Atypical features and treatment choices in bipolar disorders:a result of the National Bipolar Mania Pathway Survey in China

In this study,we examined the point prevalence rate of atypical features in bipolar disorder,and estimated the potential impact of these features on treatment practices in China. Using the atypical features criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association（DSM-IV）,we documented the atypical symptoms in 3 906 consecutive participants with bipolar disorder enrolled at 26 psychiatric services across China. We further assessed the association between atypical features and the treatment approaches,including the prescription of antidepressants. The overall point prevalence rate of atypical features was 9.1% among patients with various bipolar disorder subtypes. When the definition was broadened to include atypical features B,the overall rate increased to 11.8%. Interestingly,among patients with the mixed state and remission subtypes,there was a significant difference in the rates of antidepressant medication usage between patients who met and those who did not meet the criteria for atypical features B. These fi ndings indicate a trend of using antidepressants for these two types of patients with atypical features. Further,for both mixed state and remission patients,treatment approaches were related to atypicalfeatures B. Our findings provide evidence to assist clinicians to readily recognize atypical features in bipolar subtypes and can propose treatments based on these diagnoses.

Wernicke's encephalopathy in a rectal cancer patient with atypical radiological features:A case report

BACKGROUND Wernicke's encephalopathy is a disease caused by thiamine deficiency.The lesions usually involve the periphery of the aqueduct,midbrain,tectum,third ventricle,papillary body,and thalamus.It is very rare to affect the vermis and cerebellar hemispheres.CASE SUMMARY We report a 77-year-old female patient admitted to the emergency department of our hospital for 2 d of unconsciousness.Brain magnetic resonance imaging showed increased diffusion weighted imaging signals in the bilateral thalamus,periventricular regions of the third ventricle,corpora quadrigemina,vermis,and cerebellar hemispheres.Wernicke's encephalopathy was considered.She was given thiamine therapy and became conscious after the treatment.CONCLUSION Wernicke's encephalopathy may have various imaging manifestations.Clinicians should keep in mind that Wernicke’s encephalopathy may occur in patients who experience prolonged periods of malnutrition.

Atypical imaging features of the primary spinal cord glioblastoma:A case report

BACKGROUND Primary spinal cord(PSC)glioblastoma(GB)is an extremely rare but fatal primary tumor of the central nervous system and associated with a poor prognosis.While typical tumor imaging features are generally easy to recognize,glioblastoma multiforme can have a wide range of imaging findings.Atypical GB is often misdiagnosed,which usually delays the optimal time for treatment.In this article,we discuss a clinical case of pathologically confirmed PSC GB under the guise of benign tumor imaging findings,as well as the most recent literature pertaining to PSC GB.CASE SUMMARY A 70-year-old female complained of limb weakness lasting more than 20 d.Irregular masses were observed inside and outside the left foramina of the spinal canal at C7-T1 on medical imaging.Based on the imaging features,radiologists diagnosed the patient with schwannoma.Tumor resection was performed under general anesthesia.The final histopathological findings revealed a final diagnosis of PSC GB,world health organization Grade IV.The patient subsequently underwent a 4-wk course of radiotherapy(60 Gy in 20 fractions)combined with temozolomide chemotherapy.The patient was alive at the time of submission of this manuscript.CONCLUSION Atypical GB presented unusual imaging findings,which led to misdiagnosis.Therefore,a complete recognition of imaging signs may facilitate early accurate diagnosis.