“The Old Lady and the Dead Bird”–A Case of Very-late-onset Schizophrenia-like Psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S647-S648
Author(s):  
V. Covelo ◽  
M. Marinho ◽  
A.S. Machado ◽  
J. Rebelo ◽  
R. Moreira
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Late Onset ◽  
Single Woman ◽  
Persecutory Delusions ◽  
Dead Bird ◽  
The Past ◽  
Schizophrenia Group ◽  
Competing Interest ◽  
First Time

IntroductionIn 1943, Bleuler defined “late-onset schizophrenia” as a form of schizophrenia with onset after the age of 40. Half a century had passed with no consensus on the late psychosis’ terminology, when in 1998 the international late- onset schizophrenia group Consensus proposed a nosology for these disorders: late-onset schizophrenia and very-late-onset schizophrenia-like psychosis.ObjectivesPresentation of a case and diagnostic discussion.MethodsInterviews with the patient during his hospitalisation.ResultsWe present a case of a 73-year-old single woman, with no psychiatric history, who was driven to the emergency department by her relatives when they noticed her bizarre behaviour: she had drowned and strangled her pet bird. At examination she was agitated, had persecutory delusions, thought broadcasting, cenesthetic and auditory hallucinations in the form of a masculine voice, who sang and dialogued with her. Symptoms had evolved during the past six months with no apparent functional impairment. During hospitalisation she was treated with risperidone (up to 5 mg/day) with improvement in a few days. There were no significant abnormalities on cerebral tomography and analytical exams. Neuropsychological evaluation ruled out cognitive deficits. At the time of discharge although the patient kept referring auditory hallucinatory activity, she had an appropriate behaviour, and no evidence of negative symptoms.ConclusionsThe small group of patients who meet schizophrenia's criteria for the first time at a later age present some particular clinical characteristics to be taken into account. This case highlights some of them, drawing attention to this uncommon diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Late-onset depression: issues affecting clinical care

2008 ◽  
Vol 14 (2) ◽  
pp. 152-158 ◽  
Author(s):  
Hannele Variend ◽  
Y. Vishnu Gopal
Keyword(s):  
Clinical Features ◽  
Cognitive Deficits ◽  
Early Onset ◽  
Late Onset ◽  
Clinical Care ◽  
Later Life ◽  
Recurrent Depression ◽  
Vascular Depression ◽  
Structural Abnormalities ◽  
First Time

A growing body of evidence suggests that late-onset depression (depression occurring for the first time in later life) differs from early-onset (recurrent) depression in terms of clinical features, aetiology, neuroanatomical substrates and prognosis. Some evidence suggests that late-onset depression is more associated with somatic symptoms, cognitive deficits, cerebral structural abnormalities, vascular disease (‘vascular depression’) and poorer treatment outcomes than is early-onset depression. Both general adult and old age psychiatrists face the challenges of managing late-onset depression. In this article we attempt to clarify specific issues relating to late-onset depression in terms of clinical features, aetiology, treatment response and prognosis.

Lack of insight as a third variable between subjective appraisal of cognitive impairment and psychotic symptoms

2017 ◽  
Vol 41 (S1) ◽  
pp. S384-S384
Author(s):  
R. Rossi ◽  
V. Santarelli ◽  
C. Marucci ◽  
D. Gianfelice ◽  
F. Pacitti
Keyword(s):  
Cognitive Deficits ◽  
Symptom Severity ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
Subjective Perception ◽  
Mediator Role ◽  
Competing Interest ◽  
The One ◽  
The Relationship ◽  
Mediator Variable

BackgroundThe relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly impacts on both factors. Our aim is to further asses the relationship between the subjective perception of cognitive deficits, symptom severity and lack of Insight as a mediator variable.MethodsA total of 109 subject diagnosed with schizophrenia. Positive and Negative Syndrome Scale (PANSS) was modelled as dependent variable; Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) was modeled as independent variable and “Lack of Insight” (LoI) PANSS Item was tested as a mediator variable. Mediation was assessed using the Sobel Mediation Test.ResultsLoI acts as a suppressor variable (i.e. it enhances the relation between the independent and dependent variable) between SSTICS and negative symptoms, while showing a mediator effect between SSTICS and depressive symptoms.DiscussionLoI has a central role in mediating the relationship between subjective appraisal of cognitive deficits on the one hand and positive and depressed symptoms on the other. Its suppressor role between SSTICS and depression is consistent with several reports of an enhanced risk of depression in patients fully aware of their disability. Its mediator role between STICSS and positive symptoms supports the centrality of LoI as a metacognitive function whose failure may worsen psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

When a Man Loves a Woman: a Case of Erotomania in the 21st Century

2016 ◽  
Vol 33 (S1) ◽  
pp. S464-S464 ◽  
Author(s):  
C. Rodrigues ◽  
M. Andrade ◽  
V. Palma ◽  
C. Cardoso
Keyword(s):  
Literature Review ◽  
Legal Process ◽  
Violent Behaviour ◽  
Persecutory Delusions ◽  
Clinical Process ◽  
The Past ◽  
Legal Implications ◽  
Forensic Samples ◽  
Competing Interest

IntroductionErotomania, or De Clerambault's Syndrome, was first described in 1921. However, cases of Insane Love were long known before. Presently, this condition is classified as a delusional disorder typically affecting women. However, in forensic samples, most of these reports relate to men with violent behaviour, associated to harassing or stalking of a woman.ObjectiveTo present the case of a man, diagnosed with Erotomania and literature review of similar cases.AimTo bring awareness to the infrequent diagnosis of this condition in males and the legal implications this condition may have.MethodsConsultation of the patient's clinical process and published articles focusing on Erotomania in men.ResultsA 50-year-old man was referred from Court for persistently stalking a woman on the past few years. He revealed erotomanic and persecutory delusions, believing these accusations were all part of a scheme to restrain his alleged relationship.There was a clinical improvement during hospitalization and treatment with antipsychotics. Due to the legal process in court, a forensic examination was also performed.ConclusionsOn the follow-up, the patient remained stabilized. He would not verbalize any delusional content, and calmly deny any inadequate behaviour. However, some of his stalking attitude remains. As many of these patients, we believe his delusion is still present, although his behaviour is more controlled with treatment. Recognizing the characteristics and course of this disorder in our patients, grants a better chance of intervention and attentiveness towards the legal implications that may arise.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Characteristics and duration of untreated illness in correlation with insight level of first time diagnosed schizophrenia patients in rural region of Latvia

2017 ◽  
Vol 41 (S1) ◽  
pp. s804-s804
Author(s):  
L. Berze ◽  
K. Pavlovs ◽  
K. Slikova ◽  
V. Bodins ◽  
I. Samule ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Depression Scale ◽  
First Episode ◽  
Inclusion Criteria ◽  
Symptoms Of Depression ◽  
Duration Of Untreated Illness ◽  
Schizophrenia Spectrum ◽  
Competing Interest ◽  
First Time ◽  
Written Informed Consent

IntroductionImproved insight level among schizophrenia patients is predictive for better illness prognosis.ObjectiveExplore factors connected to insight.AimEvaluate the insight level and clinical characteristics of first time hospitalized schizophrenia spectrum patients.MethodsAll consecutive first time hospitalized schizophrenia spectrum patients in a psychiatric hospital from 01.01.2016–26.09.2016. Patients were interviewed upon hospitalization and at the discharge with Scale for the assessment of positive symptoms (SAPS) and negative symptoms (SANS), Schedule of assessment of insight-extended (SAI-E), The Calgary depression scale for schizophrenia (C-sch), sociodemographic and clinical data were collected. All participants signed written informed consent and the study was approved by the Riga Stradins University Ethics committee.ResultsFrom 45 first episode patients, 38 met the inclusion criteria. Mean age was 37.66 years (SD: 11.48 years), the average duration of untreated illness (DUI) was 40.5 months (SD: 57.35 months). Psychopathologic symptoms and insight levels evaluated in scores in the 1st and 2nd interviews were as follows: SAPS 69.11 (SD: 20.78) and 33.61 (SD: 18.04), SANS 63.21 (SD: 25.30) and 40.95 (SD: 24.47), SAI-E 15.50 and 27.24 (SD: 13.24), P < 0.001, C-sch 8.50 (SD: 5.31) and 4.27 (SD: 2.86), P < 0.05. There was no statistically significant correlation between DUI and insight level. A higher level of insight at hospitalization correlated with higher levels of depression: r = 0.569, P < 0.001.ConclusionsWe noticed a tendency that lower insight levels might correlate with longer periods of untreated illness. We found that higher insight levels correlated with higher symptoms of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Fronto-parietal white matter microstructural deficits are linked to performance IQ in a first-episode schizophrenia Han Chinese sample

2012 ◽  
Vol 43 (10) ◽  
pp. 2047-2056 ◽  
Author(s):  
Q. Wang ◽  
C. Cheung ◽  
W. Deng ◽  
M. Li ◽  
C. Huang ◽  
...  
Keyword(s):  
White Matter ◽  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Diffusion Tensor ◽  
Clinical Manifestations ◽  
First Episode ◽  
Chinese Sample ◽  
Schizophrenia Group ◽  
Core Deficit ◽  
First Episode Schizophrenia

BackgroundEvidence shows that cognitive deficits and white matter (WM) dysconnectivity can independently be associated with clinical manifestations in schizophrenia. It is important to explore this triadic relationship in order to investigate whether the triplet could serve as potential extended endophenotypes of schizophrenia.MethodDiffusion tensor images and clinical performances were evaluated in 122 individuals with first-episode schizophrenia and 122 age- and gender-matched controls. In addition, 65 of 122 of the patient group and 40 of 122 controls were measured using intelligence quotient (IQ) testing.ResultsThe schizophrenia group showed lower fractional anisotropy (FA) values than controls in the right cerebral frontal lobar sub-gyral (RFSG) WM. The schizophrenia group also showed a significant positive correlation between FA in the RFSG and performance IQ (PIQ); in turn, their PIQ score showed a significant negative correlation with negative syndromes.ConclusionsOverall, these findings support the hypothesis that WM deficits may be a core deficit that contributes to cognitive deficits as well as to negative symptoms.

scholarly journals Elevated activity of superoxide dismutase in male late-life schizophrenia and its correlation with clinical symptoms and cognitive deficits

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lijuan Huo ◽  
Xiaobing Lu ◽  
Fengchun Wu ◽  
Catherine Chang ◽  
Yuping Ning ◽  
...  
Keyword(s):  
Superoxide Dismutase ◽  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Clinical Symptoms ◽  
Late Life ◽  
Pathological Process ◽  
Psychotic Symptoms ◽  
Control Group ◽  
Sod Activity ◽  
Schizophrenia Group

Abstract Background Despite inconsistent findings, accumulative evidence has shown abnormalities of the key antioxidant enzyme, superoxide dismutase (SOD), in patients with schizophrenia. However, few studies explored SOD in late-life schizophrenia (LLS). Our work aimed to investigate changes in SOD activity and the relationship between SOD activity and psychotic symptoms or cognitive deficits in LLS. Methods 32 geriatric male patients with schizophrenia (age ≥ 60) and 28 age-matched male normal controls were recruited in the study. We assessed cognitive functions with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), evaluated the severity of clinical symptoms with the Positive and Negative Syndrome Scale (PANSS), and measured the plasma levels of SOD. Results Patients with LLS presented with higher total levels of SOD compared to the controls (81.70 vs. 65.26 U/ml, p < .001). Except for the visuospatial index, the cognitive performance was significantly worse on RBANS total and other domain scores in the schizophrenia group than the control group. In the schizophrenia group, SOD levels were positively correlated with subscores of general psychopathology and negative symptoms and total scores of the PANSS (all p < .05), and inversely associated with performance in immediate memory, language, and RBANS total scores (all p < .05). Conclusions Our findings suggest that patients with LLS display disturbances in the antioxidant system, which may underlie the pathological process of cognitive impairments and negative symptoms in the late stage of schizophrenia. Supplementing with antioxidants could be a potential treatment.

Menopause and psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S46-S46
Author(s):  
J. Usall ◽  
E. Huerta-Ramos
Keyword(s):  
Clinical Trials ◽  
Postmenopausal Women ◽  
Negative Symptoms ◽  
Late Onset ◽  
Preventive Treatment ◽  
Estrogen Receptor Modulators ◽  
Competing Interest ◽  
Receptor Modulators ◽  
Better Than

There has been little research into the effects of menopause on symptoms, social and cognitive functioning in women with schizophrenia, and the results are controversial. The most replicated finding is that late-onset schizophrenia is more prevalent in women than in men and that this fact appears to be related to the diminution of estrogen levels during menopause.Estrogens have a known protective effect on CNS. Animal research has shown that estrogen has a modulating effect on the dopaminergic, glutamatergic and serotonergic systems.There are concerns about long-term use of sexual hormone therapy in postmenopausal women with regard to breast cancer risk, and the use of the selective estrogen receptor modulators (SERMS's) can be a better option.Raloxifene is a SERM that is used in the preventive treatment of postmenopausal osteoporosis and has no effect in the breast and uterus. A number of studies seem to indicate that raloxifene acts on brain dopamine and serotonin systems in a similar way to conjugated estrogens.In this presentation, I will show the results of some clinical trials that have studied the efficacy of raloxifene as a coadjuvant treatment of patients with schizophrenia. Our team has done two clinical trials that studied the efficacy of 60 mg of raloxifene for the treatment of negative symptoms in postmenopausal women with schizophrenia. Our results showed that raloxifene improved the negative symptoms better than placebo. We concluded that raloxifene seems to be a promising option to treat some patients with schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals A Selective Review of the Excitatory-Inhibitory Imbalance in Schizophrenia: Underlying Biology, Genetics, Microcircuits, and Symptoms

2021 ◽  
Vol 9 ◽  
Author(s):  
Yi Liu ◽  
Pan Ouyang ◽  
Yingjun Zheng ◽  
Lin Mi ◽  
Jingping Zhao ◽  
...  
Keyword(s):  
Cognitive Deficits ◽  
Animal Studies ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
First Episode ◽  
Gamma Aminobutyric Acid ◽  
Disease Phenotypes ◽  
The Past ◽  
Chronic Disorder ◽  
Behavior Disturbances

Schizophrenia is a chronic disorder characterized by specific positive and negative primary symptoms, social behavior disturbances and cognitive deficits (e.g., impairment in working memory and cognitive flexibility). Mounting evidence suggests that altered excitability and inhibition at the molecular, cellular, circuit and network level might be the basis for the pathophysiology of neurodevelopmental and neuropsychiatric disorders such as schizophrenia. In the past decades, human and animal studies have identified that glutamate and gamma-aminobutyric acid (GABA) neurotransmissions are critically involved in several cognitive progresses, including learning and memory. The purpose of this review is, by analyzing emerging findings relating to the balance of excitatory and inhibitory, ranging from animal models of schizophrenia to clinical studies in patients with early onset, first-episode or chronic schizophrenia, to discuss how the excitatory-inhibitory imbalance may relate to the pathophysiology of disease phenotypes such as cognitive deficits and negative symptoms, and highlight directions for appropriate therapeutic strategies.

Response to Steroids in IQSEC2-Related Encephalopathy Presenting with Rett-Like Phenotype and Infantile Spasms

2020 ◽  
Author(s):  
Divya Nagabushana ◽  
Aparajita Chatterjee ◽  
Raghavendra Kenchaiah ◽  
Ajay Asranna ◽  
Gautham Arunachal ◽  
...  
Keyword(s):  
Late Onset ◽  
Neurodevelopmental Disorder ◽  
Epileptic Encephalopathy ◽  
Infantile Spasms ◽  
The Past ◽  
Resource Limited ◽  
The Central Nervous System ◽  
Motor Milestone ◽  
Behavior And Cognition ◽  
Atypical Rett Syndrome

Abstract Introduction IQSEC2-related encephalopathy is an X-linked childhood neurodevelopmental disorder with intellectual disability, epilepsy, and autism. This disorder is caused by a mutation in the IQSEC2 gene, the product of which plays an important role in the development of the central nervous system. Case Report We describe the symptomatology, clinical course, and management of a 17-month-old male child with a novel IQSEC2 mutation. He presented with an atypical Rett syndrome phenotype with developmental delay, autistic features, midline stereotypies, microcephaly, hypotonia and epilepsy with multiple seizure types including late-onset infantile spasms. Spasms were followed by worsening of behavior and cognition, and regression of acquired milestones. Treatment with steroids led to control of spasms and improved attention, behavior and recovery of lost motor milestone. In the past 10 months following steroid therapy, child lags in development, remains autistic with no further seizure recurrence. Conclusion IQSEC2-related encephalopathy may present with atypical Rett phenotype and childhood spasms. In resource-limited settings, steroids may be considered for spasm remission in IQSEC2-related epileptic encephalopathy.

MOTIVATION AND PLEASURE IN THE SCHIZOPHRENIA SPECTRUM–FINDINGS FROM THE PRODROME

2008 ◽  
Vol 31 (4) ◽  
pp. 10
Author(s):  
G Foussias ◽  
G Remington ◽  
R Mizrahi
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Sampling Method ◽  
Personal Digital Assistant ◽  
Prodromal Phase ◽  
Daily Lives ◽  
Schizophrenia Spectrum ◽  
Influence Functional ◽  
The Moment ◽  
Positive And Negative Symptoms

Background: Schizophreniais a chronic and debilitating illness that affects approximately one percent of the population. The symptoms of schizophrenia are typically thought of in separate domains, including positive symptoms (hallucinations and delusions), negative symptoms (diminished emotional expression and amotivation), and cognitive deficits. Importantly, the negative symptoms have been consistently found to adversely influence functional outcomes, in particular due to markedamotivation.^1 There have been suggestions that these individuals also experience deficits in the experience of pleasure, especially in their capacity to anticipate pleasure.^2 However, such investigations have not included the examination of these symptoms in those in the prodromal phase ofthis illness, a time that holds promise for early intervention and altering thecourse of schizophrenia.^3 Methods: In an effort to examine deficits in motivation and pleasure in the prodromal phase of schizophrenia, we have used an experience sampling method to assess “in the moment” motivation and pleasure in individuals at high risk of developing schizophrenia and healthy controls. Subjects completed baseline assessments including evaluation of their positive and negative symptoms. Subsequently, through the use of a personal digital assistant, subjects rated their motivation and experience of consummatory and anticipatory pleasure in their daily lives, multiple times over the course of four days. Results and Conclusions: Preliminary data will be presented, as well as the importance of these findings in the context of understanding the underlying pathobiology of this illness, and guiding our search for effective treatments to improvefunctional outcomes in schizophrenia. References: 1. Sayers SL, Curran PJ, Mueser KT. Psychol Assessment 1996;8:269-80. 2. Gard DE, Kring AM, Gard GM, et al.. Schizophr Res 2007;93:253-60.

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