Differential Diagnosis Based on Age. Diagnostic Difficulties

2016 ◽  
Vol 33 (S1) ◽  
pp. S473-S473
Author(s):  
S. Rodrígue Vargas
Keyword(s):  
Differential Diagnosis ◽  
Literature Review ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Review Of The Literature ◽  
Diagnostic Difficulties ◽  
Diagnostic Hypothesis ◽  
Competing Interest

IntroductionFollowing a case presented in our inpatient unit as well as various interdepartmental from internal medicine and other emergencies, we decided to conduct a literature review on the different organic causes that can trigger the onset of psychotic symptoms in elderly.ObjectivesA correct differential diagnosis of psychiatric symptoms in elderly.AimsLiterature review of the literature on the presentation of psychotic symptoms in the elderly.MethodsDescription of a clinical case and development of diagnostic hypotheses.Results and conclusionsFor several decades are experiencing a gradual aging of the population, which means that we are at the onset of clinical symptoms not described by classical authors. Furthermore, scientific advances make infectious causes (such as neurosyphilis was our first diagnostic hypothesis) are increasingly rare. The elderly usually has multiple comorbidities, which are receiving various treatments that must be ruled out possible adverse effects.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

TRANSIENT ISCHEMIC ATTACKS: ETIOPATHOGENESIS, CLINIC. (Literature review)

Vestnik ◽  
2021 ◽  
pp. 91-96
Author(s):  
Г.Ж. Жакенова ◽  
Р.Б. Нуржанова ◽  
К.Б. Сраилова ◽  
Ж.С. Шерияздан ◽  
А.Б. Ташманова ◽  
...  
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Literature Review ◽  
Clinical Manifestations ◽  
Transient Ischemic Attacks ◽  
Review Of The Literature ◽  
Imaging Signs

В данной статье представлен обзор литературы по транзиторным ишемическим атакам: эпидемиология, этиология, патогенез, классификация, основные характеристики с учетом факторов риска, визуализационных признаков МРТ и КТ, клинических проявлений и дифференциальной диагностики данного заболевания на основе современных исследований. This article presents a review of the literature on transient ischemic attacks: epidemiology, etiology, pathogenesis, classification, main characteristics taking into account risk factors, imaging signs of MRI and CT, clinical manifestations and differential diagnosis of this disease based on modern research.

Frontotemporal dementia and psychosis: Literature review

2016 ◽  
Vol 33 (S1) ◽  
pp. S367-S367
Author(s):  
D. Brandão ◽  
J. Massano
Keyword(s):  
Literature Review ◽  
Frontotemporal Dementia ◽  
Positive Family History ◽  
Genetic Mutation ◽  
Conclusive Evidence ◽  
Psychotic Symptoms ◽  
Initial Symptom ◽  
Clinical Criteria ◽  
Competing Interest ◽  
The Right

IntroductionFrontotemporal dementia (FTD) is a progressive neurodegenerative disease especially sporadic. About 30–40% have positive family history, with an identifiable genetic mutation in a percentage of cases increasing. Although the FTD psychosis has been recognized for many years, it is not included in the clinical criteria.ObjectivesTo assess the prevalence and characteristics of psychotic symptoms in FTD, compare the presence of psychosis in FTD C9+ versus C9− and analyze the occurrence of wrong diagnoses in FTD with psychosis.MethodsLiterature review, using computerized databases (Pubmed®). Articles were selected based on the content of their abstract and their relevance.ResultsIt is frequently the presence of psychotic symptoms in FTD associated with C9+ versus C9−. These may arise as initial symptom often leading to a psychiatric diagnosis years before obtaining diagnosis of FTD. There is no conclusive evidence about the anatomical correlation of psychotic features in the FTD, although there is the possible association with the right brain degeneration.ConclusionsThe existence of psychotic symptoms do not argues against the diagnosis of FTD verifying a high frequency of psychosis in FTD – C9+. As can be the first symptom in FTD is critical to differentiate psychiatric disorders. Further studies are needed in order to obtain a better characterization of psychotic symptoms in FTD – C9+.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Culture and mental disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S517-S517
Author(s):  
A. Adrián ◽  
C. Noval Canga ◽  
H. Rebeca ◽  
S. Isabel ◽  
G. Sofía ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Mental Disorders ◽  
Psychiatric Diagnosis ◽  
Emergency Service ◽  
Psychotic Symptoms ◽  
Sociocultural Factors ◽  
Psychiatric History ◽  
Sexual Content ◽  
Competing Interest

ObjectivesShow with a case report how psychiatric pathology may face differential diagnosis problems when sociocultural aspects are involved.Methods and materialsSeventy-three year old man, born in Colombia. During the last two months, he had come many times to the emergency service due to behavioural changes. He does not have previous psychiatric history. His daughter refers that one of the patient's sisters has been diagnosed of “mystical madness”. The previous days he abandoned his medical treatment saying that he “gets in touch with his wife and that he wants to meet her”. Since his wife's dead, he had presented an excessively adapted behaviour, without grief symptoms. The first hospitalization day he said we wanted to get married with one of his daughters, with a sexual content speech, being able to get emotional when he spoke about his dead wife. Now the patient is under frequent reviews, and it is thought the differential diagnosis of depression with psychotic symptoms, due to the lack of symptoms remission.ConclusionWhenever we face different psychiatric diagnosis we don’t keep in mind some sociocultural factors, which could be masked and raise different doubts. It is important to keep in mind that each country or ethnical have their own cultural habits which are going to deeply influence patient's personality.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case of neurosarcoidosis presenting with isolated psychotic symptoms

2016 ◽  
Vol 33 (S1) ◽  
pp. S637-S637
Author(s):  
O. Onur ◽  
E. Carpar ◽  
Y. Altunkaynak
Keyword(s):  
Psychiatric Symptoms ◽  
Family Background ◽  
Systemic Disease ◽  
Cranial Nerves ◽  
Vital Signs ◽  
Intensity Change ◽  
Psychotic Symptoms ◽  
Neurologic Manifestation ◽  
Competing Interest ◽  
Granulomatous Diseases

Neurosarcoidosis (NS) is a neurologic manifestation of sarcoidosis, a rare multisystemic granulomatous disease. Although psychiatric symptoms have been reported to occur in 20% of patients with NS, isolated NS without any signs of systemic disease is a rarity.CaseA 56-year-old female admitted to psychiatry clinic due to complaints of forgetfulness, visual and auditory hallucinations, inability to go outside alone, washing hands in closet cabin, difficulty finding words for the last one year, progressing in last four months. Personal and family background was unremarkable. Vital signs and physical examination revealed no abnormalities. In neuropsychiatric examination, Glasgow Coma Scale score was 15 without any meningeal irritation signs or gait abnormalities. Cranial nerves, extrapyramidal, motor, cerebellar, and sensory systems were intact. All aspects of orientation (time, place and person) were impaired. She scored 12 points out of 30 in Mini Mental Test. Speech was non-fluent with looseness of associations. Impaired recall, abstract thinking, judgment, behaviour planning and attention were noted. Visiospatial disorientation and contructional dressing apraxia were revealed. MR Imaging reported a T2-weighted signal intensity change in nodular fashion suggesting a granulamatous lesion. Differential diagnoses included granulomatous diseases, neoplasms, infections and Behcet's disease. After necessary excluding evaluations were undergone, a diagnosis of NS was made due to increased angiotensin converting enzyme levels in cerebrospinal fluid. The clinical picture responded well to prednisone treatment and symptoms resolved within one month.ConclusionIncreased awareness is essential to identify rare granulamotous diseases as a differential diagnosis in encountering psychotic symptoms accompanying demantial clinic presentation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Organic psychosis: Much more than dopamine

2017 ◽  
Vol 41 (S1) ◽  
pp. s822-s822
Author(s):  
R. Martín Gutierrez ◽  
M. Juncal Ruiz ◽  
O. Porta Olivares ◽  
R. Landera Rodríguez ◽  
L. Sánchez Blanco ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Low Frequency ◽  
Normal Pressure ◽  
Neurological Impairment ◽  
Point Of View ◽  
Psychotic Symptoms ◽  
Psychomotor Slowing ◽  
Ekbom Syndrome ◽  
Elderly Onset ◽  
Competing Interest

IntroductionMost of elderly onset psychosis present as a consequence of one or more organic processes. We present the case of an 81-year-old patient with diagnosis of a posterior fossa meningioma. It emerged with abrupt positive symptoms of psychosis with important family and social disruption. The interest of the case lies in the low frequency of psychiatric symptoms associated to this type of tumor, given its location. Thus, these symptoms may be explained, by normal pressure hydrocephalus (NPH) secondary to the tumor.ObjectivesTo highlight the importance of performing a complete organic screening in elderly onset psycotic patients.Material and methodFrom the mentioned case, we performed a literature review of psychopathology associated with NPH.ResultsPsychiatric examination demonstrated parasitization delusions and delusional misinterpretations; tactile and visual zoomorphic hallucinations were also present. They were compatible with Ekbom syndrome; anxiety and behavioral disorganization were prominent. We introduced treatment with risperidone 0.5 mg/12 h with important decrease of positive psychotic symptoms. Currently, the patient is waiting for a ventricular-peritoneal shunt.ConclusionsThe NPH usually presents with memory failures, psychomotor slowing, problems in calculating and writing. It may progress to a neurological impairment so intense that may be indistinguishable from Alzheimer's disease. From a psychopathological point of view, affective or psychotic symptoms and/or behavioral disorganization may also appear. In few cases, HNT onset shows with prominent psychiatric symptoms instead of neurological impairment. These symptoms may improve with pharmacological and surgical treatment. Thus, it is important to get an accurate diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Heterogeneity in the psychiatric presentation of behavioural variant frontotemporal dementia (bvFTD)

2019 ◽  
Vol 27 (5) ◽  
pp. 491-495
Author(s):  
Reece Bretag-Norris ◽  
Lara Gallur ◽  
Patrick Flynn
Keyword(s):  
Differential Diagnosis ◽  
Literature Review ◽  
Psychiatric Disorder ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Case Reports ◽  
Relevant Literature ◽  
Important Differential Diagnosis

Objective: This article describes how the onset of bvFTD can be heralded by psychiatric symptoms. Method: Case reports are described with reference to the relevant literature review. Results: Three patients were admitted with psychiatric symptoms, including depression, mania, psychosis and catatonia. Two had been previously diagnosed with a psychiatric disorder. All three were diagnosed with probable bvFTD. Conclusion: bvFTD is an important differential diagnosis to consider when patients present with atypical psychiatric symptoms.

Psychiatric Symptomatology as the Initial Presentation of Brain Cancer

2017 ◽  
Vol 41 (S1) ◽  
pp. S165-S165
Author(s):  
A. Fornelos ◽  
P. Macedo ◽  
A. Figueiredo ◽  
M. Roque
Keyword(s):  
Psychiatric Symptoms ◽  
Neurological Diseases ◽  
Mass Effect ◽  
Adult Brain ◽  
Neurological Deficits ◽  
Psychotic Symptoms ◽  
Social Maladjustment ◽  
Organic Brain Disease ◽  
History Of ◽  
Competing Interest

Glioblastoma multiforme is the most common primary adult brain tumor. Clinically, non-specific psychiatric symptoms may arise as their first and only manifestation, prior to any neurological deficits. The most form of psychiatric presentation of neurological diseases are depressive complaints, although these may also be accompanied by behavioral and/or cognitive, anxious and psychotic symptoms. By explaining this case report we aim to emphasize the importance of considering the diagnosis of an organic brain disease, even when only primary psychiatric symptoms are evident. The bibliographic research was made using PubMed and Scielo, and analysis of the electronic patient process. Man of 68 years with a history of hypertension, nephrectomy, splenectomy and left brachial plegia after a car accident. He had been previously seen by a psychiatrist for a 6-month history of depressive symptoms, which had been successfully treated. He later developed new behavioral changes such as heteroaggressiveness, social maladjustment and disfasia, for which he was sent to the emergency room. Brain-CT scan displayed a left front temporal expansive injury. Admitted to the Neurology Department for further diagnostic investigation. Subsequent MRI, detected massive infiltrative lesion with significant mass effect and cystic/necrotic area. The anatomopathology disclosed a glioblastoma grade IV. This case reinforces the importance of carrying a imagiologic workup in cases like this, especially on patients with atypical presentation of psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Differential diagnosis and therapy of cycloid psychoses: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s843-s843
Author(s):  
A.M. Uminska-Albert ◽  
G. Eikmeier
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Clinical Course ◽  
Complete Recovery ◽  
Psychotic Symptoms ◽  
Cycloid Psychosis ◽  
Cycloid Psychoses ◽  
Endogenous Psychoses ◽  
Icd 10 ◽  
Competing Interest

Kraepelin already challenged his dichotomy of psychoses, because in clinical practice too many cases were not in line with his pattern. Different terms for these disorders were coined. Leonhard separated cycloid psychoses from other forms of endogenous psychoses. The idealized subtypes (anxiety-beatific, hyperkinetic-akinetic-motility and confusional exited-inhibited) are characterized by a bipolar course with complete recovery. Operationalised criteria were developed by Perris. We report on a 60 year old woman diagnosed as schizophrenic in 1984/1985 and 2006. In August 2015 she was admitted with stupor and mutism and therefore was treated with fluphenazine and lorazepame. Six days later the clinical picture changed, she became confused and very agitated. After change of treatment to benperidole her clinical condition improved within 12 days. After 3 further days she became confused, agitated and euphoric again. The symptoms persisted in spite of a change of treatment to haloperidole. After diagnostic revision therapy was augmented with lithiumcarbonate. Six days later the psychotic symptoms began to improve and were completely remitted after 10 further days. The case report points out that a differential-diagnostic revision of an apparently therapy-resistant schizophrenia should not only be carried out according to ICD 10 criteria but a cycloid psychosis should be taken into account, too. Perris-criteria are contrasted with ICD 10-criteria for schizophrenia and mania with psychotic symptoms. Symptomatology and clinical course in our patient fulfilled exactly the Perris-criteria. We recommend an augmentation trial with lithium in acute phases of cycloid psychoses by all means before ECT.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric Symptoms Paraneoplastic and Legal Obligation to Combination Therapy

2016 ◽  
Vol 33 (S1) ◽  
pp. S463-S463
Author(s):  
M.D. Piqueras Acevedo ◽  
I. Martínez Pérez ◽  
M.R. Raposo Hernández: ◽  
A.L. González Galdámez ◽  
A. Belmar Simó ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Clinical Status ◽  
Combined Treatment ◽  
Breast Disease ◽  
Medical Decision ◽  
Psychotic Symptoms ◽  
Psychiatric Clinic ◽  
History Of ◽  
Oncology Treatment ◽  
Competing Interest

Women 49-year-old with a history of left mastectomy for breast Ca. The patient is brought to the emergency by his family for disorderly conduct compatible with manic phase and psychotic symptoms by delirious speech mystical-religious content refusal of the patient to be evaluated by any medical decision and abandoned chemotherapy. Initial screening is performed from the emergency department of organic pathology (TAC without findings and normalcy in other PC). At the beginning of involuntary admission income that is corroborated by the commission judicial, a request of the family and given the history of abandonment IC Oncology treatment is performed as a result of which it is found that the onset of the psychiatric clinic communicates matches the decision to abandon treatment; after reassessment of the clinical status of the patient and recommendation by her oncologist to resume treatment with RT to court new authorization for further diagnosis and initiation of treatment after assessment by forensic and judge is granted a week tests requested. After screening of limbic encephalitis but positive AC. SD income it is maintained and combined treatment is performed. At discharge, the patient is stable DP vs. psychopathology with good controls over concomitant breast disease.ResultsThe need for medical treatment in organic pathology is justified even against the will of the patient in the context of represenDisclosure of interestThe authors have not supplied their declaration of competing interest.

Behavioral disorders in emergencies. Differential diagnosis and treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S465-S465 ◽  
Author(s):  
S.M. Bañón González ◽  
N. Ogando Portilla ◽  
M.G. García Jiménez ◽  
R. Álvarez García ◽  
F. García Sánchez
Keyword(s):  
Differential Diagnosis ◽  
Psychiatric Disorders ◽  
Behavioral Disorders ◽  
Clinical Case ◽  
Response To Treatment ◽  
Psychotic Symptoms ◽  
Oppositional Defiant ◽  
Competing Interest ◽  
Epidemiological Characteristics ◽  
The Impact

IntroductionThe clinical case has been submitted because it presents a number of difficulties in diagnosis. After seven psychiatric hospitalizations, it does not present a definitive diagnosis, poor prognosis and multiple relapses.ObjectivesBoth analyze clinical, psychopathological and epidemiological characteristics of behavioral disorders in relation to a clinical case and review causes, incidence, prevalence, diagnostic, therapeutic tools and the importance of an appropriate differential diagnosis to reach a correct therapeutic approach.MethodsReview of the impact literature for the last five years concerning behavioral disorders: prevalence, incidence, pathogenesis and its relationship with psychiatric disorders encoded in DSM-V.ResultsIt is evident that the patient has behavioral disorders and psychotic symptoms in the context of cocaine intoxication. Although sometimes the dose of cocaine has been very small and probably not justifies in all cases a toxic psychosis, it is true that withdrawal periods have been short; therefore difficult to assess. Also mania-like symptoms have been discussed because the patient has an increased activity, dysphoric mood, anxiety and decreased need for sleep.ConclusionsResponse to treatment and hyperactivity, impulsivity and inattention characteristics make us consider the diagnosis of adult Attention Deficit Hyperactivity Disorder (ADHD). ADHD in adults and adolescents have significant comorbidity with substance abuse, particularly cocaine, amphetamines and psychostimulants, also alcohol, tobacco and cannabis, and with other psychiatric disorders: oppositional defiant, personality (especially cluster B: antisocial, etc), anxiety (generalized anxiety, phobias, panic..), affective or eating disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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