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“ Frontotemporal Dementia and Related Disorders : Organic Psychoses?”

Diana De Ronchi , Anna Rita Atti. “ Frontotemporal Dementia and Related Disorders : Organic Psychoses?”. Ferrara, 26 ottobre 2012. Outline. FTD “Psicosi organiche” AD/Psicosi – Psicosi/AD.

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“ Frontotemporal Dementia and Related Disorders : Organic Psychoses?”

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  1. Diana De Ronchi , Anna Rita Atti “FrontotemporalDementia and RelatedDisorders: Organic Psychoses?” Ferrara, 26 ottobre 2012

  2. Outline • FTD • “Psicosi organiche” • AD/Psicosi – Psicosi/AD

  3. Frontotemporal Dementia and Related Disorders: Deciphering the EnigmaKeith A. Josephs, Ann Neurol 2008 • FTD is an umbrella term that includes a number of different syndromic variants, all characterized by the presence of behavioral and personality changes ±aphasia. • bvFTD (behavioral variant) • SD (semantic dementia) • and FTD-MND (FTD with motor neuron disease)

  4. Neary et al, Lancet Neurol 2005

  5. m • m • M • m • m Mendez et al, Arch Neurol 2007

  6. Diagnostic accuracy • Consensus criteria: Sens. = 36.5 % Spec. = 100.0% • Magnetic resonance: Sens. = 63.5 % Spec. = 70.4 % for • SPECT/PET scans: Sens. = 90.5 % Spec. = 74.6 % • Consensus criteria for FTD and neuropsychological measures lacked sensitivity for FTD • Alto rischio di falsi negativi…diagnosi mancate!!

  7. Velakoulis, D. et al. The British Journal of Psychiatry 2009;194:298-305 • FTD presenting as schizophrenia-like psychosis • organic psychoses, • secondary schizophrenias • Symptomatic schizophrenias • 5 of 17 patients with FTD had presented with a psychosis (schizophrenia/schizoaffective disorder n=4, bipolar disorder n=1) an average of 5 years prior to the dementia diagnosis • Literature review: 828 cases of frontotemporal dementia in 205 publications.

  8. Velakoulis, D. et al. The British Journal of Psychiatry 2009;194:298-305 Prevalence of schizophrenia-like psychosis in patients with frontotemporal dementia Patients with psychosis were younger at onset (40.2 years v. 52.4 y) and experienced a longer delay between onset and subsequent presentation (11.3 years v. 2.2) compared with the larger frontotemporaldementiagroup.

  9. Explaining the findings: more than a frontotemporal coincidence? interaction between neuropathology and normal central nervous system development sharedlocalisationofbrainpathology • non-specific, psychotic response to insult by the developing (young) brain • i.e. the occurrence of a pathological process in the same brain regions of young adults leads to a similar clinical phenotype Velakoulis, D. et al. The British Journal of Psychiatry 2009;194:298-305

  10. Despite the strong evidence for frontotemporal deficits in schizophrenia, few modern authors have drawn parallels between schizophrenia and frontotemporal dementia Finally... • subgroup of patients who are diagnosed with schizophrenia have an insidious, slowly evolving FTD associated with motor neuron disease like pathology beginning in the hippocampus Velakoulis, D. et al. The British Journal of Psychiatry 2009;194:298-305

  11. Possible explanations for cognitive decline with neuroleptics • Neuroleptics –through D2 receptor antagonism?- reduce the expression of Brain Derived Neurotrophic Factor  increase in senile plaque and neurofibrillary tangle (Chlan-Fourney et al, Brain Res 2002) • Anti-muscarinic agents increase tangles (Perry et al, Ann Neurol 2003)

  12. Outline • FTD • “Psicosi organiche” • AD/Psicosi – Psicosi/AD

  13. Systemic Medical Conditions for Organic Psychoses: • Systemic infections: HIV, Mono, Hepatitis • Endocrine: Thyroid, Parathyroid, Cushings, Addison’s, Pituitary Adenoma • Vitamin Deficiencies: B12, Folate, Niacin • Uremia, Dialysis • Acute Intermittent Porphyria

  14. Neurological Conditions for Organic Psychoses: • Parkinson’s, Huntington’s (basal ganglia) • Stroke, Tumor, Trauma, Infections • Autoimmune: Multiple Sclerosis, Lupus • Migraine headaches • Dementia • Sensory deprivation or over-stimulation (“ICU psychosis”)

  15. Substance-Induced Psychosis • Variety of substances (over-the-counter, Prescription, Recreational, and toxins) may cause psychosis

  16. Substance-Induced Psychosis • Sedative/Hypnotics: • Barbiturates • Benzodiazepines (withdrawal) • Alcohol (withdrawal) • Steroids and Hormones: • Oral Contraceptive Pills • Prednisone • Corticosteroids • Anabolic steroids

  17. Substance-Induced Psychosis • Stimulants: amphetamine, cocaine, ephedra • Analgesics • Antimicrobials • Antidepressants (rarely) • Antihistamines, anticholinergics • Thyroid hormones • Antiparkinsonian agents: L-dopa, bromocriptine, amantadine, etc • Cardiovascular Drugs

  18. Mental Disorders with Psychosis: • Autism • Mental Retardation • Obsessive Compulsive Disorder with Poor Insight • Post-Traumatic Stress Disorder • Malingering (Simulazione)

  19. Outline • FTD • “Psicosi organiche” • AD/Psicosi – Psicosi/AD

  20. the delusions in AD are typically paranoid type, non-bizarre and simple • Misidentification phenomena • belief that people are stealing things from them, that they are in danger and/or others are planning to harm them, that their spouse and/or other caregiver is an imposter (or not who they say they are), that their house is not their home, that their spouse is having an affair, that their family members are planning to abandon them, that unwelcome guests and/or television figures are actually present in the home

  21. Ropacki & Jeste, Am J Psych 2005

  22. Is psychosis a possible risk factor for dementia? • evidence that patients with psychosis of AD show a more rapid cognitive decline (role of AP?) • Is psychosis an early symptom of dementia? • subjects with late-onset acute and transient psychosis are at 11 times higher risk of subsequently getting a diagnosis of dementia (Kørner et al, 2009)

  23. La situazione nella popolazione generale… lo studio di Faenza 1992 • Scopo: • indagarefunzioni cognitive • indagarevariabili socio-demografiche • indagareinformazioni funzionali LONGITUDINALE 1995 1º follow up (riesaminato un campione residente nel centro storico di Faenza:216 soggetti) 2003 2º follow-up soggetti con deterioramento cognitivo al T0 2006 2º follow-up soggetti cognitivamente integri al T0 TRASVERSALE

  24. OBIETTIVO Stimare la prevalenza di: • Demenza • Episodio Depressivo Maggiore (MDE) • Disturbo d’Ansia Generalizzato (GAD) • Sintomi Psicotici • Ideazione Suicidaria • Abuso Alcolico

  25. Prevalenze dei disturbi p

  26. Sintomi psicotici

  27. annarita.atti@unibo.it

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