Acute psychosis in an adolescent with cerebral palsy

IntroductionCerebral Palsy is a movement, posture or muscle toning disorder caused by an insult to the immature, developing brain, most often before birth. It is a leading cause for serious disabilities in childhood and a risk factor for the development of psychiatric disorders, particularly in adolescents. Moreover, according to DSM-5, a Brief psychotic disorder is a short-term illness with psychotic symptoms, which arise suddenly, but last for less than one month, after which the person recovers completely.Objectives/AimsThe authors aim to present a case of an adolescent with cerebral palsy who has developed secondary psychotic symptoms, a rare and sparsely understood phenomenon.MethodsA non-systematic review of English scientific literature was conducted through research in the PubMed search engine, using the keywords “Cerebral Palsy” and “Brief Psychotic Disorder”.ResultsA 16-year-old female adolescent with history of Cerebral Palsy (due to neonatal anoxia) was admitted in the paediatric ward due to behaviour disorder characterized by incoherent speech, full insomnia, agitation and auto/alo-aggression. A complete clinical investigation was performed, in which trauma, organic brain injury, degenerative and inflammatory diseases, infection or toxic ingestion were all excluded. The hypothesis of an acute psychotic disorder was considered and after antipsychotic treatment, a total remission of the symptoms was obtained.ConclusionsAlthough rare, the association between cerebral palsy and psychotic disorders should be considered in the diagnostic investigation of behavioural changes. Early identification allows a proper therapeutic intervention and a better quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Brief Psychotic Disorder During the National Lockdown in Italy: An Emerging Clinical Phenomenon of the COVID-19 Pandemic

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa112 ◽

2020 ◽

Cited By ~ 3

Author(s):

Armando D′Agostino ◽

Simone D’Angelo ◽

Barbara Giordano ◽

Anna Chiara Cigognini ◽

Margherita Lorenza Chirico ◽

...

Keyword(s):

Psychotic Disorder ◽

Rating Scale ◽

Cortical Atrophy ◽

Psychotic Symptoms ◽

First Episode ◽

Antipsychotic Treatment ◽

Behavioral Abnormalities ◽

Brief Psychotic Disorder ◽

Psychiatric Rating Scale ◽

The Impact

Abstract The impact of the COVID-19 pandemic on psychosis remains to be established. Here we report 6 cases (3 male and 3 female) of first-episode psychosis (FEP) admitted to our hospital in the second month of national lockdown. All patients underwent routine laboratory tests and a standardized assessment of psychopathology. Hospitalization was required due to the severity of behavioral abnormalities in the context of a full-blown psychosis (the Brief Psychiatric Rating Scale [BPRS] = 75.8 ± 14.6). Blood tests, toxicological urine screening, and brain imaging were unremarkable, with the exception of a mild cortical atrophy in the eldest patient (male, 73 years). All patients were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout their stay, but 3 presented the somatic delusion of being infected. Of note, all 6 cases had religious/spiritual delusions and hallucinatory contents. Despite a generally advanced age (53.3 ± 15.6), all patients had a negative psychiatric history. Rapid discharge (length of stay = 13.8 ± 6.9) with remission of symptoms (BPRS = 27.5 ± 3.1) and satisfactory insight were possible after relatively low-dose antipsychotic treatment (Olanzapine-equivalents = 10.1 ± 5.1 mg). Brief psychotic disorder/acute and transient psychotic disorder diagnoses were confirmed during follow-up visits in all 6 cases. The youngest patient (female, 23 years) also satisfied the available criteria for brief limited intermittent psychotic symptoms. Although research on larger populations is necessary, our preliminary observation suggests that intense psychosocial stress associated with a novel, potentially fatal disease and national lockdown restrictions might be a trigger for FEP.

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Frontal Lobe Epilepsy Presenting as a Psychotic Disorder With Delusions and Hallucinations: A Case Study

CNS Spectrums ◽

10.1017/s1092852900012207 ◽

1999 ◽

Vol 4 (9) ◽

pp. 64-66,82 ◽

Cited By ~ 4

Author(s):

Bonnie J. Ramsey

Keyword(s):

Temporal Lobe Epilepsy ◽

Frontal Lobe ◽

Psychotic Disorder ◽

Temporal Lobe ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Frontal Lobe Epilepsy ◽

Unique Case ◽

Frontal Lobe Seizures

AbstractAlthough psychotic symptoms are a recognized manifestation of epilepsy, these are more often associated with seizures of the temporal lobe type. While 10% of children with temporal lobe epilepsy develop a psychotic disorder by adulthood, the literature does not report any cases of psychotic disorders associated with frontal lobe seizures in children. This article presents a unique case of a girl whose frontal lobe seizures were associated with delusional psychotic symptoms. Once her seizure disorder was identified through electroencephalography (EEG) and appropriate anticonvulsant therapy was initiated, her associated psychotic symptoms resolved.

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Brief psychotic disorder associated with quarantine and mild COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-240088 ◽

2020 ◽

Vol 13 (12) ◽

pp. e240088

Author(s):

Peter M Haddad ◽

Majid Al Abdulla ◽

Javed Latoo ◽

Yousaf Iqbal

Keyword(s):

Psychotic Disorder ◽

Physical Symptoms ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Psychiatric Medication ◽

Diagnostic And Statistical Manual ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Brief Psychotic Disorder

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.

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Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness

Psychological Medicine ◽

10.1017/s0033291720004444 ◽

2021 ◽

pp. 1-11

Author(s):

Andrea A. Jones ◽

Kristina M. Gicas ◽

Sara Mostafavi ◽

Melissa L. Woodward ◽

Olga Leonova ◽

...

Keyword(s):

Risk Factors ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Community Sample ◽

Dynamic Networks ◽

Premature Mortality ◽

Psychotic Symptoms ◽

Network Measures ◽

History Of ◽

Precarious Housing

Abstract Background People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. Method The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. Results Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. Conclusions Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.

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Overview of Schizophrenia and Other Psychotic Disorders

10.2310/psych.13011 ◽

2020 ◽

Author(s):

James A. Wilcox ◽

Donald W. Black

Keyword(s):

Psychotic Disorder ◽

Schizoaffective Disorder ◽

Psychotic Disorders ◽

Public Health Problem ◽

Premature Death ◽

Major Public Health Problem ◽

Schizophreniform Disorder ◽

Schizophrenia Spectrum ◽

Brief Psychotic Disorder ◽

The Individual

Psychotic disorders are among the most disabling conditions and constitute a major public health problem. Described throughout recorded time, they affect as many as 5% of the population and cause a disproportionate amount of suffering and loss to society. In the chapter on schizophrenia spectrum and other psychotic disorders, the DSM-5 lists delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, and schizoaffective disorder, as well as categories for substance- or medically induced psychotic disorders. The term psychosis indicates that the individual has a severe inability to interpret the surrounding environment in a realistic way. Symptoms include hallucinations, delusions, and bizarre behavior. Psychotic disorders are associated with premature death, mostly attributable to suicide. The pathophysiology and etiology of psychotic disorders are only now beginning to be understood, and treatment for these conditions remains suboptimal. Researchers are currently refining the cause of these symptoms and developing more effective treatments. This review contains 3 tables, and 34 references. Key words: Brief psychotic disorder, delusions, hallucinations, psychosis, schizoaffective disorder, schizophrenia, schizophreniform disorder

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Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.05.028 ◽

2017 ◽

Vol 45 ◽

pp. 104-113 ◽

Cited By ~ 18

Author(s):

A.C. Castagnini ◽

P. Fusar-Poli

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Case Identification ◽

Migrant Populations ◽

Diagnostic Categories ◽

Dsm 5 ◽

Characteristic Family ◽

Brief Psychotic Disorder ◽

Icd 10

AbstractBackground:Short-lived psychotic disorders are currently classified under “acute and transient psychotic disorders” (ATPDs) in ICD-10, and “brief psychotic disorder” (BPD) in DSM-5. This study's aim is to review the literature and address the validity of ATPDs and BPD.Method:Papers published between January 1993 and December 2016 were identified through searches in Web of Science. Reference lists in the located papers provided further sources.Results:A total of 295 articles were found and 100 were included in the review. There were only a few studies about the epidemiology, vulnerability factors, neurobiological correlates and treatment of these disorders, particularly little interest seems to exist in BPD. The available evidence suggests that short-lived psychotic disorders are rare conditions and more often affect women in early to middle adulthood. They also are neither associated with premorbid dysfunctions nor characteristic family predisposition, while there seems to be greater evidence of environmental factors particularly in developing countries and migrant populations. Follow-up studies report a favourable clinical and functional outcome, but case identification has proved difficult owing to high rates of transition mainly either to schizophrenia and related disorders or, to a lesser extent, affective disorders over the short- and longer-terms.Conclusions:Although the lack of neurobiological findings and little predictive power argue against the validity of the above diagnostic categories, it is important that they are kept apart from longer-lasting psychotic disorders both for clinical practice and research. Close overlap between ATPDs and BPD could enhance the understanding of these conditions.

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COVID-19-associated brief psychotic disorder

BMJ Case Reports ◽

10.1136/bcr-2020-236940 ◽

2020 ◽

Vol 13 (8) ◽

pp. e236940 ◽

Cited By ~ 7

Author(s):

Colin M Smith ◽

Jonathan R Komisar ◽

Ahmad Mourad ◽

Brian R Kincaid

Keyword(s):

Mental Illness ◽

Family History ◽

Psychotic Disorder ◽

Neuropsychiatric Symptoms ◽

Healthy Woman ◽

Psychotic Symptoms ◽

First Case ◽

Brief Psychotic Disorder ◽

History Of ◽

New Onset

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.

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Pathological laughing and psychotic disorder: the medical evaluation of the Joker

Acta Neurologica Belgica ◽

10.1007/s13760-020-01332-3 ◽

2020 ◽

Vol 120 (6) ◽

pp. 1379-1382

Author(s):

Alexis Demas ◽

David Tillot

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Social Withdrawal ◽

Neuropsychiatric Symptoms ◽

Public Health Problem ◽

Psychotic Symptoms ◽

Left Frontal Lobe ◽

Physically Abused ◽

Medical Evaluation ◽

Origin Story

Abstract In the psychological thriller film Joker, released in 2019 and starring Joaquin Phoenix in the first role, another possible origin story for this iconic character is reported. Above all, it brings us medical elements for the understanding of the development of this complex character. Contrary to other interpretations, we discover a lonely, timid and uncharismatic man (Arthur Fleck). He seems to be suffering from psychobehavioral disorders and seems depressed. There is a strangeness in his behavior along with social withdrawal. He suffers from fits of laughter that occur at socially inappropriate times. He also suffers from psychotic symptoms with visual delusions. We learn through the film that he was a beaten child, psychologically and physically abused with severe traumatic brain injury (TBI). The uncontrollable outbursts of laughter, behavioral and psychotic disorders followed these elements. As a neurologist, I was intrigued by these symptoms. I have explored the neuropsychiatric symptoms complicating TBI from which he seems to suffer and which have been reported in the literature. We can assume that the Joker is suffering from neuropsychiatric sequelae related to childhood TBI involving the frontotemporal regions and, in particular, the lateral aspect of the left frontal lobe. The movie Joker has medical significance and covers social aspects of medicine and health care. First, it allows us to discuss whether psychotic disorder due to TBI should be considered a neurobiological syndrome. More broadly, albeit fictitious, it asks us about the management of patients with neuropsychiatric illness, which is a public health problem. It also reminds us that semiological descriptions of patients with neuropsychiatric disorders have served as inspiration for many authors.

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Acute and transient psychoses: clinical and nosological issues

BJPsych Advances ◽

10.1192/apt.bp.115.015198 ◽

2016 ◽

Vol 22 (5) ◽

pp. 292-300 ◽

Cited By ~ 9

Author(s):

Augusto Castagnini ◽

Gian Maria Galeazzi

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Diagnosis And Treatment ◽

Cycloid Psychosis ◽

Dsm 5 ◽

Brief Psychotic Disorder ◽

Icd 10

SummaryThis article examines the clinical, epidemiological and nosological aspects of short-lived psychotic disorders as currently classified under ‘acute and transient psychotic disorders' in ICD-10 and ‘brief psychotic disorder’ in DSM-5. After describing earlier diagnostic concepts such as bouffée délirante, cycloid psychosis, reactive psychosis and schizophreniform psychosis, we present an overview of the literature and discuss implications for classification, diagnosis and treatment of these conditions, pointing out differences from longer-lasting psychotic disorders.

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is the Brief Psychotic Disorder a Distinct Nosologic Entity?: A Longitudinal Study of 80 Patients

European Psychiatry ◽

10.1016/s0924-9338(09)71421-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

L. Rodriguez Incio ◽

I. Grande Fullana ◽

V. Sánchez Gistau ◽

M. Bernardo Arroyo ◽

E. Parellada Rodón

Keyword(s):

Longitudinal Study ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Psychiatric Inpatient ◽

Psychotic Episode ◽

Inpatient Service ◽

Brief Psychotic Disorder ◽

Dsm Iv ◽

Nosologic Entity

Introduction:The DSM-IV-TR category “brief psychotic disorder” includes different concepts that have been defined before like bouffée délirante, cycloid psychosis and “acute and transient psychosis” in the last ICD-10. Limited prospective studies have been done, and they all show a marked diagnostic instability during follow-up. According to that, its independent nosologic entity is still uncertain.Aims:To determine the diagnostic stability of the brief psychotic disorders as well as their distinct clinical features.Method:Observational, retrospective, longitudinal study of 80 consecutive patients admitted at the acute psychiatric inpatient service of a general hospital between 2000 and 2006. at discharge, all of them fulfilled diagnostic criteria for “brief psychotic disorder” according to DSM-IV. Demographic and psychopathological data were analysed.Results:Mean age (SD) was 31.3 (9.5), most of them women (63%). the most frequent previous stressor was related to labour, while up to 45% didn't report any. 51% had no psychiatric family history. 15 (19%) patients previously had a brief psychotic episode. Psychopathological disturbances identified were: thought disorder 69%, anxiety 66.6%, insomnia 57.7%, suspiciousness 53.5%, rapidly changing delusions 53.3% (paranoid contents 75.3%), perplexity 46.5%, auditory hallucinations 45.1%, mood lability 36.6%, elation 23.9%, depressed mood 22.5% and irritability 12.7%. in the 24 month follow-up, 32.5% changed diagnosis to schizophrenia, 3"9% to schizoaffective, 10% to bipolar disorder and 16.9% achieved clinical remission. 28.5% were lost to follow-up.Conclusion:“Brief psychotic disorder” category is still uncertain and more data may be necessary to clarify if it should remain as a distinct nosologic entity.

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