DEPRESSIVE DISORDERS IN EPILEPSY

Depressive disorders are the most frequent psychiatric comorbidity in epilepsy but very often remain unrecognized and untreated. We examined 103 epileptic patients, aged 18-60 years, 40 males and 63 females, for the presence of interictal depressive disorder. All subjects underwent clinical psychiatric examination, including evaluation on Hamilton Depression Rating Scale (HAM-D-17). A questionnaire for demographic and seizure-related variables was also completed. Concurrent depressive disorder (clinically presented according to ICD-10 diagnostic criteria) affected 28.3% of all evaluated patients. Based on HAM-D-17 scores depression was defined as mild - 80% of all depressed patients, moderate - 17% and severe - 3%. Atypical presentation of interictal depressive disorder was frequent. Depression has a tremendous effect on one’s family, social and psychological functioning, even more than the actual seizure frequency and severity. Diagnostic difficulties come through the atypical mode of presentation of depressive disorders in epilepsy. Proper neuropsychiatric evaluation is essential for improving treatment and quality of life for patients with epilepsy

Common physiological aspects and interconnections between stress and pain

Introduction: Stress and pain are phenomena with similar conceptual explanations and they both play an essential role in our survival as individuals. They are a challenge to the organism's adaptive capacities and homeostasis processes. The physiological aspects of the two phenomena reveal common neurobiological origins and multiple interconnections.Aim: The purpose of the article is to conceptualize and structure evidence relating to the common physiological aspects of pain and stress phenomena and to analyze their interconnections.Materials and Methods: A review and critical analysis of relevant literature.Results: The relationship between stress and pain has been studied. Stress participates in the manifestation of acute pain and maintains the processes of its chronicity. It has been hypothesized that the different stress models in the pathogenesis of pain are due to the influence of factors associated with the psychological aspects of stress.Conclusion: Most authors support the idea that physiological responses to stress and pain are relatively nonspecific. They are influenced by many factors related to current physical condition, past experiences of stressful situations and pain, emotional (fear, anxiety, depression) and cognitive factors involved in generating complex programs, aimed at restoring homeostasis. The stress model of pain is a manifestation of the interconnections and the potential interactions between the two phenomena. Data analysis provokes questions and offers prospects for more comprehensive studies related to exploration of the causal relationship between the two phenomena

ON DIFFERENTIAL DIAGNOSIS BETWEEN AUTISTIC DISORDER AND ASPERGER’S SYNDROME

The differential diagnosis between Autistic disorder (AD) and Asperger’s syndrome (AS) in most cases is quite difficult since most of the symptoms are clinically undistinguished. Several factors complicate the diagnosis of AS- an autism spectrum disorder (ASD). It is considered by some authors to be simply a milder version of autistic disorder. Problems in diagnosis include disagreement among diagnostic criteria, controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome, and over- and under-diagnosis. Our paper is based on the diagnostic and differential diagnostic criteria of DSM-IV, ICD-10 and our clinical experience.In the process of diagnosis and differential diagnosis we, naturally, illustrate and discuss the similarities and differences between the two disorders

SOME ASPECTS OF THE AGGRESSIVE ACTS, COMMITTED BY SCHIZOPHRENIC PATIENTS, TRIGGERED BY SOME PSYCHO-TRAUMATIC FACTORS

The achievements of the contemporary psychopharmacology enable the out-patient treatment of schizophrenic patients, thus let them living in their usual social environment- family, relatives, neighbors, friends.In this connection, the real conditions of patients’ micro-social environment play an important role- either stimulating their compensatory mechanisms, or exercising negative impact on their adaptation and behavior.We examined 30 schizophrenic patients (22 males, 8 females), who have committed aggressive acts, triggered by psycho-traumatic situations with different sensible content, originating from their micro-social environment.Dominant were family conflicts, followed by conflicts with the neighbors. The aggressive acts were directed to concrete persons, from the close neighborhood, involved into the psycho-traumatic situations.Studying and evaluation of the aggressive acts, triggered by psycho-traumatic factors play an important role for their prevention

ASSESSMENT AND MANAGEMENT OF BEHAVIORAL PROBLEMS IN VASCULAR DEMENTIA

Behavioral disorders in dementia are troublesome and impact the family, caregivers, nursing or hospital staff. A number of strategies have been developed to reduce that burden. The assessment of demented patients is complicated by the fact that patients are usually unable to express reasons for their feelings and behavior. It is important the type and frequency of behavioral symptoms to be assessed and described and, if possible, the underlying basis of the target symptom to be determined.In our paper we discuss the most burdensome behavioral symptoms in vascular dementia and on the basis of our knowledge and clinical experience we propose different treatment solutions- pharmacological or non pharmacological. We point out that non- pharmacological solutions are usually applied to milder behavior problems, while others-without environmental triggers, that are severely distressing for caregivers, may require additional pharmacotherapy.The optimal therapeutic results require knowledge, training and experience with such a group of demented patients

PERSISTANT GENITAL AROUSAL DISORDER IN ELDERLY WOMEN: A CASE STUDY

Persistent genital arousal (PGAD) is an unusual, rarely diagnosed but a real problem for some women which causes considerable physical and psychological distress. It is characterized by physiological signs of sexual arousal that persist despite the absence of sexual desire. A number of theories have been proposed and various psychological and medical treatments have been used to treat this condition with varying success.The problem is even more serious with elderly women. In our clinical practice we have met a number of patients with such complains, which we have discussed mostly in terms of depression, panic disorder or SSRI’s application.In our paper we discuss some diagnostic and therapeutic issues and present a case of a 71 years old woman, who experienced distinct symptoms of PGAD for nearly 10 years. She was treated with a number of antidepressants and benzodiazepines without effect. Olanzapine 5 mg at bed time was administered. A good therapeutic response was achieved from the same evening and was held at the hospital stay and afterwards

Delirium in elderly: the role of psychiatric expertise in a multi-disciplinary team

INTRODUCTION: Delirium is a neurocognitive disorder frequently observed in elderly patients and can be found in any medical condition. Our experience of consulting elderly patients is that delirium is often unrecognized and respectively under-treated. The aim of our study was to evaluate the association between delirium and some risk factors and to elicit important diagnostic and therapeutic issues that could be of practical application to various specialists, dealing with elderly patients with delirium.PATIENTS AND METHODS: We studied 35 consecutive delirious patients (age 60-88), consulted or admitted at a gerontopsychiatric clinic. The patients came from different hospital settings of the university hospital. The ICD-10 and DSM-IV criteria for delirium and dementia were used. A psychiatric interview, clinical psychiatric and mental status examination, physical, laboratory examination and head computed tomography (CT) were performed. Cognitive impairment was recorded by Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT). Descriptive statistic and correlation analysis were applied.RESULTS AND DISCUSSION: Dementia was diagnosed in 23 (65.7%) out of all 35 delirious patients. Delirium was associated with factors such as prior cognitive impairment (dementia), advanced age, medical conditions and alcohol abuse. Without significant influence on the development of delirium were gender, marital status and education. Much of the disputable diagnostic issues are associated with the fact that no concrete speciality is dealing with the different aspects of delirium. The risk factors (predisposing and precipitating) provoking delirium should be concerned. The role of psychiatry services should be not restricted only to placement issues and acute treatment.CONCLUSION: Delirium in elderly is a serious medical problem, requiring precise and appropriate diagnosis and management. The fact that delirium is often multifactorial in origin necessitates a broad intervention strategy. The attention should be on prevention, primary and secondary, mostly by active psychiatric consultation.Keywords: delirium, elderly, risk factors, diagnosis, management, psychiatric expertis

FINANCIAL AVAILABILITY OF IN-HOME MEDICAL TREATMENT OF PATIENTS WITH ALZHEIMER’S DISEASE

Background: Alzheimer's disease (AD) is a progressive neurodegenerative disorder and presents a great burden for the person, family and society as a whole. Since 2012, in Bulgaria, AD is accepted as a disorder of a great socio-economic significance and the drugs for home treatment are included in the reimbursement list of the National Health Insurance Fund (NHIF). Objective: To trace the access to treatment of Alzheimer’s in-home patients, as a result of generic substitution on the base of share distribution of the original and generic products. Methods: We collected data for the sales of pharmaceutical products (PP’s), containing donepezil hydrochloride and memantine hydrochloride from a distributor for the Northeast region of Bulgaria (Varna) in the period 2014-2015. An analysis of the percentage share distribution of the original and generic products was conducted. Results: According to our results original product Aricept accounts for only 4%, while the market share for its generics is 96%. In this group the share to be paid from NHIF is 25%, the remaining 75% from the cost is paid by the patients. The original product Axura occupies 8% market share, the generics- 92%. In this group the share to be paid from NHIF is 50% for generics, while Axura was removed from the Positive reimbursement list. We comment the significant differences in the sale shares in several directions. Conclusion: The reduction of expenses, with the use of generics, would help more patients to receive an optimal treatment and the savings could be redirected for other costly treatments