The hyperviscosity syndrome has been described clinically as the triad of bleeding, visual signs and neurological manifestations associated with elevated serum viscosity. Several reports have recognised an association between... more
The hyperviscosity syndrome has been described clinically as the triad of bleeding, visual signs and neurological manifestations associated with elevated serum viscosity. Several reports have recognised an association between hyperviscosity and altered mental status. Since to our knowledge only a case of hyperviscosity-induced delirium has been described (1), we raise the possibility of this diagnosis in the most of this reported cases, based on the nature of the symptoms, sudden onset and fluctuating course, and its resolution with plasmapheresis. In this paper we review the literature about hyperviscosity syndrome and altered mental status. In conclusion, serum hyperviscosity should be added to the large list of causes altered mental status, especially of delirium. Since plasmapheresis can reverse clinical symptoms, it early recognition and the measurement of serum viscosity is essential in patients suffering from diseases that may lead to this syndrome, and who develop psychiatri...
Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients... more
Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale-Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7-11.1) and place (OR 3.8, 95% CI 1.7-8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ(2) test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too.
A sample of 41 women suffering from psychogenic pain according to DSM-III diagnostic criteria were psychometrically studied, in order to ascertain if they showed specific psychological traits or mechanisms. Type A behavior, extraversion,... more
A sample of 41 women suffering from psychogenic pain according to DSM-III diagnostic criteria were psychometrically studied, in order to ascertain if they showed specific psychological traits or mechanisms. Type A behavior, extraversion, neuroticism, psychoticism and dissimulation and hostility-aggressivity traits were the psychological variables studied both in the pain sample and in a matched control group. Psychogenic pain patients were significantly more neurotic and suspicious and less physically aggressive than healthy subjects and also scored significantly higher in dissimulation, which suggests a tendency to use defense mechanisms of denial.
Publication Date: 1988
Publication Name: Psychotherapy and Psychosomatics
