Psychosis due to traumatic brain injury – controversies and diagnoses difficulties

2016 ◽  
Vol 33 (S1) ◽  
pp. S626-S626
Author(s):  
A. Amorim
Keyword(s):  
Traumatic Brain Injury ◽  
Differential Diagnosis ◽  
Brain Injury ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Medical Condition ◽  
Correct Diagnosis ◽  
Clinical History ◽  
Competing Interest ◽  
Psychiatric Complications

IntroductionA traumatic brain injury (TBI) can cause numerous psychiatric complications. Humor and anxious disorders, personality disorders and psychoses are some of those possible problems. The diagnosis of psychosis due to traumatic brain injury (PDTBI), although controversial, has been subject of crescent debate and the idea that a TBI could cause a psychosis is gaining credibility. Diagnosing a PDTBI can be difficult. DSM-5 criteria are rather vague and there are many potential confounding factors due to similarities with other etiological psychosis.Objectives and aimsAlert clinicians to the diagnosis of PDTBI, clarify this clinical entity and define features that may allow them to do the differential diagnosis with other etiologic psychotic disorders.MethodsThe authors performed a research in PubMed using the keywords psychosis and traumatic brain injury and selected the adequate articles to meet the objectives proposed.ResultsDifferential diagnosis of PDTBI should be done with schizophrenia, schizoaffective psychosis, delusional disorder, substance-induced psychosis, psychosis due to other medical condition and with posttraumatic stress disorder. Differentiating PDTBI and schizophrenia can be particularly difficult. Some features have been proposed in the literature as potentially differentiating, namely the presence of negative symptoms (more common in schizophrenia), findings in MRI/CT and EEG.ConclusionsEstablishing PDTBI diagnosis can be difficult. While awaiting new studies, clinicians should, in cases of TBI related psychosis, achieve a meticulous clinical history and mental exam, in order to ensure a correct diagnosis and, therefore, determine an appropriate intervention.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Toxic role in schizophrenia: A review by a clinical case

2016 ◽  
Vol 33 (S1) ◽  
pp. S292-S292
Author(s):  
M. Canseco Navarro ◽  
A. Peña Serrano ◽  
J.M. Hernández Sánchez ◽  
M. Canccino Botello ◽  
F. Molina López ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Negative Symptoms ◽  
Clinical Case ◽  
Paranoid Schizophrenia ◽  
Clinical History ◽  
Positive Symptoms ◽  
History Of ◽  
Competing Interest ◽  
Hospital General

IntroductionOften find it difficult diagnostic approach to patients with symptoms that could correspond to several clinical entities. This requires making a correct differential diagnosis to enable a better understanding and addressing the disease in an individualized way.ObjectiveDescribe pathogenetic factors of paranoid schizophrenia highlighting their relationship with drug consumption.MethodsReview of the clinical history of a patient admitted to acute ward of the Hospital General Universitario of Valencia.ResultsA case of a 30-year-old man, whose income is motivated by persistent and structured autolytic ideation occurs. It presents positive symptoms for several years and amotivational syndrome ago. It has a history of cannabis, cocaine and alcohol since he was thirteen and remains abstinent for more than six months ago. Differential diagnosis arises between amotivational toxic syndrome, reactive depressive symptoms to the disease and negative symptoms for chronic psychotic process. Finally diagnosed with paranoid schizophrenia and is included in the program of first psychotic episodes.Today the productive symptoms disappeared and remain negative though with less intensity achieving an improvement in overall activity.ConclusionsConsumption of toxic influences the development of a chronic psychotic process that may appear years later, becoming a etiological and maintainer factor, not only if its consumption continue, but other effects that occur long term amotivational syndrome and worsening prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Chronic psychiatric changes in a severe post-traumatic brain injury patient

2016 ◽  
Vol 33 (S1) ◽  
pp. S318-S318
Author(s):  
J. Silva ◽  
J. Mota ◽  
P. Azevedo
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Social Impairment ◽  
Mood Stabilizers ◽  
Work Related ◽  
Randomized Controlled Studies ◽  
Injury Patient ◽  
Post Traumatic ◽  
Competing Interest

IntroductionSevere traumatic brain injury (TBI) causes neuropsychiatric disturbances. Emotional and personality disturbances seem to cause much more seriously handicap than residual cognitive or physical disabilities. The prognosis may be poor associated with marked social impairment, so a multidisciplinary approach team is required in order to improve patient's quality of life and reintegration in family and society.ObjectivesTo summarize the latest literature about this field and to present a case report.AimTo explore and learn more about chronic psychiatric changes in severe post-traumatic brain injury and share with the scientific community how challenging the approach of this entity can be.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “traumatic brain injury” and “psychiatric changes”. A case report is presented.ResultsAlthough SSRI, benzodiazepines, mood stabilizers and antipsychotics are commonly used, new options are reported such as methylphenidate and cholinesterase inhibitors. The presented patient, a 27-year-old male, began with neuropsychiatric disturbances after a work-related fall from 9 meters high: convulsions and alcohol compulsive drinking. Three years have passed and his changes are still difficult to approach. Besides other medication, such as benzodiazepines and mood stabilizers, flufenazine injections and naltrexone seemed to be determinant in his behaviour and mood stabilization. He is also on a long-term alcoholism programme.ConclusionsAlthough the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed, such as randomized-controlled studies to study new pharmacological and non-pharmacological approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Role of quetiapine in protection of neurodegeneration after traumatic brain injury

2019 ◽  
Vol 55 (2) ◽  
pp. 67-73 ◽  
Author(s):  
Joseph A Morra ◽  
Adekola O Alao
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Negative Symptoms ◽  
Memory Loss ◽  
Hospital Setting ◽  
Small Animal ◽  
Rehabilitation Unit ◽  
Neuroprotective Effects ◽  
Neurologic Deficits ◽  
Patients Experience

Objective Schizophrenia is a chronic psychotic disorder in which patients experience positive and negative symptoms for over six months. Schizophrenia is associated with early mortality, with 40% of this excess mortality due to suicide. This is a case of patient with schizophrenia who was treated with quetiapine after suffering a traumatic brain injury and recovered enough to be discharged to a rehabilitation unit. This case illustrates the neuroprotective effects of quetiapine in treating neurologic deficits in a patient who recently suffered a traumatic brain injury. Method This is a case report of a patient with schizophrenia treated in the hospital setting. He was placed on quetiapine after suffering a traumatic brain injury due to a suicide attempt in which he shot himself with a nail gun. Results The patient initially presented with neurologic deficits suggestive of traumatic brain injury (inattention, memory loss, muscle weakness) and psychosis from schizophrenia. He was treated with quetiapine and recovered enough to be discharged to a rehabilitation unit. Conclusion Quetiapine, a second-generation antipsychotic, has been shown to significantly decrease blood–brain barrier hyperpermeability by preserving tight junction integrity in small animal models. This anti-inflammatory effect may also help to preserve neurogenesis in patients with traumatic brain injury, as shown in this case. This case may help elucidate the nature of quetiapine’s neuroprotective effects in patients who have suffered traumatic brain injury and also highlights the need to further investigate other atypical antipsychotics and their potential neuroprotective role in treating traumatic brain injury.

Cycloid Psychosis: A Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S532-S532
Author(s):  
G. Martinez-Ales ◽  
I. Louzao ◽  
A. Irimia ◽  
M.F. Bravo ◽  
J. Marin
Keyword(s):  
Case Report ◽  
Psychotic Disorders ◽  
Clinical History ◽  
Diagnostic Systems ◽  
Cycloid Psychosis ◽  
History Of ◽  
Competing Interest ◽  
High Index Of Suspicion ◽  
Clinical Pictures ◽  
Restitutio Ad Integrum

IntroductionEpisodes of time-limited acute psychosis, with full recovery in between, are categorized as acute polymorphic psychotic or brief psychotic disorders. Leonhard described the three forms of cycloid psychosis (CP). Perry considers it a separate entity.Case reportWe report the case of a 54-year-old male, with a 9-year history of brief psychotic disorders. He was admitted to an inpatient unit after a 4-day episode of persecutory delusion, leading to high emotional repercussions and isolation at home. Euthymia was present. Previous admissions, 9 and 5 years before, presented similar clinical pictures. Treatment with low dose paliperidone during 6-month periods had led to the complete resolution of the episodes (restitutio ad integrum: no psychotic manifestations and the ability to run his business). In this episode, 8 days after the reintroduction of 12 mg of paliperidone per day, cessation of the symptoms took place. Careful reconstruction of the clinical history showed no stressors or drug consumption. And immediately previous 5-day phase of insomnia, hyperactivity and expenditure was described by the patient's wife.DiscussionThree inpatient admissions, a careful clinical history and a thorough review of the evidence regarding Perris criteria led to a diagnosis of CP.ConclusionCP, a classical nosological approach, is helpful in a clinical setting, as it might imply different prognosis and treatment. Recognition of CP, not included as an entity by the major diagnostic systems, requires a high index of suspicion.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Basic symptoms as subjective cognitive deficit in schizophrenia: Cognitive, clinical and functional associations

2016 ◽  
Vol 33 (S1) ◽  
pp. S108-S108
Author(s):  
M.L. Vargas ◽  
S. López-Lorenzo ◽  
I. Legascue ◽  
A. Nagore ◽  
P. Serrano ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Cognitive Deficit ◽  
Psychotic Disorders ◽  
Clinical Status ◽  
Cognitive Status ◽  
Screening Tools ◽  
Basic Symptoms ◽  
Neuropsychological Status ◽  
Subjective Complaints ◽  
Competing Interest

IntroductionBasic symptoms are subjective complaints that present at the early states in psychotic disorders and persist in the long-term. They can be studied using hetero applied clinical instruments or self-administered questionnaires. Basic symptoms can be useful as screening tools in at risk populations.AimsTo determine if basic symptoms (subjective cognitive deficits) are associated with the objectively measured cognitive deficit after controlling for functioning and symptomatology.MethodsOne observational, transversal, psychopathological and neuropsychological study was performed on a schizophrenia outpatients sample (n = 78). Correlations were measured by using Spearman's Rho coefficient. Basic symptoms were registered by using the Frankfurt Complaints Questionnaire (FCQ-3); cognitive status was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); clinical status was assessed by PANSS and Clinical Global Impression (CGI); functional status was measured with Global Assessment of Functioning (GAF).ResultsAll the dimensions were related to subjective complaints: cognitive functioning (r = −.38; P < .001); positive symptoms (r = .54; P < .001); negative symptoms (r = .26; P < .02); general symptoms (r = .41; P < .001); CGI (r = .57; P < .001); GAF (r = −.45; P < .001). The association between subjective and objective cognitive deficit remains significative after controlling for the clinical and functional variables, except when controlling for CGI.ConclusionsThe evaluation of basic symptoms with FCQ-3 is related with an objective cognitive deficit and could be useful as a screening tool.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Autism-plus spectrum disorders: Interfaces with psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S356-S356
Author(s):  
I. Peixoto ◽  
R. Velasco Rodrigues ◽  
C. Marques
Keyword(s):  
Autism Spectrum Disorder ◽  
Differential Diagnosis ◽  
Clinical Case ◽  
Psychotic Disorders ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Case Vignette ◽  
The Face ◽  
Competing Interest ◽  
Definition Of

IntroductionDespite categorical differentiation, autistic and psychotic disorders are historically related diagnostic entities and there is still much controversy regarding their limits and developmental course. Particularly in children, the presence of idiosyncratic fears, difficulties in the social sphere and thought disorder are important factors in the differential diagnosis. There are some research-derived clinical constructs that operationalize symptomatology aiming to highlight the interfaces and the overlap between such disorders. Their clinical implications can be extremely relevant in the face of the limits of current nosology.ObjetivesTo phenomenologically describe differentiating parameters and high-risk clinical profiles for the development of psychosis in children with autism spectrum disorder.MethodsSelective review of the literature in PubMed (MEDLINE). Illustration with a clinical case vignette.ResultsThe clinical case reflects well the difficulties posed in the differential diagnosis due to the multiple interfaces between autism and psychosis. Constructs such as “multiple complex developmental disorder” or “multidimensionally impaired syndrome” allow a clearer and more practice-friendly characterization of such individuals.ConclusionThe constelation of symptoms identified in these criteria may become useful through the definition of subgroups of autism spectrum disorder individuals with complex psychopathology. Studies in this regard are still scarce, but the validation and reproduction of the positive results observed in the near future can help optimize the clinical approaches in these children.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Lauren Surdyke ◽  
Jennifer Fernandez ◽  
Hannah Foster ◽  
Pamela Spigel
Keyword(s):  
Traumatic Brain Injury ◽  
Differential Diagnosis ◽  
Brain Injury ◽  
Treatment Plan ◽  
Inpatient Rehabilitation ◽  
Individualized Treatment ◽  
Rehabilitation Team ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Comprehensive Therapy

Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

scholarly journals Barbiturate-induced dyskalaemia in patients with traumatic brain injury patient

2019 ◽  
Vol 12 (4) ◽  
pp. e228119 ◽  
Author(s):  
Danny Theodore ◽  
Dea Mahanes
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Side Effect ◽  
Traumatic Brain Injury Patient ◽  
Correct Diagnosis ◽  
Barbiturate Coma ◽  
Electrolyte Disturbances ◽  
Rare Side Effect ◽  
Injury Patient

A young man with severe traumatic brain injury and refractory intracranial hypertension was treated with a barbiturate coma. A rare side effect of barbiturates is dyskalaemia. The dyskalaemia presented with acute hypokalaemia that quickly became hyperkalaemia. Both electrolyte disturbances can have serious physiological complications. The cellular cause of the dyskalaemia is not well understood. The correct diagnosis and treatment of barbiturate dyskalaemia is essential in providing care. Clinicians treating patients with barbiturates need to be aware of this rare side effect. Our patient was quickly and correctly treated for the dyskalaemia and suffered no complications related to this side effect.

The Elusive Nature of Mild Traumatic Brain Injury

Biofeedback ◽  
2009 ◽  
Vol 37 (3) ◽  
pp. 92-95
Author(s):  
Ronald J. Swatzyna
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Impulse Control ◽  
Head Injuries ◽  
Poor Response ◽  
Clinical History ◽  
Response To Treatment ◽  
Quantitative Electroencephalography ◽  
History Of

Abstract The author discloses a personal history of undiagnosed mild traumatic brain injury (MBTI) and identifies a typical course and progression of this condition. He advocates a careful inquiry for possible head injury whenever the clinical history shows an original period of normal functioning, a progression of disturbance over time, multiple diagnoses, and poor response to treatment with medication. He discusses the use of quantitative electroencephalography (QEEG) in assessing possible mild traumatic brain injury, describes typical features of quantitative electroencephalography in mild traumatic brain injury, and cautions about the frequency of false negatives. He provides two case histories showing the progression of disturbing cognitive, personality, and impulse control problems following early head injuries.

Unconsciousness, amnesia and psychiatric symptoms following road traffic accident injury

2000 ◽  
Vol 177 (6) ◽  
pp. 540-545 ◽  
Author(s):  
Richard A. Mayou ◽  
John Black ◽  
Bridget Bryant
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Psychiatric Symptoms ◽  
Self Report ◽  
Post Traumatic Stress ◽  
Accident Injury ◽  
Psychiatric Complications

BackgroundAlthough road traffic accident injury is the most common cause of traumatic brain injury, little is known of the prevalence of psychiatric complications or the significance of unconsciousness and amnesia.AimsTo describe amnesia and unconsciousness following a road traffic accident and to determine whether they are associated with later psychological symptoms.MethodInformation was obtained from medical and ambulance records for 1441 consecutive attenders at an emergency department aged 17–69 who had been involved in a road traffic accident. A total of 1148 (80%) subjects completed a self-report questionnaire at baseline and were followed up at 3 months and 1 year.ResultsAltogether, 1.5% suffered major head (and traumatic brain) injury and 21% suffered minor head injury. Post-traumatic stress disorder (PTSD) and anxiety and depression were more common at 3 months in those who had definitely been unconscious than in those who had not, but there were no differences at 1 year.ConclusionsPTSD and other psychiatric complications are as common in those who were briefly unconscious as in those who were not.

Sign in / Sign up

Export Citation Format

Share Document