A case of neurosarcoidosis presenting with isolated psychotic symptoms

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.

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Organic psychosis: Much more than dopamine

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1603 ◽

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.

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Parkinson's disease and psychosis: Report of a case

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1667 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s843-s844

Author(s):

M. Valverde Barea ◽

A. España Osuna ◽

F. Cartas Moreno

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Family Background ◽

Significant Risk ◽

Significant Risk Factor ◽

Behavioral Disorder ◽

Psychotic Symptoms ◽

Psychiatric Clinic ◽

Good Tolerance ◽

Competing Interest

IntroductionJealous delusional ideation appears in 7-14% of cases of Parkinson's disease. Treatment with dopaminomimetics drugs is a significant risk factor for psychosis. However, the most likely etiology of psychosis in these patients is a loss of central cholinergic function associated with age since described psychosis even before the introduction of the L-Dopamine. Cognitive impairment and sleep disorders are predictors of development of psychosis.ObjectivePresent a clinical case of psychosis in Parkinson's disease and its treatment.MethodReason for consultation. Patient diagnosed with Parkinson's disease with behavioral disorder and delusional.Current illnessThe patient after antiparkinsonian medication has increased suspicion, self-referentiality, delusional jealousy ideation to her husband, delusional interpretations regarding somatic symptoms, insomnia and behavioral disorders with aggression.Family backgroundMother with Alzheimer's.Personal historyNo contact with mental health.Psychopathological examinationConscious, repetitive language, dysphoric mood with delusions of prejudice and jealousy.Mixed insomnia.DiagnosisPsychosis in Parkinson's disease.TreatmentQuetiapine 300 mg/day. Carbidopa 25 mg/L-dopa 100 mg: 1-0-1. On subsequent visits quetiapine was suspended and replaced by clozapine 200 mg/day.ResultsThe treatment of psychosis was effective with the use of quetiapine and subsequently clozapine with good tolerance and effectiveness. He also said lower antiparkinsonian medication.ConclusionsPsychotic symptoms are the most common psychiatric clinic in Parkinson's disease. Often not enough antiparkinsonian dopaminomimetics reduced to control psychotic symptoms and use of antipsychotics is required. The use of antipsychotics in Parkinson's disease should be careful for the likely increase in motor clinical and increased mortality. The most useful, are especially quetiapine and clozapine atypical antipsychotics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychiatric Symptomatology as the Initial Presentation of Brain Cancer

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2047 ◽

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.

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Differential Diagnosis Based on Age. Diagnostic Difficulties

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1727 ◽

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.

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Psychiatric Symptoms Paraneoplastic and Legal Obligation to Combination Therapy

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1685 ◽

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.

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Hyperthyroidism and Psychotic Symptoms: a Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1601 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S440-S441

Author(s):

S. Benavente López ◽

N. Salgado Borrego ◽

L. arroyave Villa ◽

C. Hernández Durán ◽

E. Muro Fernández de Pinedo ◽

...

Keyword(s):

Case Report ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Psychiatric Symptoms ◽

Auditory Hallucinations ◽

Psychotic Symptoms ◽

Generalized Anxiety ◽

Thyroid Function Tests ◽

Competing Interest ◽

Thyroid Profile

IntroductionHyperthyroidism may lead to high anxiety status, emotional lability, irritability, overactivity, exaggerated sensitivity to noise, and fluctuating mood, insomnia and hyporexia. in extreme cases, they may appear delusions and hallucinations as psychiatric symptoms.Case reportwe report the case of a 53-year-old female who was diagnosed of hyperthyroidism and generalized anxiety disorder. The patient went to emergency department because of high levels of anxiety, with heart palpitations, trembling, shortness of breath and nausea. She was presenting auditory hallucinations and delusions as psychiatric symptoms. an urgent thyroid profile was made and it was observed the next results: TSH < 0.005; T4:4; T3:21. Due to a severe thyroid malfunction, the patient was admitted and treated with antithyroid agent, improving the psychiatric and somatic symptoms.Discussionin this case, a patient diagnosed of hyperthyroidism and generalized anxiety disorder presented very severe psychiatric symptoms, with hallucinations and delusions. These symptoms may be produced by primary psychiatric disorders, but is very important to look for thyroid alterations, because if they are the cause, the acute treatment of thyroid malfunction is the correct management of the patient.ConclusionsHyperthyroidism is very common in general population, being infradiagnosed most of times. in patient with anxiety or other psychiatric symptoms, it is very important to make a thyroid function tests before the diagnosis of a psychiatric disorder. in extreme cases, hyperthyroidism status may lead to severe psychiatric and somatic complications.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychosis and Schizencephaly – A Case Report and Systematic Review

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1035 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S-S

Author(s):

S. Gunturu ◽

L. Schmalz ◽

J. Zebelian ◽

L. Gonzalez ◽

C. Drazinic ◽

...

Keyword(s):

Systematic Review ◽

Grey Matter ◽

Psychiatric Symptoms ◽

Psychiatric Service ◽

Psychotic Symptoms ◽

First Episode ◽

Neurodevelopmental Outcomes ◽

Episode Psychosis ◽

Competing Interest ◽

The Brain

Psychotic symptoms have been reported in association with a wide array of brain abnormalities. Few published reports have examined the association between schizencephaly and psychiatric illness. Originally defined by Wilmarth and later by Yakolev and Wadsworth – Schizencephaly is an uncommon congenital disorder of cerebral cortical development, defined as a grey matter-lined cleft extending from the pial surface to the ventricle. The nosology is based on neuroradiologic findings and confirmed by neuropathology when available. The Clinical presentation and neurodevelopmental outcomes of the disorder vary and are usually related to the extent/areas of the brain involved. In this article we review the medical literature around Schizencephaly paying particular attention to the pathophysiology, etiology and diagnosis of such patients. We then present a case of Schizencephaly and first episode psychosis in a 16-year-old adolescent who was admitted to our inpatient psychiatric service. Lastly, we present the findings of a systematic review from PubMed whereby we summarize 10 cases of Schizencephaly with associated psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The emergence of psychosis in a patient with severe hypothyroidism: A case report and literature review

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1662 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s842-s842

Author(s):

M.L. Turk ◽

J. Rosen

Keyword(s):

Psychiatric Symptoms ◽

Hormone Replacement ◽

Psychotic Symptoms ◽

Free T4 ◽

Thyroid Hormone Replacement ◽

History Of ◽

Speed Up ◽

Competing Interest ◽

Shed Light ◽

Basic Medical

Hypothyroidism is associated with changes in mental state that can range from mild cognitive impairment to depression to florid myxedema coma. A few cases have linked the occurence of psychotic symptoms in the context of severe hypothyroidism, an event referred in the literature as “myxedema madness”. We describe the case of a 48-year-old male with no past psychiatric history and a past medical history of hypertension and hypothyroidism who presented to the psychiatric unit for management of new-onset psychosis, particularly paranoid delusions. On basic medical screening, the patient was found to have severe hypothyroidism manifested by a TSH level of 51.85 and a free T4 level less than 0.4. The patient was treated with both an antipsychotic and thyroid hormone replacement, after which his hypothyroid symptoms and his psychosis improved. Liothyronine was also prescribed to speed up the recovery course, as his delusions were thought to be due to his hypothyroidism. The aim of this poster is to shed light on the possibility of development of psychosis concomitantly with severe hypothyroidism, given the rarity of such events, as well as to illustrate the importance of treating the underlying medical cause rather than only focusing on the treatment of the psychiatric symptoms. The use of Liothyronine proved to be beneficial in this case, as the patient's symptoms drastically improved after its administration. This could potentially illustrate the importance of using Liothyronine particularly in the treatment of delusional disorder in severe hypothyroidism.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Clinical symptomatology and facial emotion recognition in schizophrenia: Which relationship?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.066 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S96-S96

Author(s):

A. Arous ◽

J. Mrizak ◽

R. Trabelsi ◽

A. Aissa ◽

H. Ben Ammar ◽

...

Keyword(s):

Emotion Recognition ◽

Cognitive Abilities ◽

Social Cognitive ◽

Psychiatric Symptoms ◽

Depression Scale ◽

Facial Emotion Recognition ◽

Facial Emotion ◽

Psychotic Symptoms ◽

Facial Emotions ◽

Competing Interest

IntroductionPatients with schizophrenia show impairments in social cognitive abilities, such as recognizing facial emotions. However, the relationships between specific deficits of emotion recognition and with clusters of psychotic remain unclear.ObjectivesTo explore whether facial emotion recognition was associated with severity of symptoms and to which presentation of psychotic symptoms.MethodsFacial emotion recognition (FER) were evaluated in 58 patients with stable schizophrenia with a newly validated FER task constructed from photographs of the face of a famous Tunisian actress representing the Ekman's six basic emotions (happiness, anger, disgust, sadness, fear, and surprise). Symptomatology evaluation comprised the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impressions Scale Improvement and severity (CGI).ResultsPatients who failed to identify anger had significantly higher scores in hyperactivity item (P < 0.0001). The patients who had a difficulty to identify sadness had more grandiosity (P ≤ 0.002). The impairment in happiness recognition was correlated with hallucination (P = 0.007) and delusion (P = 0.024) items. Incapacity to identify fear was associated to lack of judgment and insight (P = 0.004).ConclusionsDeficits in recognition of specific facial emotions may reflect severity of psychiatric symptoms. They may be related to specific clusters of psychotic symptoms, which need to be confirmed in further studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychopathology and Spiritual Experiences: Criteria for Differential Assessment

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1954 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S528-S528

Author(s):

I. Bone-Pina

Keyword(s):

Mental Disorders ◽

Personal Growth ◽

Psychiatric Symptoms ◽

Psychology Of Religion ◽

Well Being ◽

Psychotic Symptoms ◽

Future Research ◽

Spiritual Experiences ◽

Critical Approach ◽

Competing Interest

IntroductionThere is a plurality of differing opinions defining borders between mental disorders and spiritual experiences. This research proposes criteria for clarifying those boundaries.ObjectivesSummarize practical criteria for clinicians to assess psychopathological symptoms with spiritual content and to attain a differential diagnosis from healthy spiritual experiences.AimsMerge different approaches from psychopathology, psychology of religion and religious studies to attain practical criteria.MethodsLiterature review using a phenomenological and critical approach.Results1. Severe psychiatric symptoms with religious content: (1) are usually in the context of personal impoverishment; (2) appear odd in cultural environments and within a person's biography; (3) do not enhance action or, in the phenomenological tradition, (4) these symptoms come from a weakening of the “intentional arc”. 2. A guiding map is suggested to evaluate spiritual expressions and their relationships with mild or moderate mental disorders and with mental health and personal growth. This map is developed by combining different traditions from the psychology of religion. 3. Psychiatric and psychological judgment of religious/spiritual experiences should be self-limited. There is a judgment about its content and about its validity or truth, which is only possible within the different spiritual traditions.ConclusionsPsychopathology establishes principles to discriminate some psychotic symptoms from healthy spiritual experiences. Psychology of religion offers some general rules to guide the psychological evaluation of spiritual beliefs and their influence on mental well-being and personal growth. This review opens fields for future research in relating psychopathology and the study of religious experience.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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