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Depressive and anxiety disorders for the clinician: challenges in diagnosis and treatment
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Abstracts / Journal of the Neurological Sciences 357 (2015) e457–e512
1718 WFN15-1831 Psychiatry for Neurologists T 16.1 - Challenging mental disorders of adult and childhood Bipolar disorder P. Ruiz. Psychiatry and Behavioral Sciences, University of Miami, Miami, USA Will be participating in symposium presentation. No abstract required. doi:10.1016/j.jns.2015.09.292
1719 WFN15-1823 Psychiatry for Neurologists T 16.1 - Challenging mental disorders of adult and childhood Depressive and anxiety disorders for the clinician: challenges in diagnosis and treatment L. Küey. Psychiatry, Istanbul Bilgi University, Istanbul, Turkey Depressive and anxiety disorders constitute a major health problem. Categorical approach in the classification of mental disorders had reached a point where the dilemma of comorbidity became a crucial matter of concern. The overlapping and discriminating features of depressive and anxiety states have both conceptual and clinical importance. In clinical practice, the common co-existence of these two states makes it difficult to keep them as complete distinct entities. The dilemma of comorbidity may be discussed in different levels of description: distinct disorders, comorbid disorders, overlapping syndromes, shared symptoms, and common personality traits and psychosocial stress. Depending on the level of description these conditions may be reviewed (i) as independent two distinct clinical entities; (ii) as comorbid conditions; (iii) as one having the primary diagnosis associated with the other syndrome; (iv) as mixed states where both conditions have concomitant sub-threshold symptoms; (v) as related personality traits and psychosocial stresses. Researches have shown that, the distinction is more prominent at the level of disorders, where the overlap becomes more prominent at the levels of symptomatology and personality traits and psychosocial stress. Depressive and anxiety states are strongly associated with one another. To some extent, methodological problems may be responsible for their co-occurrence; but explanations are insufficient to reveal the strong observed correlation. The differences between these two states are best viewed as relative, rather than absolute. This presentation will focus on the implications for clinical practice and future research. doi:10.1016/j.jns.2015.09.293
1720 WFN15-1879 Psychiatry for Neurologists T 16.1 - Challenging mental disorders of adult and childhood Psychiatric disorders in childhood E. Belfort. Secretary for Education, World Psychiatry Association, Caracas, Venezuela Psychiatric disorders in childhood From a clinical perspective, understanding the patient’s illness needs, helps determine our assessment, diagnosis and our treatment plan in the population of child and adolescents. The effective
evaluation of different dimensions: Psychosocial Features: expectations, perceptions, and needs; Health Features: reference source, symptoms, quality of life impact; as well as geographic and linguistic diversity, cultural framework, must be also considered. The review of the two main diagnostic and classification systems in the field of psychiatry: the ICD-10 (chapter on mental and behavioral disorders) and the DSM-IV, represents the most important challenge, especially for the diagnostic and assessment in Child & Adolescent Psychiatry. The diagnostic classification should include additional information or dimensions that, while not a part of diagnosis per se, are important for making decisions about patient care, such as associated disability, acuity, exacerbating psychosocial factors, level of social support, and cultural factors. Clinical symptoms based on international classifications, allows identifying clinical entities in the population of children and adolescents, such as, substance use and abuse, emotional disorders especially bipolar disorders, attention deficit disorder and high prevalence of psychiatric comorbidity among themselves, hindering further diagnosis. In this speech, an overview of these conditions, particularly bipolar disorder in children and adolescents and their comorbidity, will be presented. doi:10.1016/j.jns.2015.09.294
1721 WFN15-1806 Autonomic Nervous System T 1.1 Central and/or peripheral autonomic disorders – an overview E. Benarroch. Neurology, Mayo Clinic, Rochester MN, USA Central and Peripheral Autonomic Disorders: and Overview Eduardo E. Benarroch, M.D. Abstract: Autonomic disorders may reflect processes affecting any ofthe central or peripheral nervous system. They may manifest with autonomicfailure or autonomic hyperactivity involving the sympathetic, parasympathetic,or enteric nervous system (ENS), either selectively or in various combinations. Autonomic failure manifests primarily with orthostatic hypotension (OH), impaired sweating, impaired gastric emptying, urinary retention, or erectile dysfunction, in several combinations. Disorders causing autonomic failure can be classified according to the presence or absence of associated neurologic manifestations, their temporal profile (acute/subacute,chronic progressive, static, or episodic. Effect of medications or comorbid conditionsshould always be considered. Subacute isolated autonomic failure affecting sympathetic, parasympathetic and ENS function, in various combinations, occurs in autoimmune (including paraneoplastic) autonomic ganglionopathy. Autonomic failure may be an important manifestation of sensorimotor peripheral neuropathies (such as those associated with diabetes or amyloidosis); sensory ganglionopathy (such as occurs in paraneoplastic or Sjögren disease), or distal painful peripheral neuropathies (including those associated with diabetes; amyloidosis;vasculitis; Fabry disease; or sodium channelopathies). Progressive autonomic failure associated with motor or cognitive manifestations, or both, occurs in neurodegenerative synucleinopathies such as multiple system atrophy (MSA) or Lewy body disorders. Autonomichyperactivity typically involves the sympathetic output producing tachycardia, hypertension and hyperhidrosis. This can occur in traumatic or hypoxic brain injury,subarachnoid hemorrhage, limbic encephalitis, GuillainBarré syndrome, autonomic dysreflexia, or toxidromes. Disorders of orthostatic tolerance, such as postural tachycardia syndrome
Abstracts / Journal of the Neurological Sciences 357 (2015) e457–e512
1718 WFN15-1831 Psychiatry for Neurologists T 16.1 - Challenging mental disorders of adult and childhood Bipolar disorder P. Ruiz. Psychiatry and Behavioral Sciences, University of Miami, Miami, USA Will be participating in symposium presentation. No abstract required. doi:10.1016/j.jns.2015.09.292
1719 WFN15-1823 Psychiatry for Neurologists T 16.1 - Challenging mental disorders of adult and childhood Depressive and anxiety disorders for the clinician: challenges in diagnosis and treatment L. Küey. Psychiatry, Istanbul Bilgi University, Istanbul, Turkey Depressive and anxiety disorders constitute a major health problem. Categorical approach in the classification of mental disorders had reached a point where the dilemma of comorbidity became a crucial matter of concern. The overlapping and discriminating features of depressive and anxiety states have both conceptual and clinical importance. In clinical practice, the common co-existence of these two states makes it difficult to keep them as complete distinct entities. The dilemma of comorbidity may be discussed in different levels of description: distinct disorders, comorbid disorders, overlapping syndromes, shared symptoms, and common personality traits and psychosocial stress. Depending on the level of description these conditions may be reviewed (i) as independent two distinct clinical entities; (ii) as comorbid conditions; (iii) as one having the primary diagnosis associated with the other syndrome; (iv) as mixed states where both conditions have concomitant sub-threshold symptoms; (v) as related personality traits and psychosocial stresses. Researches have shown that, the distinction is more prominent at the level of disorders, where the overlap becomes more prominent at the levels of symptomatology and personality traits and psychosocial stress. Depressive and anxiety states are strongly associated with one another. To some extent, methodological problems may be responsible for their co-occurrence; but explanations are insufficient to reveal the strong observed correlation. The differences between these two states are best viewed as relative, rather than absolute. This presentation will focus on the implications for clinical practice and future research. doi:10.1016/j.jns.2015.09.293
1720 WFN15-1879 Psychiatry for Neurologists T 16.1 - Challenging mental disorders of adult and childhood Psychiatric disorders in childhood E. Belfort. Secretary for Education, World Psychiatry Association, Caracas, Venezuela Psychiatric disorders in childhood From a clinical perspective, understanding the patient’s illness needs, helps determine our assessment, diagnosis and our treatment plan in the population of child and adolescents. The effective
evaluation of different dimensions: Psychosocial Features: expectations, perceptions, and needs; Health Features: reference source, symptoms, quality of life impact; as well as geographic and linguistic diversity, cultural framework, must be also considered. The review of the two main diagnostic and classification systems in the field of psychiatry: the ICD-10 (chapter on mental and behavioral disorders) and the DSM-IV, represents the most important challenge, especially for the diagnostic and assessment in Child & Adolescent Psychiatry. The diagnostic classification should include additional information or dimensions that, while not a part of diagnosis per se, are important for making decisions about patient care, such as associated disability, acuity, exacerbating psychosocial factors, level of social support, and cultural factors. Clinical symptoms based on international classifications, allows identifying clinical entities in the population of children and adolescents, such as, substance use and abuse, emotional disorders especially bipolar disorders, attention deficit disorder and high prevalence of psychiatric comorbidity among themselves, hindering further diagnosis. In this speech, an overview of these conditions, particularly bipolar disorder in children and adolescents and their comorbidity, will be presented. doi:10.1016/j.jns.2015.09.294
1721 WFN15-1806 Autonomic Nervous System T 1.1 Central and/or peripheral autonomic disorders – an overview E. Benarroch. Neurology, Mayo Clinic, Rochester MN, USA Central and Peripheral Autonomic Disorders: and Overview Eduardo E. Benarroch, M.D. Abstract: Autonomic disorders may reflect processes affecting any ofthe central or peripheral nervous system. They may manifest with autonomicfailure or autonomic hyperactivity involving the sympathetic, parasympathetic,or enteric nervous system (ENS), either selectively or in various combinations. Autonomic failure manifests primarily with orthostatic hypotension (OH), impaired sweating, impaired gastric emptying, urinary retention, or erectile dysfunction, in several combinations. Disorders causing autonomic failure can be classified according to the presence or absence of associated neurologic manifestations, their temporal profile (acute/subacute,chronic progressive, static, or episodic. Effect of medications or comorbid conditionsshould always be considered. Subacute isolated autonomic failure affecting sympathetic, parasympathetic and ENS function, in various combinations, occurs in autoimmune (including paraneoplastic) autonomic ganglionopathy. Autonomic failure may be an important manifestation of sensorimotor peripheral neuropathies (such as those associated with diabetes or amyloidosis); sensory ganglionopathy (such as occurs in paraneoplastic or Sjögren disease), or distal painful peripheral neuropathies (including those associated with diabetes; amyloidosis;vasculitis; Fabry disease; or sodium channelopathies). Progressive autonomic failure associated with motor or cognitive manifestations, or both, occurs in neurodegenerative synucleinopathies such as multiple system atrophy (MSA) or Lewy body disorders. Autonomichyperactivity typically involves the sympathetic output producing tachycardia, hypertension and hyperhidrosis. This can occur in traumatic or hypoxic brain injury,subarachnoid hemorrhage, limbic encephalitis, GuillainBarré syndrome, autonomic dysreflexia, or toxidromes. Disorders of orthostatic tolerance, such as postural tachycardia syndrome