Kraepelin's ghost: Late onset schizophrenia, dementia (non)praecox, or paraphrenia? (case report)

2016 ◽  
Vol 33 (S1) ◽  
pp. S535-S535 ◽  
Author(s):  
V. Vukovic ◽  
S. Nikolić Lalić ◽  
T. Voskresenski ◽  
S. Jokić
Keyword(s):  
Case Report ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Thought Disorder ◽  
Psychotic Symptoms ◽  
Causative Role ◽  
Visual Hallucinations ◽  
Formal Thought Disorder ◽  
Adequate Treatment

IntroductionIt is difficult to establish whether a patient has late onset schizophrenia or frontotemporal dementia. The object of the following case report is to point out the difficulty of making a differential diagnosis between these two entities.Case summaryA 49-year-old female patient was admitted to our hospital after presenting with auditory and visual hallucinations, formal thought disorder, persecutory delusions, ideas of reference, insomnia. Memory, executive function and attentional tasks were severely compromised. Computerized tomography showed incipient frontal lobe atrophy. There were no significant abnormalities found in blood and urine samples or physical and neurological examinations. After showing no response to olanzapine, and extrapyramidal side effects to fluphenazine, risperidone was initiated which subsequently led to complete withdrawal of positive symptoms.DiscussionPatients presenting with psychotic symptoms after the age of 40 presented a diagnostic quandary, as they were less likely to present with negative symptoms, formal thought disorder or affective blunting, and more likely to have systematised delusions and visual hallucinations. Frontotemporal dementia is a disorder that can present itself with cognitive decline and a large range of psychiatric symptoms. The risk of late onset schizophrenia is greater in women, possibly implicating a causative role of female sex hormones. Atypical antipsychotics risperidone and olanzapine seem to be an adequate treatment.ConclusionSchizophrenia is a heterogeneous disease with a large variety of clinical manifestations. Special care should be given to patients with age over 40, including neurocognitive assessment, laboratory and hormone tests, and a long-term follow-up.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical overlap between behavioral variant of frontotemporal dementia and bipolar disorder: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S335-S336 ◽  
Author(s):  
P. Oliveira ◽  
C. Roque ◽  
V. Santos ◽  
N. Madeira
Keyword(s):  
Bipolar Disorder ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Single Photon ◽  
Photon Emission ◽  
Interpersonal Behavior ◽  
Psychotic Symptoms ◽  
Emission Computed Tomography ◽  
Global Pattern

The behavioral variant of frontotemporal dementia (FTD) often begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders might be challenging.This work presents a case of a manic episode with psychotic features in a 61-year-old man, whom personality changes and daily life difficulties arouse and persist after optimal management of the active manic and psychotic symptoms. Neuropsychological assessment detailed severe deficits among visuospatial and planning performances. Structural neuroimaging (CT-scan) primary revealed a global pattern of brain volume reduction. Severe perfusion deficits on frontal and both parietal lobes were shown on 99mTc-HMPAO single-photon emission computed tomography (SPECT). The hypothesis of probable FTD (behavioral variant) was established.The present case highlights how putative atypical and late-onset forms of bipolar disorder (BD) might instead progress to FTD. Several links are being advanced between the BD and FTD, for instance the close involvement of the C9ORF72 gene in a group of BD patients which progresses to dementia. These relations have actually been on focus recently. The field is however still relatively unexplored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals 457 - VERY LATE-ONSET SCHIZOPHRENIA-LIKE PSYCHOSIS… A DIAGNOSTIC DILEMMA…

2020 ◽  
Vol 32 (S1) ◽  
pp. 178-178
Author(s):  
Joana Regala ◽  
Francisco Moniz-Pereira
Keyword(s):  
Case Report ◽  
Basal Ganglia ◽  
Negative Symptoms ◽  
Late Onset ◽  
Previous History ◽  
Psychotic Symptoms ◽  
Formal Thought Disorder ◽  
Diagnostic Dilemma ◽  
Ischemic Disease ◽  
Thought Disorders

Background:The nosology and etiological underpinnings of very late -onset schizophrenia-like psychosis (VLOSLP) have remained controversial. This case report highlights its diagnostic complexity.Case report:A 64-year-old woman, with a previous history of hypertension, diabetes, mild cognitive decline, right grade-4 hemiparesis as sequelae of an ischemic-stroke (three years before), started persecutory and partition delusions. After six months, the delusions were accompanied by complex visual hallucinations (scenic, lilliputian and holocampine), elementary auditory, tactile, olfactory, and gustatory hallucinations, causing a profound daily life impact, consequently she was hospitalized. Neither negative symptoms nor formal thought disorders were present. Electroencephalography and laboratorial evaluations were unremarkable (including thyroid function, folic acid, cyanocobalamin, infectious serologies and anti-gliadin/transglutaminase antibodies). Neuroimaging displayed subcortical microvascular lesions in the left centrum semiovale, bilateral thalamic and basal ganglia lacunes. Neuropsychological examination revealed mild/moderate impairment in working-memory, sustained-attention, executive functions, abstract thinking, and visuospatial abilities. Mini-mental state examination (MMSE) scored 20/30. Clozapine was started. As psychotic symptoms ameliorated cognitive deficits also improved (MMSE score: 25/30). She was discharged with residual symptoms.Discussion:Late-life psychosis implies a thorough investigation, bringing about challenges in diagnosis. Several medical causes, including neuroinflammatory/immunologic, were ruled out. This two-stage progression, with partition delusions and multimodal hallucinations, in the absence of formal thought disorder and negative symptoms is typical of VLOSP. It is arguable to ascribe our patient’s psychosis to a previous vascular dementia or to VLOSLP. Almost half of VLOSLP patients may develop dementia. It is still debatable whether this propensity is a true characteristic of VLOPSL or reflects an initial misdiagnosis. Some neuropathological studies suggest a restricted limbic tauopathy underlying VLOSP. Notwithstanding, cognitive impairment is common in VLOSLP, including in those patients who do not develop dementia. Neuroimaging studies evidence that lacunar infarction in the basal ganglia alongside chronic white matter small vessels ischemic disease, may underlie the pathophysiology of psychosis via a disruption in the frontal-subcortical pathways. Nevertheless, cases of post-stroke psychosis usually resolve in few months. In conclusion, the neurobiological underpinnings of VLOSLP are complex and multifaceted. More systematized studies using biomarkers and neuroimaging are needed so clinicians can perform a more accurate diagnosis of VLOSLP.

Voltage-gated potassium channel limbic encephalitis presenting as functional cognitive impairment

2020 ◽  
Vol 13 (12) ◽  
pp. e233179
Author(s):  
Eric Garrels ◽  
Fawziya Huq ◽  
Gavin McKay
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Potassium Channel ◽  
Limbic Encephalitis ◽  
Psychiatric Symptoms ◽  
Differential Diagnoses ◽  
Visual Hallucinations ◽  
Voltage Gated ◽  
History Of ◽  
Impaired Cognition

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

scholarly journals Very late-onset behavioral variant frontotemporal dementia

2013 ◽  
Vol 7 (1) ◽  
pp. 136-139
Author(s):  
Henrique Cerqueira Guimarães ◽  
Tatiana de Carvalho Espindola
Keyword(s):  
Case Report ◽  
Frontotemporal Dementia ◽  
Frontotemporal Lobar Degeneration ◽  
Clinical Presentation ◽  
Late Onset ◽  
Ground Level ◽  
Dementia Diagnosis ◽  
Behavioral Variant Frontotemporal Dementia ◽  
Genetically Determined ◽  
Late Onset Dementia

ABSTRACT Current concepts regarding frontotemporal lobar degeneration (FTLD) have evolved rapidly in recent years. Genetically determined FTLD cohorts have broadened our knowledge pertaining to its clinical presentation, neuroimaging findings and demographics. In this study we present a case report of a patient diagnosed with behavioral variant frontotemporal dementia diagnosis in her nineties during hospital admission for a ground-level fall. We believe this case reinforces the pervasive nature of this clinical entity, and may contribute to an increased awareness of this diagnostic possibility in late-onset dementia.

scholarly journals Improvement in refractory psychosis after initiating management for underlying ADHD

2015 ◽  
Vol 84 (S1) ◽  
pp. 6-8
Author(s):  
Michael Blaszak ◽  
Danica Brister ◽  
Jordon Charlebois ◽  
Erica Hoe ◽  
Maggie Siu
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Case Report ◽  
Clinical Practice ◽  
Attention Deficit ◽  
Clinical Case ◽  
Psychotic Symptoms ◽  
Visual Hallucinations ◽  
Hyperactivity Disorder ◽  
Stimulant Medications ◽  
Pathophysiologic Mechanisms

We report on a unique clinical case of psychosis precipitated by Attention Deficit Hyperactivity Disorder (ADHD) and explore its implications for clinical practice as well as our understanding of these conditions. We describe a clinical case of a 46-year-old male presenting with auditory, olfactory, tactile, and visual hallucinations. We reviewed the literature on reported cases in which psychotic symptoms were treated with stimulant medications for ADHD comorbidity. This case report reveals the potential for properly selected patients to benefit from a consideration of ADHD comorbidity and a trial of treatment with that focus. In addition, the literature reveals a pathophysiologic association between psychosis and ADHD supported by neurobiological data. However, far more research is required to fully understand these conditions and their relationship. We conclude that ADHD and psychosis have some related pathophysiologic mechanisms but their connection has not been adequately explored. This case adds support to literature suggesting that in refractory psychosis, clinicians should re-evaluate the diagnosis and one of the considerations should be ADHD. In certain cases, the presence of psychotic symptoms with ADHD should not exclude the use of stimulants.

scholarly journals Catatonia Associated With Late Paraphrenia Successfully Treated With Lithium: A Case Report

2020 ◽  
Author(s):  
Hiroko Sugawara ◽  
Junpei Takamatsu ◽  
Mamoru Hashimoto ◽  
Manabu Ikeda
Keyword(s):  
Case Report ◽  
Mood Disorders ◽  
Electroconvulsive Therapy ◽  
Late Onset ◽  
Treatment Strategies ◽  
Psychotic Symptoms ◽  
Case Presentation ◽  
Limited Efficacy ◽  
Cumulative Evidence ◽  
The Brain

Abstract Background: Catatonia is a psychomotor syndrome that presents various symptoms ranging from stupor to agitation, with prominent disturbances of volition. Its pathogenesis is poorly understood. Benzodiazepines and electroconvulsive therapy (ECT) are safe and effective standard treatments for catatonia; however, alternative treatment strategies have not been established in cases where these treatments are either ineffective or unavailable. Here, we report a case of catatonia associated with late paraphrenia classified as very-late-onset schizophrenia-like psychosis, which was successfully treated with lithium. Case presentation: A 66-year-old single man with hearing impairment developed hallucination and delusions and presented with catatonic stupor after a fall. He initially responded to benzodiazepine therapy; however, his psychotic symptoms became clinically evident and benzodiazepine provided limited efficacy. Blonanserin was ineffective, and ECT was unavailable. His catatonic and psychotic symptoms were finally relieved by lithium monotherapy.Conclusions: Catatonic symptoms are common in patients with mood disorders, suggesting that lithium may be effective in these cases. Moreover, lithium may be effective for both catatonic and psychotic symptoms, as it normalizes imbalances of excitatory and inhibitory systems in the brain, which underlies major psychosis. Cumulative evidence from further cases is needed to validate our findings.

Late-Onset Huntington's Disease: A Geriatric Psychiatry Perspective

1996 ◽  
Vol 9 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Kenneth I. Shulman ◽  
Anne Lennox ◽  
Harry Karlinsky
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Elderly Patients ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Clinical Aspects ◽  
Illustrative Case ◽  
Wide Range

Late-onset Huntington's disease is more common than has been generally appreciated and is associated with a wide range of psychiatric symptoms and syndromes. Geriatric psychiatrists have an important role to play in establishing the diagnosis and providing guidance to elderly patients and their families as they struggle with difficult management decisions. An illustrative case report and selective literature review are presented that highlight the genetic and clinical aspects of the condition.

Very Late-onset Schizophrenia-Like Psychosis: Case Report and Current Status of the Issue

2016 ◽  
Vol 33 (S1) ◽  
pp. S471-S471
Author(s):  
R. Martín Aragón ◽  
M. Gutiérrez Rodríguez ◽  
S. Bravo Herrero ◽  
C. Moreno Menguian ◽  
N. Rodríguez Criado ◽  
...  
Keyword(s):  
Case Report ◽  
Age Of Onset ◽  
Late Onset ◽  
Current Knowledge ◽  
Age At Onset ◽  
Review Literature ◽  
Current Status ◽  
Diagnostic Systems ◽  
Formal Thought Disorder ◽  
Pubmed Database

IntroductionSchizophrenia has traditionally been considered to strictly be an early-onset disorder. Current nosologies, including DSMV, are not restrictive with age of onset in schizophrenia and all patients that satisfy diagnostic criteria fall into the same category. Since 1998, International Late-Onset Schizophrenia Group consensus, patients after 60 are classified as very-late onset schizophrenia-like psychosis. Female overrepresentation, low prevalence of formal thought disorder, and a higher prevalence of visual hallucinations are associated with later age at onset. Atypical antipsychotics represent the election treatment because of the reduced likelihood of EPS and tardive dyskinesias, and should be started at very low doses, with slow increases.ObjectiveTo review the current knowledge about very late-onset schizophrenia through systematic review of the literature and the analysis of a case.MethodsCase Report. Review. Literature sources were obtained through electronic search in PubMed database of last fifteen years.ResultsWe present a case of a 86-year-old woman suffering from delusions and hallucinations, diagnosed with very late-onset schizophrenia-like psychosis, after differential diagnosis with other disorders. We analyze ethiology, epidemiology, clinical features and treatment in geriatric patients with schizophrenia.ConclusionsReluctance to diagnose schizophrenia in old people is still present today, probably in relation with the inconsistency in diagnostic systems and nomenclature, and consideration of medical conditions in the diagnosis. Identification of these patients is really important in order to start an appropriate treatment, which can lead to patient clinical stability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Ekbom Syndrome associated with Lewy Body Dementia: A case report

2020 ◽  
Vol 14 (1) ◽  
pp. 83-87
Author(s):  
Felippe José Pontes de Mendonça ◽  
Ivan Abdalla Teixeira ◽  
Valeska Marinho
Keyword(s):  
Case Report ◽  
Lewy Body ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Correct Diagnosis ◽  
Lewy Body Dementia ◽  
Rare Condition ◽  
Adequate Treatment ◽  
Thought Disorders ◽  
Ekbom Syndrome

ABSTRACT Ekbom Syndrome, also known as parasitosis delusion or psychogenic parasitosis, is a rare condition in which patients present with a fixed belief of being infested by parasites, vermin or small insects, along with tactile hallucinations (such as pruritus or sensations of the parasites crawling over or under the skin). The syndrome may occur idiopathically or be associated with other medical conditions and drug use. This case report describes the occurrence of Ekbom syndrome in a patient diagnosed with Lewy Body Dementia (LBD), a neurodegenerative disease that commonly presents with sensory perception and thought disorders and other neuropsychiatric symptoms. Although visual hallucination is considered a core diagnostic criterion, other modalities of psychiatric symptoms can also occur posing a further challenge for correct diagnosis. Proper recognition allows early diagnosis and adequate treatment, preventing hazardous antipsychotic use in these patients.

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