Gestchwind syndrome and epileptic psychosis, beyond the schizophrenia frontier

During late 19th and early 20th century neuropsychiatrists began to identify common behavioral and cognitive disturbances in epilepsy, but it is not until 1973 that Norman Gestchwind described the basics of what we know as Gestchwind syndrome. This syndrome includes the triada of hyper-religiosity, hypergraphia and hypo/hypersexuality and it was mainly associated with temporal lobe epilepsy. Moreover, it is well known the association between epilepsy and psychotic symptoms, the so-called schizophrenia-like syndrome, which can lead us to a false diagnosis of schizophrenia. We report a 44-year-old man who was brought to the hospital with delusional ideation of prosecution and reference in his work environment with important behavioral disruption, as well as delusional ideation of religious content. He had a diagnosis of schizophrenia since he was 18-years-old and personal history of generalized tonic-clonic convulsions in his twenties. During the admission, he recovered ad integrum very rapidly with low doses of risperidone, but referred recurrence of déjà vu episodes. After reviewing his patobiography and past medical history, we identified the presence of hypergraphia, hypersexuality and a profound religious feeling, fulfilling the criteria for Gestchwind syndrome, in the context of which was later diagnosed as chronic epileptic psychosis. It is very important a careful approach to the patobiography and personal history. Also, we should include classic differential diagnosis such as Gestchwind syndrome, as they can lead us finally to the correct diagnosis, which in this case meant not only a different treatment but also a better prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Electroconvulsive therapy (ECT) treatments in late-onset schizophrenia: Report of a case

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2053 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S556-S556

Author(s):

M. Valverde Barea ◽

F. Cartas Moreno ◽

M.E. Ortigosa Luque

Keyword(s):

Behavioral Disorders ◽

Electroconvulsive Therapy ◽

Psychotic Disorders ◽

Late Onset ◽

Personal History ◽

Psychotic Symptoms ◽

Sexual Content ◽

History Of ◽

Competing Interest ◽

Effective Result

Female patient, 66 years old, who goes to the doctor because of behavioral disorders and delusional injury 8 months of evolution. She showed no personal history of psychiatric disorders. In the psychopathological examination some relevant symptoms are seen delusions of prejudice with their immediate surroundings, self-referential regarding neighbors and walls. Delusional interpretations of sexual content. Punitive pseudo hallucinations hearing which are identifies with her daughters and sex with her son-in-law. Behavioral disorders consisting of going out naked into the street overnight and rebuking pedestrians; furthermore, she showed heteroaggressivity towards objects. Logical psychotropic treatment is initiated as indicated by the guidelines having no effect. Electroconvulsive therapy being tested an effective result. The late-onset schizophrenia symptoms should be taken into account in people with psychotic symptoms start at an advanced age, but is most prevalent at younger ages. Electroconvulsive therapy (ECT) may be used as an adjunct to drug therapy or as second-line treatment in patients with affective or psychotic disorders resistant to treatment with psychotropic drugs. It is essential a differential diagnosis with dementia symptoms previously established, given that part of the late-onset schizophrenia evolves to dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cannabis-induced Psychotic Disorders and THC use Among Patients with Psychotic Symptoms

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2156 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S203-S203

Author(s):

A. Fernandez-Quintana ◽

C. Quiroga-Fernandez ◽

A. Novo-Ponte ◽

M.D.C. Garcia-Mahia

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Cannabis Use ◽

Personal History ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Time Interval ◽

Old Patients ◽

History Of ◽

Competing Interest

IntroductionCausality between THC and psychotic symptoms has been outlined in several studies and a potential role for THC in the development of Schizophrenia remains to be assessed.MethodsRetrospective study undertaken in a sample of 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms. Medical records were reviewed to obtain clinical and sociodemographic variables.Objectives(1) To analyse the prevalence of THC consumption among psychotic patients in ED; (2) to establish the prevalence of cannabis-induced psychotic disorder; (3) to underpin the socio-demographic and clinical variables associated with cannabis-induced psychosis.ResultsPersonal history of cannabis use 31.5% (6.5% as a single drug.) Accumulated time interval of cannabis use prior to the first psychotic episode: 0 – 5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5 – 10 years 9.2%, more than 10 years 20.8%. Cannabis-induced psychotic disorder (F12.5) was diagnosed in 3.3% of the sample. The prevalence of this diagnosis was the same among male and female patients. The highest prevalence of cannabis-induced psychosis was found among 36–50 years old patients (50%). All patients with a diagnosis of Cannabis-induced psychotic disorder had a personal history of THC use and urine tests had been positive for THC in 75% of the cases. Habitat: 75% urban, 25% rural. Marital status: 50% single, 50% married.ConclusionsCannabis use is highly prevalent among patients who present with psychotic symptoms in ED and THC is correlated with psychotic episodes. The prevalence of cannabis-induced psychosis has also increased. Further studies comprising larger samples are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Discrimination and delusional ideation

The British Journal of Psychiatry ◽

10.1192/bjp.182.1.71 ◽

2003 ◽

Vol 182 (1) ◽

pp. 71-76 ◽

Cited By ~ 172

Author(s):

I. Janssen ◽

M. Hanssen ◽

M. Bak ◽

R. V. Bijl ◽

R. De Graaf ◽

...

Keyword(s):

Sexual Orientation ◽

General Population ◽

The Netherlands ◽

Prospective Study ◽

Perceived Discrimination ◽

Psychotic Symptoms ◽

Minority Populations ◽

Delusional Ideation ◽

History Of ◽

The Uk

BackgroundIn the UK and The Netherlands, people with high rates of psychosis are chronically exposed to discrimination.AimsTo test whether perceived discrimination is associated longitudinally with onset of psychosis.MethodA 3-year prospective study of cohorts with no history of psychosis and differential rates of reported discrimination on the basis of age, gender, disability, appearance, skin colour or ethnicity and sexual orientation was conducted in the Dutch general population (n=4076). The main outcome was onset of psychotic symptoms (delusions and hallucinations).ResultsThe rate of delusional ideation was 0.5% (n=19) in those who did not report discrimination, 0.9% (n=4) in those who reported discrimination in one domain, and 2.7% (n=3) in those who reported discrimination in more than one domain (exact P=0.027). This association remained after adjustment for possible confounders. No association was found between baseline discrimination and onset of hallucinatory experiences.ConclusionsPerceived discrimination may induce delusional ideation and thus contribute to the high observed rates of psychotic disorder in exposed minority populations.

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A broken heart

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.386 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S422-S423

Author(s):

M.J. Gordillo Montaño ◽

S. Ramos Perdigues ◽

S. Latorre ◽

M. de Amuedo Rincon ◽

P. Torres Llorens ◽

...

Keyword(s):

Heart Function ◽

Mood Stabilizer ◽

Psychotic Symptoms ◽

Emotional States ◽

Cardiac Syndrome ◽

History Of ◽

Competing Interest ◽

High Doses ◽

Depressive Episodes ◽

The Impact

IntroductionWithin the various cultures and throughout the centuries has observed the relationship between emotional states and heart function, colloquially calling him “heartbroken”. Also in the medical literature are references to cardiac alterations induced by stress.ObjectiveTakotsubo is a rare cardiac syndrome that occurs most frequently in postmenopausal women after an acute episode of severe physical or emotional stress. In the text that concerns us, we describe a case related to an exacerbation of psychiatric illness, an episode maniform.MethodWoman 71 years old with a history of bipolar I disorder diagnosed at age 20. Throughout her life, she suffered several depressive episodes as both manic episodes with psychotic symptoms. Carbamazepine treatment performed and venlafaxine. He previously performed treatment with lithium, which had to be suspended due to the impact on thyroid hormones and renal function, and is currently in pre-dialysis situation.She requires significant adjustment treatment, not only removal of antidepressants, but introduction of high doses of antipsychotic and mood stabilizer change of partial responders. In the transcurso income, abrupt change in the physical condition of the patient suffers loss of consciousness, respiratory distress, drop in blood pressure, confusion, making involving several specialists. EEG was performed with abnormal activity, cranial CT, where no changes were observed, and after finally being Echocardiography and coronary angiography performed when diagnosed Takotsubo.Results/conclusionsIn this case and with the available literature, we can conclude that the state of acute mania should be added to the list of psychosocial/stressors that can trigger this condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Malignant catatonia and neuroleptic malignant syndrome: How different/similar are they?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2407 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S640-S640 ◽

Cited By ~ 1

Author(s):

P. Sales ◽

M. Bernardo ◽

A. Lopes ◽

E. Trigo

Keyword(s):

Supportive Care ◽

Neuroleptic Malignant Syndrome ◽

Specific Treatment ◽

Hemodynamic Instability ◽

Psychotic Symptoms ◽

Muscle Rigidity ◽

Life Threatening ◽

History Of ◽

Competing Interest ◽

Malignant Catatonia

IntroductionCatatonia is a neuropsychiatric syndrome that appears in medical, neurological or psychiatric conditions. There are presentation variants: “malignant catatonia” (MC) subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), possibly reflecting common pathophysiology.Objectives/methodsWe present a clinical vignette and review the literature available on online databases about MC/NMS.ResultsWe present a man, 41-years-old, black ethnicity, with no relevant medical history. He had two previous episodes compatible with brief psychosis, the last one in 2013, and a history of adverse reactions to low doses of antipsychotics. Since the last episode he was asymptomatic on olanzapine 2.5 mg id. He acutely presented to the Emergency Room with mutism, negativism, immobility and delusional speech, similar to the previous episodes mentioned and was admitted to a psychiatric infirmary, where his clinical condition worsened, showing muscle rigidity, hemodynamic instability, leukocytosis, rhabdomyolysis and fever. Supportive care was provided, olanzapine was suspended and electroconvulsive therapy (ECT) was initiated. After two months, he was discharged with no psychotic symptoms. He is still under ECT and no antipsychotic medication was reintroduced.Discussion/conclusionMany studies suggest that clinical or laboratory tests do not distinguish MC from NMS and that they are the same entity. These two conditions are life-threatening and key to treatment is a high suspicion level. There is no specific treatment; supportive care and stopping involved medications are the most widely used measures. ECT is a useful alternative to medication.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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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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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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Substance-induced Psychotic Disorders in an Emergency Department

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2155 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S203-S203

Author(s):

A. Fernandez-Quintana ◽

A. Novo-Ponte ◽

C. Quiroga-Fernandez ◽

M.D.C. Garcia-Mahia

Keyword(s):

Emergency Department ◽

Substance Abuse ◽

Psychotic Disorders ◽

Drug Misuse ◽

Psychotic Symptoms ◽

First Year ◽

Time Interval ◽

History Of ◽

Competing Interest ◽

Urine Testing

IntroductionSubstance abuse has been correlated with psychotic disorders albeit more accurate details on causality remain to be assessed. Furthermore, the prevalence and prognosis of substance-induced psychotic disorders have not been clearly established.MethodRetrospective study performed in 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms over a 6-month period. Medical records were reviewed to obtain clinical and socio-demographic variables.Objectives(1) To analyse substance abuse patterns among ED psychotic patients; (2) to estimate the prevalence of substance-induced psychotic disorders in ED; (3) to underpin the socio-demographic and clinical variables associated.ResultsPersonal history of substance abuse: THC 31.5%, alcohol 29%, cocaine 18.5%, benzodiazepines 18.5%, opiates 6.5%, MDMA 4%, amphetamines 3.2%, hallucinogens 2.4%. Accumulated time interval of substance abuse prior to psychotic onset: 0–5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5–10 years 9.2%, more than 10 years 20.8%. Urine testing for drug misuse undertaken in 80.6% of cases: positives 53%, negatives 47%. Among positive urine test results: THC 16.5%, benzodiazepines 16.5%, cocaine 6.1%, opiates 5.1%, alcohol 0.9%, amphetamines 0.8%, hallucinogens 0.8%. Substance-induced psychotic disorder (F19.15) was diagnosed among 20.4% of patients. This diagnosis was 1.5 times more prevalent among males. Forty-eight percent of patients were single, 36% married, 12% divorced, 4% widowers. Habitat: 68% urban, 34% rural. Highest prevalence group 36 – 50 year olds.ConclusionsBoth substance abuse and substance-induced psychotic disorders are highly prevalent in our sample. Their socio-demographic and clinical profile is similar to that found in schizophrenia. Further refinements of these findings are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Tardive dyskinesia: When one should suspect of another diagnosis?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1347 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S375-S375

Author(s):

R. Almendra ◽

A.R. Figueiredo ◽

V. Espirito Santo ◽

A. Almeida ◽

P. Guimarães ◽

...

Keyword(s):

Family History ◽

Physical Examination ◽

Tardive Dyskinesia ◽

Personal History ◽

Diagnostic Process ◽

Involuntary Movements ◽

Cag Expansion ◽

Detailed Medical History ◽

History Of ◽

Competing Interest

IntroductionTardive dyskinesia is a collection of symptoms related to the side effects of neuroleptic medications that can mimic other types of disorders. Accurate diagnosis can be challenging, as there is no single test for tardive dyskinesia.Case reportFemale patient, 64 years old, with personal history of Chronic Myeloid Leukaemia and psychosis since forth decade, currently medicated with quetiapine 350 mg/day, risperidone IM 50 mg 15/15 days and trazodone 150 mg/day (previously medicated with haloperidol, amisulpride and olanzapine). She started with involuntary movements interpreted as tardive dyskinesia after 2 years on neuroleptic treatment. The difficult control of involuntary movements motivated the reference to ambulatory Neurology department. The review of personal history suggested a family history of involuntary movements and psychiatric illness. Physical examination showed generalized choreic movements. The analytical and imagiologic study was unremarkable. The presence of family history and involuntary movements atypical to be classified as tardive dyskinesia supported a genetic test for Huntington's disease who detected a CAG expansion with 43 repetitions in HTT gene. Despite treatment with amantadine and riluzole she maintains disease progression and evident cognitive deterioration.ConclusionThe diagnostic process of involuntary movements may involve more than one physician and requires the review of a detailed medical history, a physical examination and a neuropsychological evaluation in order to determine whether one is indeed suffering from tardive dyskinesia or a different neurological disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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