2021 Neuropsychiatry Updates

This Neuropsychiatric Update will focus on various medical conditions presenting with psychiatric symptomatology. We will discuss the pathophysiology, clinical presentation, and the evidence-based management of the following neuropsychiatric disorders:

José Maldonado – Cytokines Induced Mechanism of Delirium related to COVID-19 and other infectious processes. Neurological and neuropsychiatric manifestations of COVID-19 are increasingly described in the fast developing scientific literature and lay media. Recently published case series have documented central and peripheral nervous system manifestations. Similarly, case reports have described an ever-increasing incidence of delirium and agitation among ICU-COVID-19 patients. Chief among the hypothesized pathophysiological causes of delirium are infectious processes, even those occurring peripherally, eliciting the activation of brain parenchymal cells, which expresses cytokines and other inflammatory mediators in the CNS, leading to neuronal and synaptic dysfunction, and subsequent neurobehavioral and cognitive symptoms characteristic of delirium, with suggestions that severe deterioration in some patients is closely related to the occurrence of cytokine storms. In fact, available evidence from severely ill patients with human coronavirus (HCoV) suggest that proinflammatory responses plays a significant pathogenetic role in the pulmonary and, likely central nervous system alterations of HCoVs.

Filza Hussain – Cefepime related neurotoxicity: Cefepime is a commonly used 4th generation broad spectrum cephalosporin. It can cross the blood brain barrier and cause neurotoxicity secondary to GABA antagonism. Symptoms can range from delirium, aphasia, seizures, myoclonus and coma. Patients in the intensive care unit with multi organ failure and those with kidney failure are the most susceptible. Using a case example Dr. Hussain will discuss the clinical manifestations, pathophysiology and management options.

Sheila Lahijani – Paraneoplastic Limbic Encephalitis: Paraneoplastic limbic encephalitis (PLE) is a rare neuroplastic syndrome that can precede the diagnosis of a tumor or be a complication of chemotherapy. PLE presents with a range of neuropsychiatric symptoms, including mood disturbances, psychosis, and cognitive changes. Evaluation of PLE is based on clinical findings and different diagnostic criteria. A multidisciplinary approach is used to manage the underlying etiology and potential long-term sequelae. Dr. Lahijani will present on these components using a case and will highlight the important consideration of PLE for CL psychiatrists and their trainees who are called upon to assess these patients.

Andrea Ament – Identification & Management of Fronto-Temporal Dementia (FTD): CL psychiatrists are commonly consulted to evaluate new onset psychiatric symptoms in later decades of life. Symptoms are often subacute but a dramatic change from baseline, ranging from a change in personality, to disinhibition, to frank mania. The differential diagnosis for these presentations is broad, and there is frequently a debate between neurology and psychiatry on the underlying etiology. This presentation will review the clinical presentations, course and treatment FTD and how to distinguish it from other psychiatric conditions.