Corticosteroid-induced psychosis: Case report and review of the literature

IntroductionSteroid psychosis still presents many unsettled clinical aspects. Despite several reviews and case reports are available, modes of onset and recovery need a more accurate description. We will focus on a 53-year-old woman who was hospitalized against her will because of her agitated psychotic state. Her symptoms were indicative of an acute psychotic disorder resulting from the use of corticosteroids. We considered it important to report this case because corticosteroids have been widely prescribed since about 1950 to treat a broad spectrum of somatic illnesses and to emphasize the relevance of the dose of steroids in this case.ObjectivesWe describe a case of substance-induced psychotic disorder resulting from corticosteroids administration and we review the scientific literature about this topic.AimsTo obtain more information about the incidence of steroid-induced psychotic symptoms, the relation between the type of steroids, its dose and the clinical presentation, the most important risk factors and how to prevent psychotic episodes during steroids-treatment.MethodsAfter discussing the case, we studied the literature systematically using official medical browsers.ResultsVery little reliable evidence has been available relating to steroid-induced psychosis.ConclusionsThere is much to learn about adverse psychiatric reactions to corticosteroid treatment. It should be improved awareness of the limited available knowledge and to stimulate research aimed at improved methods of prevention, recognition and treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A case of share psychotic disorder induced by mephedrone

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1058 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S309-S309

Author(s):

R.A. Baena ◽

Y. Lázaro ◽

J. Rodriguez ◽

L. Olivares ◽

A. Matas ◽

...

Keyword(s):

Psychotic Disorder ◽

Scientific Literature ◽

Case Reports ◽

Rare Condition ◽

Psychiatric History ◽

Psychiatric Disturbance ◽

Medical Treatments ◽

Novel Drugs ◽

Close Relationship ◽

Competing Interest

IntroductionShare psychotic disorder “folie à deux” is a rare condition characterized by the transmission of delusional aspects from a patient to another linked by a close relationship. We report the case of two Spanish men who have experienced a combined delusional episode induced by mephedrone.ObjectivesDescribe a case of share psychotic disorder induced by mephedrone. Make a review on scientific literature about the use of mephedrone (little is known about the psychiatric consequences of the use of these compounds). The patients had no psychiatric history.AimsShow the danger of these novel drugs that are often bought as apparently safe and legal.ConclusionsShare psychotic disorder was first introduced by Lasegue and Falret who hypothesized that transmission of psychiatric disturbance from one person to another was possible under certain circumstances. The correlation of symptoms with the intake of these substances is supposed in the light of a negative psychiatric history and no other concomitant medical treatments. An important number of case reports documented deaths related to the ingestion of mephedrone. Another problem is that these substances are not detected by standard blood and urine test so that the diagnosis of intoxication is often delayed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Severe Psychotic Disorder as the Main Manifestation of Adrenal Insufficiency

Case Reports in Psychiatry ◽

10.1155/2015/512430 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Julia de Lima Farah ◽

Carolina Villar Lauand ◽

Lucas Chequi ◽

Enrico Fortunato ◽

Felipe Pasqualino ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Psychotic Disorder ◽

Clinical Presentation ◽

Neuropsychiatric Symptoms ◽

Clinical Signs ◽

Brain Magnetic Resonance Imaging ◽

Serum Cortisol ◽

Psychotic Symptoms ◽

Primary Adrenal Insufficiency ◽

Very High

We describe a case of severe psychotic disorder as the only manifestation of primary adrenal insufficiency. A 63-year-old man presented with psychotic symptoms without any prior psychiatric history. During the clinical and laboratorial investigation, exams revealed a normovolemic hyponatremia. The patient showed no other clinical signs or symptoms compatible with adrenal insufficiency but displayed very high ACTH and low serum cortisol concentrations. Brain magnetic resonance imaging showed no significant changes, including the pituitary gland. The patient was initially treated with intravenous corticosteroids, resulting in rapid remission of the psychotic symptoms. The association between adrenal insufficiency and neuropsychiatric symptoms is rare but these symptoms can often be the first clinical presentation of the disease.

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Parkinson Psychosis: A Complex Interaction of Disease and Medication Related Factors

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1119 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S662-S662

Author(s):

S. Petrykiv ◽

L. de Jonge ◽

M. Arts

Keyword(s):

English Language ◽

Case Reports ◽

Pharmacological Therapy ◽

Complex Interaction ◽

Psychotic Symptoms ◽

Psychiatric Ward ◽

Related Factors ◽

Appropriate Therapy ◽

Competing Interest ◽

Paranoid Psychosis

IntroductionPsychotic symptoms are the most important non-motoric symptoms of the Parkinson disease (PD). The quality of life of those patients can be significantly improved with an appropriate therapy. In this article we provide evidence about the etiology, differential diagnosis and therapeutic possibilities with a work-up for the clinics.Objectives & aimsTo provide a case report of patient with PD who developed a paranoid psychosis after administration of levodopa/carbidopa, followed by a literature review on psychotic symptoms evoked by psychotropic medication by patients with PD.MethodsAn English-language literature search was conducted using Pubmed, EMBASE searching for case reports and observational studies reporting iatrogenic psychotic symptoms by patients with PD.ResultsMs. C. was a 65-year old woman with PD who was observed in a polyclinic setting and who used a levodopa/carbidopa combination. She developed paranoid psychosis with a following admission to the psychiatric ward. We have gradually lowered the dose of anti-Parkinson medication. Subsequently, treatment with clozapine was initiated and the psychotic symptoms resolved within five months.ConclusionParkinson psychosis is due to a complex interaction of neurodegenerative changes and pharmacological therapy. Therefore, the role of iatrogenic factors must be always carefully assessed. Psychosis inducting agents should be lowered or stopped before the treatment with antipsychotic medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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“Bouffée Délirante” Induced by Meditation

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1971 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S533-S533 ◽

Cited By ~ 1

Author(s):

R.A. Baena Mures ◽

L. Niell Galmes ◽

Y. Lázaro Pascual ◽

M.D. Saiz Gonzalez

Keyword(s):

Adverse Events ◽

Female Patient ◽

Literature Search ◽

Case Reports ◽

Psychotic Symptoms ◽

Cultural Syndromes ◽

Vulnerable Patients ◽

Psychotic Reaction ◽

Dsm Iv ◽

Competing Interest

IntroductionMeditation is frequently applied in Western as well as non-Western countries for different purposes; we know little about adverse events. The symptomatology of a meditation-related psychosis appears to show similarities with that we call “bouffée delirante”.MethodsA female patient is described who developed an acute and transient psychosis with polymorphic symptomatology after meditating (Bikram-yoga). We made a literature search for psychotic states related to meditation.ResultsThere are some case reports of psychosis disorder induced by meditation. Some cultural syndromes like Qi-gong appear on DSM-IV as psychotic reaction. In this case, the syndrome is not culture bound.ConclusionsMeditation can act as a stressor in vulnerable patients who may develop a transient psychosis with polymorphic symptomatology (confusion, pananxiety, mood swings and mood dystonic psychotic symptoms) with a short duration.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The Social Defeat Hypothesis of Schizophrenia: an Update

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.068 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S66-S66

Author(s):

E. Van der Ven

Keyword(s):

Psychotic Disorder ◽

Minority Groups ◽

Social Defeat ◽

Autism Spectrum ◽

Psychotic Symptoms ◽

Mesolimbic Dopamine System ◽

Behavioral Expression ◽

Future Challenges ◽

Competing Interest ◽

Socially Excluded

Research provides strong evidence of an elevated risk for developing psychotic symptoms and psychotic disorder among various ethnic and other minority groups. Furthermore, ethnicity may modify the risk for autism-spectrum disorder, but the evidence of this is still thin. Misdiagnosis, selective migration and other methodological artefacts are implausible explanations for the findings on psychotic disorder. Instead, we propose that ‘social defeat’, defined as the chronic experience of being excluded from the majority group, may increase the risk for psychotic disorder by sensitizing the mesolimbic dopamine system. Future challenges lie in connecting the underlying biological mechanisms to behavioral expression in socially excluded groups, as well as in bridging the gap with the clinical field and the wider society by stimulating the implementation of strategies that strengthen the position of minority populations.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Agenesis of the Corpus Callosum in A Patient With Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1813 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S493-S493

Author(s):

J. Nogueira ◽

R. Ribeiro ◽

J. Vieira ◽

R. Sousa ◽

S. Mendes ◽

...

Keyword(s):

Bipolar Disorder ◽

Corpus Callosum ◽

Past History ◽

Case Reports ◽

Manic Episode ◽

Psychotic Symptoms ◽

Major Depressive ◽

Mixed Features ◽

Competing Interest ◽

The Brain

BackgroundThe corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).Case reportA 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.ConclusionThis case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Folie à deux

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2133 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S576-S576

Author(s):

C. Cocho ◽

M. Baquero ◽

I. Vera ◽

J. Alvarez-arenas

Keyword(s):

Psychotic Disorder ◽

Close Association ◽

Rare Condition ◽

Psychotic Symptoms ◽

Mother And Daughter ◽

Folie À Deux ◽

Competing Interest ◽

The Relationship ◽

Shared Psychotic Disorder ◽

Folie A Deux

IntroductionThe induced delusional disorder or folie à deux, is a rare condition characterized by psychotic symptoms at least in two individuals in close association.ObjectivesWe report a case of shared psychotic disorder between mother and daughter. We briefly review both classical and current literature.MethodsWe summarized the results from articles identified via MEDLINE/PubMed using “induced delusional/shared psychotic disorder” as keywords. We report a case of a woman who develops psychotic symptoms characterized by delusions of persecution. Her daughter started, during the first high school grade with referring sexual threats and having delusions of persecution lived by her mother like a fact. They have very symbiotic relationship. Seven years later, the mother has required hospitalization for chronic delusions.ResultsThe term folie à deux was first coined by Lasègue and Falret, they assume the transmission of delusions was possible when an individual dominated the other and existed relative isolation. Recent studies found no significant differences in age and sex, although described higher comorbidity with other psychiatric diseases. Relative to treatment, separation by itself is insufficient; an effective neuroleptic treatment is required.ConclusionsOur case meets criteria for shared psychotic disorder. The daughter, with a ruling attitude who dominates the relationship, was the inducer. The mother showed no resistance in accepting delusions and remains them active after separation. This leads us to consider the possible predisposition to psychotic illness by both patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Vitamin B12 deficiency induced psychosis – a case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1557 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s805-s805 ◽

Cited By ~ 1

Author(s):

A.R. Carvalho ◽

S. Vacas ◽

C. Klut

Keyword(s):

Vitamin B12 ◽

Case Reports ◽

Vitamin B12 Deficiency ◽

The Body ◽

Psychotic Symptoms ◽

Concurrent Administration ◽

Persecutory Delusions ◽

B12 Deficiency ◽

Competing Interest ◽

Psychotic Features

Vitamin B12 is one of the most essential vitamins affecting various systems of the body. Cases of neuropsychiatry disorders due to its deficiency are more common in elderly patients with prevalence of 10–20%. The most common psychiatry symptoms reported in the literature associated with vitamin B12 deficiency was depression, mania, psychotic symptoms, cognitive impairment and delirium. Here, we report a case of vitamin B12 deficiency in a 52-year-old male who presented with psychotic features: persecutory delusions, tactile and auditory hallucinations. Patient had neither recorded psychiatry history nor any drug abuse. Medical history includes hypertension, diabetes mellitus and glaucoma. The patient was not a vegetarian. All relevant laboratory evaluations and head CT were normal except vitamin B12. The patient was treated with antipsychotics (risperidone 3 mg/day) and intramuscular vitamin B12. One week after, there was total remission of psychotic symptoms. In the follow-up during the next four months, psychiatry symptoms did not recur at any time. This case reports a rare case of vitamin B12 deficiency induced psychosis. Although there was concurrent administration of an antipsychotic along with vitamin B12, it underlines the importation of evaluation of vitamin B12 and other potential reversible causes of psychosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Characteristics of 23 cases of animal hoarding in Catalonia (Spain)

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1168 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S677-S677

Author(s):

C. González ◽

P. Calvo ◽

J. Bowen ◽

A. Bulbena ◽

R. Cirac ◽

...

Keyword(s):

Scientific Literature ◽

Case Reports ◽

Cross Cultural ◽

Common Elements ◽

Financial Situation ◽

City Councils ◽

Co Morbidity ◽

Care Health ◽

Competing Interest ◽

Over 40 Years

IntroductionAnimal hoarding is considered an under-reported problem, which affects the welfare of both people and animals. Few reports on animal hoarding are available in scientific literature, particularly outside North America.ObjectivesWe designed a study to analyse cases of animal hoarding in Catalonia.AimsWe wanted to expose the presence and consequences of this disorder in our area and to check for cross-cultural similarities with previous studies in other countries.MethodsData was obtained retrospectively from 23 case reports of animal hoarding in Catalonia collected by city councils and the Catalonian police from 1992 to 2015.ResultsThirty-three people (20 women and 13 men) and 1521 animals, mainly dogs and cats, were involved. Most cases (n = 13) involved a sole animal hoarder. Most cases (n = 14) were chronic (lasting longer than 5 years). Object hoarding co-morbidity was found in most cases (n = 17). All hoarders were over 40-years-old, with half of them aged over 65. Only in 4 cases was an intervention by the healthcare system reported. Most of the hoarders (9 out of 13) actively opposed animal removal. In more than 50% of cases, the hoarder's personal care, health and financial situation were precarious. No awareness of the impaired welfare of the animals was found in most cases.ConclusionsTo the author's knowledge, this is the first study on animal hoarding in Catalonia and one of the few available in Europe. Our results are aligned with previous research, adding evidence of cross-cultural common elements of animal hoarding.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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First psychotic episode on the fifth decade? Differential diagnosis of psychotic symptoms, about a case

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2390 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S635-S635

Author(s):

P. Manzur Rojas ◽

P. Botias Cegarra ◽

A.L. Gonzalez Galdamez ◽

M.I. Ibernon Caballero ◽

M.R. Raposo Hernandez ◽

...

Keyword(s):

Psychotic Disorder ◽

Temporal Lobe ◽

Brain Mri ◽

Response To Treatment ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Complex Partial Seizures ◽

Sensory Aphasia ◽

Competing Interest ◽

Structural Epilepsy

The postictal psychosis is a psychotic disorder that begins shortly after a crisis. Most often it affects patients with partial epilepsy and especially those with temporal lobe epilepsy. The postictal psychosis according to several publications can occur in up to 25% of patients with epilepsy. The psychotic disorder usually occurs within 24–48 hours after, be transient, with good response to treatment with antipsychotics and complete remission of psychotic symptoms. This case is for a woman of 58 years diagnosed with structural epilepsy after brain abscess left temporal intervened in childhood. The patient is being followed by neurology for complex partial seizures with secondary generalization in anti-epileptic treatment. The patient has previous studies of EEG, video EEG and brain MRI, evidence involvement of temporal lobe and hippocampus. The patient is brought to the emergency room after episode of sensory aphasia, unconsciousness and tonic-clonic limb movements, decreasing with diazepam. The patient, during the stay under observation, has auditory hallucinations, that generate anxiety must initiate being him quetiapina and clonazepam orally, yielding partially psychotic disorder, acute intracranial lesions are discarded and the patient is admitted by neurology. The evolution of psychotic disorder with antipsychotic down in a few weeks remaining asymptomatic. Epileptic psychosis is more common in refractory epilepsy. In all cases, you should make a joint approach between psychiatry and neurology, usually they have good response to antipsychotics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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