénicoRESUMEN
The authors report a case of fatal neuropsychiatric Lyme disease (LD) that was expressed clinically by progressive frontal lobe dementia and pathologically by severe subcortical degeneration. Antibiotic treatment resulted in transient improvement, but the patient relapsed after the antibiotics were discontinued. LD must be considered even in cases with purely psychiatric presentation, and prolonged antibiotic therapy may be necessary.