Journal Article Annotations
2021, 4th Quarter
Annotations by Katiuska Ramirez, MD and Carlos Fernandez Robles, MD
This is a retrospective study of 28 patients, consisting of 19 women and 9 men, diagnosed with probable behavioral variant frontal temporal dementia (bvFTD) at a public psychiatric hospital in Cali, Columbia. Of the study population, 71.4% of patients were incorrectly diagnosed with psychiatric disorders at the time of their initial evaluation. Women were more likely to be initially diagnosed with depression and bipolar disorder while men were more likely to be diagnosed with an anxiety disorder or a psychotic disorder. The average amount of time between the onset of neuropsychiatric symptoms to the diagnosis of bvFTD was 4.3 years, which is similar to prior North American and European studies. Additionally, the study demonstrated a disproportionate level of caregiver burden for women caring for patients with bvFTD compared to male caregivers.
Strength and weaknesses:
The retrospective nature of this study is a potential limitation given possible deficits in documentation or variations in diagnostic assessments. Having assessments completed by psychiatrists may also introduce a diagnostic bias into the study design. Additionally, the distribution of men and women in the study was skewed, which may limit generalizability. A notable strength of the study is its use of a diverse Latin American population with Indigenous, African, and European backgrounds and lower socioeconomic status and educational background.
C-L psychiatrists are frequently asked to help distinguish between primary mood or psychotic disorders and other neuropsychiatric disorders or general medical conditions. Behavioral variant frontotemporal dementia (bvFTD) can be especially challenging in this regard given overlapping symptoms seen in bvFTD and primary psychiatric disorders. In the study, rates of misdiagnosis were found to be higher in this population compared to studies conducted in higher-income countries. The authors explore potential causes of this discrepancy including lower public awareness about dementia, a gap in professional training in this area, and limited access to resources including biomarkers used in diagnostic work-up.
Acute stress disorder (ASD) in hospitalized burn patients was 23.4%, comparable to other studies and higher than reported for other forms of trauma such as car accidents and rape victims. A feeling of life-threat (an individual’s subjective interpretation of the risk of death) was the highest risk factor for the development of ASD. This personal experience is independent of the severity of the injury. Other factors associated with the presentation of ASD in the burned patient include severe pain, electrical burn, and burn in special areas such as the face, hands, genitals, and joints.
Strengths and weaknesses
This well-designed and well-powered nested case-control study carried out in a burn unit allows for the early and adequate collection of information and close monitoring of each case and adequately analyses the different observed variables. One of the significant limitations is that most severe cases missed enrolment requirements due to sedation related to prolonged ICU stays or could not provide potentially valuable information. Finally, objective evaluation of reliability was not carried out among the evaluators; however, all raters were trained CL psychiatrists, which may mitigate this issue.
This is a high-quality study with the largest number of participants in a disorder (ASD) that is poorly described in the scientific literature. Given that this study was conducted entirely in an inpatient burn unit is of crucial importance to C-L psychiatrists. They should use these findings to inform their treatment decisions and plan for early interventions, particularly for those identified as high risk for ASD. In turn, these early interventions can help reduce rates of PTSD in this population. This work reflects the high-quality research being conducted in South America and the opportunity for meaningful collaborations in C-L psychiatry across national borders.