Psychotic symptoms in a patient diagnosed with temporal lobe epilepsy and schizoaffective disorder

IntroductionEpilepsy is considered a complex neurological disorder, and its clinical picture can resemble many different cerebral dysfunctions, including those associated to major psychiatric disorders.Case reportWe report the case of a 52-year-old gentleman, with a 30-year history of schizoaffective disorder and of complex partial epilepsy with secondary generalization. He was admitted to an emergency room due to a voluntary overdose with 8 mg of clonazepam. The patient explained how he had recently experienced visual hallucinations and insomnia, symptoms that originally led to the psychotic diagnosis. He had previously presented these symptoms, along with stupor, delusions and lability, as a prodrome of complex motor epileptic decompensations. Thus, he took the overdose not to suffer seizures. After carefully reconstructing the clinical history, psychiatric admissions had shown seizures, and periods of clinical stability had been achieved by regulating antiepileptic medication. Eslicarbazepine and lamotrigine reintroduction, and quetiapine withdrawal, led to symptomatic remission.DiscussionEpilepsy and major psychiatric disorders show a high comorbidity. There has been an effort to even include epilepsy and psychosis in a unique diagnosis (alternant psychosis). Furthermore, polimorphism and restitutio ad integrum may resemble classic cycloid psychosis. In this case, chronological study showed all symptoms could be explained by one disorder.ConclusionEpilepsy includes a variety of neuropsychiatric symptoms. It can be difficult to withdraw psychiatric diagnoses from patients after years of follow-up. However, a carefully taken medical history clarifies temporal criteria.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The squeezing snake, a psychiatric presentation of epilepsy: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.317 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S347-S347

Author(s):

M. Mangas ◽

L. Bravo ◽

Y. Martins ◽

A. Matos Pires

Keyword(s):

Psychiatric Disorders ◽

Medical History ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Brain Mri ◽

Outpatient Service ◽

Clinical History ◽

Depressive Mood ◽

Night Time ◽

Competing Interest

IntroductionEpilepsy is considered a complex neurological disorder with a great variety of clinical presentations that can resemble psychiatric disorders.ObjectivesDisclose an unusual clinical case with psychiatric symptoms as the presentation of epilepsy.MethodsPsychiatric assessments and retrospective review of the clinical file and literature research.ResultsA 40-years-old Romanian woman presented to the psychiatry outpatient service with a history of persistent depressive mood and disturbed sleep for the past 3 years, complaining of a feeling that she described as “a snake squeezing around her body, starting in her left leg and spreading to the rest of her body up to the neck” associated with a sense of pins and needles, occurring during night time. She attended general practice, neurosurgery and psychiatry appointments. Her medical history included “gastritis” and lower left leg fracture and a pituitary microadenoma revealed in brain CT-scan. Blood work, including endocrine tests and brain-MRI were normal. Her symptoms initially led to diagnosis of: anxiety, somatization, Ekbom syndrome and depression. She was treated with antidepressives, antipsychotics and anxiolytics, without response. After careful reconstruction of the clinical history and further analyses of her complaints, the diagnosis of focal sensory jacksonian seizure was made. Levetiracetam introduction led to symptomatic remission.ConclusionEpilepsy includes a variety of neuropsychiatric symptoms. This case illustrates that epileptic patients may experience non-convulsive seizures that might be mistaken as primary psychiatric disorders. Neurologists and psychiatrists must be aware of this varied presentation while obtaining the medical history in order to investigate and manage this patient effectively.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Delayed post-hypoxic leukoencephalopathy: Case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1654 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s839-s839 ◽

Cited By ~ 1

Author(s):

M. Solerdelcoll Arimany ◽

M. Garriga ◽

E. Parellada

Keyword(s):

Neuropsychiatric Symptoms ◽

Brain Mri ◽

Clinical History ◽

Good Prognosis ◽

Mri Findings ◽

The Mean ◽

Competing Interest ◽

Weighted Sequences ◽

Direct Toxicity ◽

Progressive Cognitive Impairment

IntroductionDelayed post-hypoxic leukoencephalopathy (DPHL) is an underrecognized syndrome of delayed demyelination, where patients manifest neuropsychiatric symptoms after a period of 2–40 days of apparent recovery from a cerebral hypo-oxygenation episode.ObjectivesWe report a case of a patient who successfully recovered from an overdose of heroin, but then suffered a delayed abrupt neurological deterioration.AimsTo improve assessment and recognition of DPHL.MethodsAn adequate retrospective collection of clinical data and nonsystematic review of the literature was performed.ResultsA 43-year-old male with schizoaffective disorder who attempted suicide with an overdose of heroin, was successfully revived and return to his previously mental status, but 3 weeks after, he abruptly developed progressive cognitive impairment with akinetic mutism and ataxia. He was admitted to our acute psychiatric unit after brain CT and chemistry analyses were unremarkable. Brain MRI showed diffusely symmetric hyperintensity in the white matter (WM), pronominally the periventricular WM, on FLAIR and T2 weighted sequences. At 16 weeks postoverdose, he presented improvement both cognitive and motor symptoms, lasting deficits in frontal-executive functions.DiscussionDPHL is characterized by similar clinical and neuroimaging features regardless of the initial insult. The mean lucid interval coincides with the replacement half-life for myelin related lipids and proteins. Prolonged mild-to-moderate hypo-oxygenation of WM is thought to disrupt myelin turnover. It appears probable that these were responsible for DPHL in our patient rather than a direct toxicity.ConclusionDPHL can be diagnosed when clinical history, laboratory assessments and MRI findings are concordant. DPHL requires extensive support care and carries a relatively good prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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MON-252 Pituitary Tumor Apoplexy Presenting with Acute Psychosis

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1517 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Maria Mercedes Pineyro ◽

Patrica Agüero ◽

Florencia Irazusta ◽

Claudia Brun ◽

Paula Duarte ◽

...

Keyword(s):

Psychiatric Disorders ◽

Pituitary Tumor ◽

Psychiatric Treatment ◽

Psychiatric Symptoms ◽

Mental Illnesses ◽

Psychotic Symptoms ◽

Acute Psychosis ◽

Sellar Mass ◽

History Of ◽

Pituitary Tumor Apoplexy

Abstract Background: Pituitary tumors (PT) can present with neuropsychiatric symptoms. It has been associated with hormonal changes, as well as extension of the tumor to the diencephalon. Psychopathology has been reported in up to 83% in Cushing Disease (CD) and 35% in acromegaly (ACR). Psychiatric disorders (depression, anxiety and psychosis) have been reported up to 77% in CD and 63% in ACR. We present a rare case of a patient presenting with acute psychosis and a PT apoplexy. Case: A 27 year-old Caucasian female with a PMH of primary hypothyroidism presented with a 15-day history of delusions. She had delusional ideas on the subject of harm and prejudice, persecutory and mystical-religious. The mechanism was mainly intuitive and interpretive with false acknowledgments. She also had sleep disturbance, death ideation and subacute alteration of consciousness. There was no history of substance abuse or psychiatric disorders. She did not report headaches, visual disturbances, symptoms of hormone hypersecretion or hypopituitarism. She had regular menses on BCP. She had no family history of mental illnesses. Physical exam revealed reluctance, latency in responses and bradypsychia. She did not have acromegalic or cushingoid features. She was diagnosed with acute psychosis with atypical features so a brain CT was performed, which showed a sellar mass. Pituitary MRI revealed a sellar mass measuring 15x12x13 mm, with suprasellar extension, optic chiasm compression, hyperintense on T1- and hypointense on T2-weighted imaging compatible with subacute hemorrhage. She was treated with neuroleptics and benzodiazepines. Lab work revealed high prolactin (PRL) (114ng/dl), and normal 8 AM cortisol, FT4, LH, FSH and IGF-1 levels. Repeated PRL was 31,6 ng/dl after changing psychiatric treatment to aripiprazole. Her psychiatric symptoms improved. We postulate a diagnosis of PT apoplexy that presented with acute psychosis. In relation to the nature of the PT we postulate a non functioning pituitary adenoma (NFA) or a partial resolution of a prolactinoma after apoplexy. A follow up MRI is pending. Discussion: Infrequently, psychiatric symptoms may be the primary manifestation of brain tumors. Patients with PT have been reported to have altered quality of life, reduced coping strategies, increased prevalence of psychopathological alterations and maladaptive personality disorders. In addition, they can present with psychotic symptoms, mostly reported with hormone excess (GH and cortisol). Psychiatric symptoms such as anxiety and neurosis have been reported in NFA and prolactinomas. However, it is not clear a higher prevalence of psychiatric illnesses in these tumors. To our knowledge this is the first case of a pituitary tumor apoplexy presenting with acute psychosis. Conclusion: Psychiatric symptoms can be the first manifestation of PT, so atypical presentations should warrant further workup with brain imaging.

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COVID-19-associated brief psychotic disorder

BMJ Case Reports ◽

10.1136/bcr-2020-236940 ◽

2020 ◽

Vol 13 (8) ◽

pp. e236940 ◽

Cited By ~ 7

Author(s):

Colin M Smith ◽

Jonathan R Komisar ◽

Ahmad Mourad ◽

Brian R Kincaid

Keyword(s):

Mental Illness ◽

Family History ◽

Psychotic Disorder ◽

Neuropsychiatric Symptoms ◽

Healthy Woman ◽

Psychotic Symptoms ◽

First Case ◽

Brief Psychotic Disorder ◽

History Of ◽

New Onset

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.

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Cycloid Psychosis: A Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1969 ◽

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.

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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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Manic episode associated with interferon alpha therapy: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1156 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S332-S332 ◽

Cited By ~ 1

Author(s):

L. González ◽

C. Gomis ◽

V. Rodriguez ◽

C. Gomez ◽

E. tercelan ◽

...

Keyword(s):

Malignant Melanoma ◽

Interferon Alpha ◽

Neuropsychiatric Symptoms ◽

Manic Episode ◽

Chronic Fatigue ◽

Psychotic Symptoms ◽

Entire Family ◽

Urine Drug ◽

Competing Interest ◽

Urine Drug Test

Interferon alpha is a cytokine with antiviral and antineoplastic action, which is commonly used for treatment of Hepatitis C and B, malignant melanoma, Kaposi's sarcoma, kidney cancer and certain hematologic diseases. It is well-known some of its neuropsychiatric symptoms such as depressive symptoms, cognitive impairment, chronic fatigue, dysphoria and anxiety, but there are also other less common like mania, psychotic symptoms and suicide risk that have been reported. These symptoms interfere in the quality of life very significantly, which at the end can affect treatment adherence.We report a case of a 33-year-old man who was taken to the emergency department by his family referring nervousness, irritability, verbose, and insomnia during the last 5 days. The patient had not psychiatric history. He was diagnosed with a malignant melanoma stage III A a year ago which required to start interferon alpha treatment.Patient and family tell that symptoms began after forgetting last interferon dose. In the psychopathology exploration, we could observe mood lability, delusion ideas of prosecution, which includes his entire family and autorreferentiality. In the emergency room the blood test, urine drug test and CT were normal.During the admission, and in collaboration with the Oncology service, it was agreed the reintroduction and maintenance of interferon combined with olanzapine up to 30 mg/day and clonazepam up to 6 mg/day, which resulted in the resolution of symptoms in two weeks.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Gestchwind syndrome and epileptic psychosis, beyond the schizophrenia frontier

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2405 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S639-S639

Author(s):

V. Rodriguez ◽

C. Gómez ◽

C. Gomis ◽

L. González ◽

E. Tercelán ◽

...

Keyword(s):

Correct Diagnosis ◽

Personal History ◽

Psychotic Symptoms ◽

Delusional Ideation ◽

Religious Feeling ◽

Cognitive Disturbances ◽

History Of ◽

False Diagnosis ◽

Competing Interest ◽

Clonic Convulsions

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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Diabetes: Psychiatric and somatic comorbidity

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1424 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S396-S397

Author(s):

J.Á. Monforte Porto ◽

A. San Román Uría ◽

C. Llanes Álvarez ◽

P. Herguedas Vela ◽

I.E. Escuer Núñez ◽

...

Keyword(s):

Psychiatric Disorders ◽

Rural Areas ◽

Diabetic Patients ◽

Liaison Psychiatry ◽

Somatic Comorbidity ◽

History Of ◽

Principles Of Justice ◽

Competing Interest ◽

Somatic Diseases ◽

Symptomatic Control

IntroductionDiabetes mellitus (DM) has been associated with major depressive disorder, schizophrenia, Alzheimer's, Parkinson's and mild cognitive impairment. To determine the psychiatric and somatic comorbidity in diabetic patients treated by our Liaison Psychiatry Unit.MethodsSociodemographic variables (age, sex, marital status, place of residence) and clinical (somatic disease that motivates the admission, comorbid somatic pathology, number of concomitant somatic diseases, drug consumption and its type, psychiatric history, previous psychiatric diagnosis, number of concomitant psychiatric disorders).Study DesignEpidemiological study of 172 diabetic patients, from the total of 906 consulted from 1 January 2012 until 31 December 2014.Bioethical considerationsThe study complies with the principles of justice, non-maleficence, autonomy and beneficence.ResultsThe average age is 72 years, 50% are women, 49.4% are married, and 54.1% live in rural areas. Somatic diseases that most frequently motivate admission at the hospital are the endocrine-metabolic (14%), gastrointestinal (12%) and cardiovascular (12.2%). A total of 32.5% of the sample have six comorbid somatic diseases and 55.2% five. A percentage of 14.5 of patients recognize consumption of toxic (cigarettes–12.2%–7.6% Alcohol). One hundred and eight patients have a history of psychiatric disorders (62.8%), especially anxiety disorders (28.4%), depression (14.5%) and organic mental disorders (11.1%).ConclusionsThere is a high psychiatric and somatic comorbidity in diabetic patients, therefore it would be desirable early diagnosis and treatment to provide symptomatic control of both types of pathologies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Alcohol and substances acute intoxication in a population of suicide attempters

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2235 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S599-S599

Author(s):

S. Di Marco ◽

I. Coppola ◽

C. Delicato ◽

E. Gattoni ◽

A. Venesia ◽

...

Keyword(s):

Suicide Attempt ◽

Statistical Significance ◽

Clinical History ◽

Acute Intoxication ◽

Suicide Attempters ◽

Drugs And Alcohol ◽

Alcohol And Drugs ◽

History Of ◽

Competing Interest ◽

Demographic Features

IntroductionThe effects of psychotropic drugs and alcohol acute intoxication are important risk factors for attempted suicide among individuals with and without substance use disorder (SUD).AimsThe first aim of this study is describing the socio-demographic features and clinical history of subjects who were acutely intoxicated when attempting suicide. The second aim is to compare their features with those of subjects without acute alcohol and substances intoxication at suicide attempt time.MethodsDeterminants of ER psychiatric consultations were studied prospectively during the period 2008–2014 at the “Maggiore della Carità” Hospital in Novara, Italy. For each patient, a data sheet was filled in by experienced psychiatrists, in order to gather demographic features, psychiatric history and present clinical issues like blood and urine dosage of amphetamine and methamphetamine, cannabinoid, cocaine and alcohol. Comparison of qualitative data was performed by means of the Chi2 test. Statistical significance was set at P ≤ 0.05.ResultsWe collected a sample of 495 suicide attempters who referred to our ER. Statistical analysis of demographic and clinical data is still ongoing.ConclusionsPreliminary results point out that acute alcohol and drugs intoxication at suicide attempt time is much more frequent in subjects without a SUD. Implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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