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Objective
There has been considerable debate about the safety of lithium–neuroleptic combination in patients.Case report
In this case report, we present a 30-year-old woman with a four-year history of bipolar disorder who developed residual neurological deficits related to lithium and antipsychotic combination. The patient was treated with standard doses of lithium carbonate (750 mg/day) and haloperidol (9 mg/day). There was history of having received intravenous haloperidol (dose not known). The psychotropic medications were discontinued. One month later, she developed a high temperature, excessive sweating, cramps and tremors in limb muscles, muscle rigidity, and impaired consciousness. Several laboratory abnormalities are found: massively elevated creatine kinase of 18,000 IU/L; serum lithium levels above 3 mEq/L, as well as acute renal failure (urea: 2.92 g/L, creatinine 77.6 mg/L). A provisional diagnosis of neuroleptic malignant syndrome (NMS) was made and patient was treated with bromocriptine (5–15 mg/day) initially. Patient became afebrile, sensorium improved but she continued to exhibit mutism and rigidity. The neurologist opined that a possibility of neurological sequelae related to the lithium and antipsychotic combination resulting in NMS be considered. The electroencephalogram (EEG) and neuroimaging (MRI) show no cerebral abnormality. The patient needs long periods of intensive physiotherapy.Conclusion
The case of this young woman serves to remind us that, like lithium and concomitant neuroleptics is very common, care should be used to reduce the risk of neurotoxicity. 相似文献10.
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《Motricité Cérébrale》2016,37(4):127-138
Measuring the quality of life of people with profound intellectual and multiples disabilities (PIMD) is a major issue for the affected persons themselves, for their families and for the professionals working near them, but raises serious methodological issues for researchers. A study was lead in 2011 by a team of researchers from Comité d’études, d’éducation et de soins auprès des personnes polyhandicapées (CESAP – Comity for studies, education and care for people with PIMD), in order to build a quality of life scale for children with PIMD from 6 to 14 years old. In this paper, we present its theoretical as well as methodological learnings: the scale could not be statistically verified, but we gathered very rich data about personal and environmental features of children with PIMD nowadays in France. Moreover, this study opens up interesting perspectives to imagine other ways to investigate those children's quality of life. 相似文献
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S. Halayem M. Hammami R. Fakhfakh N. Gaddour K. Tabbane I. Amado M.-O. Krebs A. Bouden 《L'Encéphale》2017,43(2):128-134
Background
Neurological soft signs (NSS) include anomalies in motor integration, coordination, sensory integration and lateralization and could be endophenotypic markers in autism spectrum disorders (ASD). Their characterization provides a more precise phenotype of ASD and more homogeneous subtypes to facilitate clinical and genetic research. Few scales for NSS have been adapted and validated in children including children with ASD. Our objective was to perform an adaptation to the child of a scale assessing neurological soft signs and a validation study in both general and clinical populations.Methods
We have selected the NSS scale of Krebs et al. (2000) already validated in adults. It encompasses 5 dimensions: motor coordination, motor integration, sensory integration, involuntary movement, laterality. After a preliminary study that examined 42 children, several changes have been made to the original version to adapt it to the child and to increase its feasibility, particularly in children with ASD. Then we conducted a validation study by assessing the psychometric properties of this scale in a population of 86 children including 26 children with ASD (DSM 5 Criteria) and 60 typically developing children. Children's ages ranged between 6 and 12 years, and patients and controls were matched for gender, age and intelligence. Patients were assessed using the Autism diagnostic Interview-revised and the Childhood Autism Rating Scale to confirm diagnosis. Typically developing children were assessed using the semi-structured Mini International Neuropsychiatric Interview for Children and Adolescents to eliminate any psychiatric disorder. All children with neurological pathologies (history of cerebral palsy, congenital anomaly of the central nervous system, epilepsy, tuberous sclerosis, neurofibromatosis, antecedent of severe head trauma) and obvious physical deformities or sensory deficits that could interfere with neurological assessment were excluded from the study. Both patients and controls were assessed using the Raven Progressive Matrices to exclude intellectual disability, and the adapted Krebs’ scale for the assessment of NSS.Results
Adaptation of the scale consisted of a modification in the order of items, in the use of concrete supports for the assessment of laterality and in the elimination of item constructive praxis. The internal consistency was good with a Cronbach alpha of 0.87. Inter-rater reliability was good, kappa coefficient was greater than 0.75 for 16 items, 3 items had a kappa value between 0.74 and 0.60, only 1 item had a kappa coefficient between 0.4 and 0.59. Good inter-rater reliability was also checked for the total score with a value of intra-class correlation coefficient (ICC) of 0.91. Principal component analysis found five factors accounting for 62.96 % of the total variance. About the comparison between patients and controls, significant differences were found for NSS total score (P = 0.000) and all subscores.Conclusion
The adaptation for children of the Krebs et al.’ NSS scale proved to be valid, especially in children with ASD. 相似文献17.
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