Iqbal Ahmed

Psychotic disorder following traumatic brain injury: A conceptual framework

Introduction. Psychotic Disorder Following Traumatic Brain Injury (PDFTBI) is a relatively rare disorder that may provide clues to understanding schizophrenia and psychosis. The objective of this paper was to develop a conceptual framework describing how traumatic brain injury (TBI) can contribute to the development of a psychosis and potential neurobiological mechanisms that cause a psychosis in this population. Methods. The literature on PDFTBI and previous conceptualisations of the disorder were reviewed. A model of psychosis was described as a context for a conceptualisation of PDFTBI. Results. PDFTBI is associated with abnormalities to the temporal and frontal areas. The general presentation includes persecutory delusions and auditory hallucinations with an absence of negative symptoms. The mean onset is 4-5 years after TBI with the majority of cases occurring within 2 years. The progression and course of PDFTBI is variable. Neuroleptics appear to be the most efficacious medication. Previous conceptualisations of PDFTBI are varied and suggest that the relationship is not a simple one. Conclusion. We propose that psychosis results from damage to the frontal and temporal areas and dysregulation of the dopaminergic system. Everyone is vulnerable to a psychotic disorder and psychosis will result when a threshold of damage to these areas are attained. Traumatic brain injury can be the primary cause of psychosis or contribute to the development of a psychosis through secondary seizure disorder, increasing biological and psychological risk, and triggering psychosis in vulnerable patients. The relationship may also be coincidental. Traumatic brain injury triggers pathophysiological processes that generally result in a psychosis after a delay of 1-5 years. Directions for future research includes prospective studies examining the impact of TBI on developing psychosis, retrospective studies examining TBI as a risk factor in schizophrenia or other populations at risk for secondary psychosis, and studies examining prevention of psychotic illness.

Psychotic disorder caused by traumatic brain injury.

Psychosis is a rare and severe sequela of traumatic brain injury (TBI). This article assists clinicians in differential diagnosis by providing literature-based guidance with regard to use of the Diagnostic and Statistical Manual for Mental Disorders 5 criteria for this condition. This article also describes potential relationships between TBI and the development of a psychosis within the conceptualization of psychosis as a neurobehavioral syndrome.

Folk and Biological Perceptions of Dementia Among Asian Ethnic Minorities in Hawaii

OBJECTIVE To study if Asian ethnic groups in Hawaii today maintain folk-based beliefs about dementia, have inadequate biomedical understanding of dementia, and differ among each other regarding perceptions of dementia. DESIGN The study adapts and expands a 2004 survey of ethnic groups on perceptions of Alzheimer disease demonstrating that ethnic minority groups hold more folk perceptions and less biomedical perceptions of dementia than Caucasians. This study surveys particular ethnic minority family members of elders admitted to four long-term care and inpatient facilities in Hawaii. Seventy-one family members completed surveys, including 23 Chinese, 18 Filipino, and 30 Japanese participants. Elders may or may not have had the diagnosis of dementia, though an estimated half of elders in all four facilities already held the diagnosis of dementia. RESULTS Findings indicated that Japanese and Chinese respondents in this study held perceptions about dementia that were more consistent with current biomedical understanding compared with their Filipino counterparts (mean differences/percent correct for Japanese: 57%, Chinese: 56% versus Filipino: 38%; F = 6.39, df = 2,55, p = 0.003). Filipino respondents were less likely than Japanese and Chinese respondents to report that persons with dementia can develop physical and mental problems-97% of Japanese participants and 82% of Chinese participants responded correctly compared with 63% of Filipino participants (Fishers Exact test p = 0.009). With regard to folk beliefs about dementia, variation occurred with no consistent trend among the groups. CONCLUSION Low levels of biomedical understanding of dementia were reflected by all three subgroups of Asians living in Hawaii with less prominence of folk beliefs compared with prior studies of ethnic minority perceptions. Education did not predict variability in dementia perceptions among the groups. Lower levels of acculturation, suggested by primary home language other than English, may correlate with a perception of dementia that is less consistent with current biomedical understanding of dementia. Persisting folk beliefs about dementia and the evident lack of biomedical understanding, particularly the belief that dementia is a normal part of aging, emphasizes the need for more culturally tailored strategies in patient education about dementia and the importance of early intervention.

The spectrum of psychotic disorders : neurobiology, etiology, and pathogenesis

Part I. Introduction: 1. Introduction: is psychosis a neurobiological syndrome? Daryl E. Fujii and Iqbal Ahmed Part II. Primary Psychotic Disorders: 2. Schizophrenia Gerald Goldstein, Daniel N. Allen and Gretchen L. Haas 3. Childhood onset schizophrenia Jason Schiffman 4. Late onset schizophrenia Katerine Osatuke, John W. Kasckow and Somaia Mohamed 5. Schizoaffective disorder David B. Arciniegas and Daniel J. Abrams 6. Schizophreniform and brief psychotic disorder Andreas Marneros and Frank Pillman 7. Delusional disorders Theo Manschrek Part III. Mood Disorders: 8. Psychosis in bipolar disorder Deborah Yurgelun-Todd 9. Psychosis in major depression Eric G. Smith, Philip R. Burke, Jessica E. Grogan, Susan E. Frantoni and Anthony J. Rothschild Part IV. Neurodevelopmental and Genetic Disorders: 10. Psychosis associated with intellectual deficits Nick Bouras and Colin P. Hemmings 11. Psychosis secondary to velo-cardio-facial syndrome Wendy R. Kates and Wanda Fremont 12. Psychosis secondary to autism Dirk M. Dhossche Part V. Central Nervous System Disorders: 13. Psychosis secondary to traumatic brain injury Daryl E. Fujii, Nikki Armstrong and Iqbal Ahmed 14. Psychosis secondary to epilepsy Perminder Sachdev 15. Psychosis secondary to cerebral vascular accident James A. Bourgeois 16. Psychosis secondary to brain tumors Tamara Dolenc and Teresa Rummans 17. Psychosis secondary to infections Sarah Reading and John T. Little 18. Psychosis secondary to inflammatory and demyelinating Disease Katherine H. Taber and Robin A. Hurley Part VI. Substance Abuse and Medications: 19. Psychosis secondary to cannabis abuse Luis Alfonso Nunez Domingo 20. Psychosis secondary to cocaine abuse Daryl E. Fujii and Erin Y. Sakai 21. Psychosis secondary to methamphetamine abuse Liz Jacob and William Haning III 22. Psychosis secondary to medications Junji Takeshita, Diane Thompson and Stephen E. Nicolson Part VII. Neurodegenerative Disorders: 23. Psychosis secondary to dementia of the Alzheimers type Robert A. Sweet 24. Psychosis secondary to Lewy Body Dementia Sasha Ericksen and Debby Tsuang 25. Psychosis secondary to Parkinsons Disease David L. Sultzer and G. Webster Ross Part VIII. Sensory Impairments: 26. Psychosis secondary to deafness, blindness, and release hallucinations Suzanne Holroyd Part IX. Conclusion: 27. Is psychosis and neurobiological syndrome: integration and conclusions Daryl E. Fujii and Iqbal Ahmed.

Increased Elderly Utilization of Psychiatric Emergency Resources as a Reflection of the Growing Mental Health Crisis Facing Our Aging Population

The elderly population continues to soar in the United States, with the number of those older than 65 years expected to double from 2010 to 2050. Many are predicting an imminent mental health crisis for our seniors, as available resources lag further behind the demand. One contributing factor is the evergrowing number of individuals with dementia-related behavioral symptoms. In Hawaii, a top retirement destination known for longevity of life, we have experienced greater use by elderly patients of the psychiatric emergency department (ED) at the largest general hospital in the state. As evidence of this trend, we present age-specific psychiatric ED utilization patterns from 2007 to 2011, a period during which local resources for geriatric mental health had remained static. We collected data (age, mode of arrival, main diagnosis, length of stay [LOS], and disposition) for all psychiatric ED visits (N = 22,124) in the 5-year period. Patients were grouped as younger (aged <65 years) or older (aged ≥65 years, N = 1,370). Within this period, there was a general trend of more access by elderly patients, with yearly numbers and proportions at 234 (5.7%) in 2007, 220 (5.5%) in 2008, 301 (7.2%) in 2009, 298 (6.2%) in 2010, and 319 (6.5%) in 2011. A more pronounced and alarming progression was seen in law enforcement being increasingly relied upon, usually because of violent behavior, to bring older patients to the ED (12.5% in 2007, 11.0% in 2008, 16.9% in 2009, 18.4% in 2010, and 24.5% in 2011; χ(8) = 41.56, p < 0.01), whereas the numbers of those who arrived by ambulance (64.7%, 50.7%, 59.5%, 59.2%, 54.5%, respectively) or with caregivers/self (22.8%, 38.4%, 23.6%, 22.4%, 21.0%, respectively) trended downward. Behavior due to dementia of all types was recorded as the main presenting diagnosis among 14% of older patients. This number is likely much higher as we were unable to capture secondary diagnoses reliably. Using LOS to estimate ED utilization, older patients had longer LOS (median: 400 minutes) than younger patients (median = 351 minutes, U = 12,362,765, p < 0.01). Among older patients, those receiving medical admission (11% of all elderly visits) had the highest LOS (median: 519 minutes), followed by psychiatric admission (31%, median = 431 minutes) and discharge (58%, median = 352 minutes, KruskalWallis (df 2) = 76.43, p < 0.01; post-hoc medical > psychiatric > discharge). Further, highly advanced age (≥80 years defined as “older old”), compared with “younger old” (aged 65–79 years), was associated with an even greater LOS, but only among those who were psychiatrically admitted (F(2, 1364) = 5.36, p = 0.01, using log-transformed LOS because of positive skew), with the significant interaction term characterized by a median LOS of 457 minutes in “older old” and 409 minutes in “younger old”. Such findings were not surprising. Because of a shortage of geriatric mental health services, exhausted caregivers were often unwilling accept patients back from the ED (usually cases involving the oldest old), where they had to endure lengthy (often multi-day) searches for a limited number of appropriate psychiatric beds. Our observations reflect worrisome outcomes of a fairly stagnant geriatric mental health system, during a period in which growth of the elderly population outpaced other age groups. As a result, symptom acuity and potential for harm rose steadily, as indicated by more law enforcement being invoked by caregivers for transfer to the ED. Lack of acute placement options further worsened crowding in the ED, straining finite acute resources further. Our study period (2007–2011) ushers the very beginning of the baby boomer cohort becoming 65 years or older. Thus, the degree of reliance on ED behavioral services by seniors, especially those with dementia, and their caregivers is likely to increase. Long-term solutions to shore up widening gaps in geriatric mental health are becoming even more urgent.

Death, Dying, and End-of-Life Care

All physicians face end-of-life issues during their training and many continue to work in specialties where life and death are part of their daily duties. This chapter addresses a key challenge for physicians who work with older and critically ill patients.

The Spectrum of Psychotic Disorders: Contents

Part I. Introduction: 1. Introduction: is psychosis a neurobiological syndrome? Daryl E. Fujii and Iqbal Ahmed Part II. Primary Psychotic Disorders: 2. Schizophrenia Gerald Goldstein, Daniel N. Allen and Gretchen L. Haas 3. Childhood onset schizophrenia Jason Schiffman 4. Late onset schizophrenia Katerine Osatuke, John W. Kasckow and Somaia Mohamed 5. Schizoaffective disorder David B. Arciniegas and Daniel J. Abrams 6. Schizophreniform and brief psychotic disorder Andreas Marneros and Frank Pillman 7. Delusional disorders Theo Manschrek Part III. Mood Disorders: 8. Psychosis in bipolar disorder Deborah Yurgelun-Todd 9. Psychosis in major depression Eric G. Smith, Philip R. Burke, Jessica E. Grogan, Susan E. Frantoni and Anthony J. Rothschild Part IV. Neurodevelopmental and Genetic Disorders: 10. Psychosis associated with intellectual deficits Nick Bouras and Colin P. Hemmings 11. Psychosis secondary to velo-cardio-facial syndrome Wendy R. Kates and Wanda Fremont 12. Psychosis secondary to autism Dirk M. Dhossche Part V. Central Nervous System Disorders: 13. Psychosis secondary to traumatic brain injury Daryl E. Fujii, Nikki Armstrong and Iqbal Ahmed 14. Psychosis secondary to epilepsy Perminder Sachdev 15. Psychosis secondary to cerebral vascular accident James A. Bourgeois 16. Psychosis secondary to brain tumors Tamara Dolenc and Teresa Rummans 17. Psychosis secondary to infections Sarah Reading and John T. Little 18. Psychosis secondary to inflammatory and demyelinating Disease Katherine H. Taber and Robin A. Hurley Part VI. Substance Abuse and Medications: 19. Psychosis secondary to cannabis abuse Luis Alfonso Nunez Domingo 20. Psychosis secondary to cocaine abuse Daryl E. Fujii and Erin Y. Sakai 21. Psychosis secondary to methamphetamine abuse Liz Jacob and William Haning III 22. Psychosis secondary to medications Junji Takeshita, Diane Thompson and Stephen E. Nicolson Part VII. Neurodegenerative Disorders: 23. Psychosis secondary to dementia of the Alzheimers type Robert A. Sweet 24. Psychosis secondary to Lewy Body Dementia Sasha Ericksen and Debby Tsuang 25. Psychosis secondary to Parkinsons Disease David L. Sultzer and G. Webster Ross Part VIII. Sensory Impairments: 26. Psychosis secondary to deafness, blindness, and release hallucinations Suzanne Holroyd Part IX. Conclusion: 27. Is psychosis and neurobiological syndrome: integration and conclusions Daryl E. Fujii and Iqbal Ahmed.

The Spectrum of Psychotic Disorders: List of Contributors

Part I. Introduction: 1. Introduction: is psychosis a neurobiological syndrome? Daryl E. Fujii and Iqbal Ahmed Part II. Primary Psychotic Disorders: 2. Schizophrenia Gerald Goldstein, Daniel N. Allen and Gretchen L. Haas 3. Childhood onset schizophrenia Jason Schiffman 4. Late onset schizophrenia Katerine Osatuke, John W. Kasckow and Somaia Mohamed 5. Schizoaffective disorder David B. Arciniegas and Daniel J. Abrams 6. Schizophreniform and brief psychotic disorder Andreas Marneros and Frank Pillman 7. Delusional disorders Theo Manschrek Part III. Mood Disorders: 8. Psychosis in bipolar disorder Deborah Yurgelun-Todd 9. Psychosis in major depression Eric G. Smith, Philip R. Burke, Jessica E. Grogan, Susan E. Frantoni and Anthony J. Rothschild Part IV. Neurodevelopmental and Genetic Disorders: 10. Psychosis associated with intellectual deficits Nick Bouras and Colin P. Hemmings 11. Psychosis secondary to velo-cardio-facial syndrome Wendy R. Kates and Wanda Fremont 12. Psychosis secondary to autism Dirk M. Dhossche Part V. Central Nervous System Disorders: 13. Psychosis secondary to traumatic brain injury Daryl E. Fujii, Nikki Armstrong and Iqbal Ahmed 14. Psychosis secondary to epilepsy Perminder Sachdev 15. Psychosis secondary to cerebral vascular accident James A. Bourgeois 16. Psychosis secondary to brain tumors Tamara Dolenc and Teresa Rummans 17. Psychosis secondary to infections Sarah Reading and John T. Little 18. Psychosis secondary to inflammatory and demyelinating Disease Katherine H. Taber and Robin A. Hurley Part VI. Substance Abuse and Medications: 19. Psychosis secondary to cannabis abuse Luis Alfonso Nunez Domingo 20. Psychosis secondary to cocaine abuse Daryl E. Fujii and Erin Y. Sakai 21. Psychosis secondary to methamphetamine abuse Liz Jacob and William Haning III 22. Psychosis secondary to medications Junji Takeshita, Diane Thompson and Stephen E. Nicolson Part VII. Neurodegenerative Disorders: 23. Psychosis secondary to dementia of the Alzheimers type Robert A. Sweet 24. Psychosis secondary to Lewy Body Dementia Sasha Ericksen and Debby Tsuang 25. Psychosis secondary to Parkinsons Disease David L. Sultzer and G. Webster Ross Part VIII. Sensory Impairments: 26. Psychosis secondary to deafness, blindness, and release hallucinations Suzanne Holroyd Part IX. Conclusion: 27. Is psychosis and neurobiological syndrome: integration and conclusions Daryl E. Fujii and Iqbal Ahmed.

The Spectrum of Psychotic Disorders: Index

Part I. Introduction: 1. Introduction: is psychosis a neurobiological syndrome? Daryl E. Fujii and Iqbal Ahmed Part II. Primary Psychotic Disorders: 2. Schizophrenia Gerald Goldstein, Daniel N. Allen and Gretchen L. Haas 3. Childhood onset schizophrenia Jason Schiffman 4. Late onset schizophrenia Katerine Osatuke, John W. Kasckow and Somaia Mohamed 5. Schizoaffective disorder David B. Arciniegas and Daniel J. Abrams 6. Schizophreniform and brief psychotic disorder Andreas Marneros and Frank Pillman 7. Delusional disorders Theo Manschrek Part III. Mood Disorders: 8. Psychosis in bipolar disorder Deborah Yurgelun-Todd 9. Psychosis in major depression Eric G. Smith, Philip R. Burke, Jessica E. Grogan, Susan E. Frantoni and Anthony J. Rothschild Part IV. Neurodevelopmental and Genetic Disorders: 10. Psychosis associated with intellectual deficits Nick Bouras and Colin P. Hemmings 11. Psychosis secondary to velo-cardio-facial syndrome Wendy R. Kates and Wanda Fremont 12. Psychosis secondary to autism Dirk M. Dhossche Part V. Central Nervous System Disorders: 13. Psychosis secondary to traumatic brain injury Daryl E. Fujii, Nikki Armstrong and Iqbal Ahmed 14. Psychosis secondary to epilepsy Perminder Sachdev 15. Psychosis secondary to cerebral vascular accident James A. Bourgeois 16. Psychosis secondary to brain tumors Tamara Dolenc and Teresa Rummans 17. Psychosis secondary to infections Sarah Reading and John T. Little 18. Psychosis secondary to inflammatory and demyelinating Disease Katherine H. Taber and Robin A. Hurley Part VI. Substance Abuse and Medications: 19. Psychosis secondary to cannabis abuse Luis Alfonso Nunez Domingo 20. Psychosis secondary to cocaine abuse Daryl E. Fujii and Erin Y. Sakai 21. Psychosis secondary to methamphetamine abuse Liz Jacob and William Haning III 22. Psychosis secondary to medications Junji Takeshita, Diane Thompson and Stephen E. Nicolson Part VII. Neurodegenerative Disorders: 23. Psychosis secondary to dementia of the Alzheimers type Robert A. Sweet 24. Psychosis secondary to Lewy Body Dementia Sasha Ericksen and Debby Tsuang 25. Psychosis secondary to Parkinsons Disease David L. Sultzer and G. Webster Ross Part VIII. Sensory Impairments: 26. Psychosis secondary to deafness, blindness, and release hallucinations Suzanne Holroyd Part IX. Conclusion: 27. Is psychosis and neurobiological syndrome: integration and conclusions Daryl E. Fujii and Iqbal Ahmed.