Kleine–Levin syndrome. A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s856-s856
Author(s):  
S. Sanz Llorente ◽  
Z. González Vega ◽  
P. Bernal Romaguera ◽  
A.I. Ojeda Martinez ◽  
T. Ventura Faci ◽  
...  
Keyword(s):  
Case Report ◽  
Sleep Disorder ◽  
Memory Loss ◽  
Poor Performance ◽  
Behavioral Disorder ◽  
Psychotic Episode ◽  
Stressful Situation ◽  
Not Otherwise Specified ◽  
Competing Interest ◽  
Similar Episode

IntroductionNowadays, 30% of the Spanish population suffers from some form of sleep disorder, occupying much of the visits to a psychiatrist. Sleep disorders are not a serious condition by itself, but have serious implications in daily life: physical exhaustion, poor performance, daytime sleepiness. Insomnia is a most common sleep disorder, however, hypersomnia must also be considered due to the limitations that it causes.ObjectiveBy the description of case report, we will carry out a review of the syndrome Kleine Levine.MethodsCase report.ResultsA case of Kleine–Levin syndrome in a 23-year-old male is described. The episodic disorder was characterized by excessive sleep, voracious appetite, hyper-sexuality, irritability and memory loss. Among its history, he included a psychotic episode in childhood and an episode of behavioral disorder caused by a stressful situation. His partner refers a similar episode of hypersomnia last year that was self-limiting in 15 days and he did not go to the doctor. Patients often act normal between episodes. Remission was spontaneous. Prospects, for organic aetiology, differential diagnosis. However, arises additional tests (analytical, brain CT, EEG…) resulted no pathological. Patient fulfilled the criteria for KLS, but due to the rarity of the disorder he was previously diagnosed as psychosis not otherwise specified.ConclusionsThis case report aim to highlight that KLS though considered a rare disorder but not uncommon and lack of enough available research data is likely to be responsible for missed or erroneous diagnosis; thus we require more systematic studies regarding etiologies and treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The relevance of Paraphrenia: Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S699-S699
Author(s):  
M. Peixoto ◽  
M.M. Oliveira ◽  
M. Bragança
Keyword(s):  
Case Report ◽  
Psychotic Episode ◽  
Psychiatric Ward ◽  
Cognitive Deterioration ◽  
Medical Work ◽  
First Psychotic Episode ◽  
Not Otherwise Specified ◽  
Personality Changes ◽  
Competing Interest ◽  
Disorganized Speech

IntroductionParaphrenia is a chronic psychotic disorder with a better-preserved affect and minimal disturbances of emotion and volition and a much less cognitive deterioration and personality changes.Objectives/aimsTo report a case with probable Paraphrenia and to highlight the importance of the differential diagnosis in a first psychotic episode.MethodsCase report and systematic review of the literature.ResultsWe report a case of a 41-year-old man without a past psychiatry history that was led to the psychiatry emergency department (PED), by officers, because of strange behaviour and aggressiveness towards his family. In the PED the patient said that his real father was his father-in-law and that his ex-wife was his sister. His mental exam revealed disinhibition, disorganized speech with slightly mood elation, persecutory, mystic and influential delusions with various delusional interpretations. After being admitted to the psychiatric ward, in compulsatory care, he began treatment and a medical work up was completed. According to the family the patient had begun this strange behaviour four years prior. During the hospitalization it became clear that the patient was experiencing imaginative-confabulatoric multi-thematic delusions, sometimes interviewer guided, without showing cognitive deterioration and retaining his personality.ConclusionsThe diagnosis of atypical psychosis or psychosis not otherwise specified is not satisfactory since it agglutinates different conditions together. Paraphrenia is a well-established concept and should be used in order to define a group of psychotic patients who exhibited characteristic symptoms of schizophrenia, minus personality impairment and slower cognitive decline.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Diagnostic Stability in First Psychotic Episode after 5 years follow-up

2017 ◽  
Vol 41 (S1) ◽  
pp. S197-S197
Author(s):  
M. Mota-Oliveira ◽  
M.J. Peixoto ◽  
I. Ferraz ◽  
E. Pereira ◽  
R. Guedes ◽  
...  
Keyword(s):  
Health Clinic ◽  
Admission Diagnosis ◽  
Psychotic Episode ◽  
Diagnostic Stability ◽  
First Psychotic Episode ◽  
Not Otherwise Specified ◽  
Competing Interest ◽  
Drop Outs

IntroductionThe diagnosis of psychosis is based on the presence or absence of characteristic symptoms. The presence of such symptoms varies during the course and treatment, raising the question of diagnostic stability after a first psychotic episode.Aims and objectivesThe aim of this study is to evaluate the diagnostic stability after a first psychotic episode in the long term (five years after the first inpatient admission).MethodologyA retrospective study that included patients with first psychotic episode between 2007 and 2011 admitted to the inpatient unit of the psychiatry and mental health clinic of São João hospital center, Oporto, Portugal and re-evaluation of the diagnosis after five years.ResultsWe included 60 patients with a first psychosis episode, 22 of which were drop-outs after five years. Of the 38 patients evaluated, it was possible to see that after 5 years 68.4% (n = 26) maintained the same diagnosis during follow-up. In particular, the diagnosis of schizophrenia was kept in 83.3% of patients after 5 years (n = 15, 18 patients with the diagnosis of schizophrenia after first admission). Diagnosis of acute and transient psychotic disorder and psychosis not otherwise specified were the least stable diagnosis after 5 years.ConclusionsThe diagnosis after a first psychotic episode has important therapeutic and prognostic implications. The presence of characteristic symptomatology, with periods of partial or total remission between subsequent episodes emphasizes the need for regular monitoring, since this group of patients appears to be more vulnerable to changes in diagnosis over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Organic Personality Disorder and Diogenes Symptoms: Case Report and Current Status of the Issue

2016 ◽  
Vol 33 (S1) ◽  
pp. S507-S507
Author(s):  
N. Rodríguez Criado ◽  
J.F. Cruz Fourcade ◽  
P. Muñoz-Calero Franco ◽  
B. Sánchez Sánchez ◽  
R. Martín Aragón ◽  
...  
Keyword(s):  
Case Report ◽  
Personality Disorder ◽  
Current Knowledge ◽  
Review Literature ◽  
Behavioral Disorder ◽  
Current Status ◽  
Early Management ◽  
Diogenes Syndrome ◽  
Competing Interest ◽  
Organic Personality Disorder

ObjectiveTo review the current knowledge about Diogenes symptoms and organic personality disorder through systematic review of the literature and the analysis of a case.MethodsCase report. Review. Literature sources were obtained through electronic search in PubMed.gov database of 10 last years.ResultsBackground: Diogenes syndrome is a behavioral disorder characterized by severe self-neglect, hoarding, domestic dirt, and lack of shame regarding one's living state. Patients may present due to a range of reasons, few studies has been described hoarding symptoms secondary to brain injury. Early management could reduce their high-mortality condition.Case presentationWe present a case of a 67-year-old Caucasian female known with a organic personality disorder secondary to a head trauma with obsessive hoarding symptoms. After being hospitalizated, we were authorized to explore her personal items trough photographs. Her handbag and her house were filled with rubbish and rotting food. Our patient had no insight into any self-hygiene or public health problems.ConclusionsInformation of the characteristics of Diogenes syndrome can help in earlier recognition of such persons, in order to decrease their morbidity and mortality.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals A large ovarian steroid cell tumor‐not otherwise specified with a unique combination of benign and malignant features as a challenging cause of oligomenorrhea and hirsutism in a 21‐year‐old Syrian female: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sawsan Ismail ◽  
Munawar Hraib ◽  
Rana Issa ◽  
Thanaa Alassi ◽  
Zuheir Alshehabi
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Virgin Female ◽  
Cell Tumor ◽  
Diagnostic Methods ◽  
Unique Combination ◽  
Ovarian Steroid ◽  
Not Otherwise Specified ◽  
Steroid Cell Tumor ◽  
Rare Category

Abstract Background Ovarian steroid cell tumors represent a rare category of sex cord-stromal tumors that constitute less than 0.1% of all ovarian tumors. These neoplasms are classified into three main subtypes according to the cell of origin: Leidyg cell tumors, stromal luteomas, and steroid cell tumors not otherwise specified (SCTs-NOS). The latter subtype is defined as a neoplasm of an uncertain lineage that mostly affects middle-aged women, whereas it’s rare in younger ages. Case presentation We report a case of a 21-year-old virgin female who presented to our hospital with complaints of mild abdominal pain, hirsutism, and oligomenorrhea for more than a year. Before her current admission, the patient had attended an external gynecologic clinic where she had been prescribed oral contraceptives to regulate her periods. Nevertheless, on presentation to our institution, physical examination revealed abdominal tenderness with a palpable pelvic mass and mild hirsutism in the thigh. Ultrasonography demonstrated a large left ovarian mass measuring 154 × 104 mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy was performed, and interestingly, pathologic examination of the large aforementioned mass alongside with immunohistochemical correlation revealed the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a unique combination of benign and malignant features. Conclusions Although ovarian steroid cell tumors represent a rare category, they must be considered in the differential diagnosis for mild virilization symptoms in young females due to the importance of early diagnosis and management. In this manuscript, we aimed to present the first case report from Syria that highlights the crucial role of detailed morphological examination for challenging cases despite the difficulties in differential diagnosis, and the absence of ancillary techniques. Furthermore, we managed to discuss a brief review of diagnostic methods, histological characteristics, and treatment recommendations.

Cerebellar atrophy supporting diagnosis of alcohol dependence: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S311-S311
Author(s):  
F. Pavez Reyes ◽  
M. Sánchez ◽  
E. Moral ◽  
M. Terradillos ◽  
N. López ◽  
...  
Keyword(s):  
Case Report ◽  
Alcohol Dependence ◽  
Cerebellar Atrophy ◽  
Clinical Suspicion ◽  
Gamma Glutamyl Transferase ◽  
The Family ◽  
Other Information ◽  
Diagnostic Hypothesis ◽  
Competing Interest ◽  
Glutamyl Transferase

Chronic use of alcohol is a known cause of cerebellar atrophy. This finding could be a valuable diagnosis support when there are not other information sources. In this case report, we describe a 65-year-old male patient who was referred from primary care to specialized consultation because a depressive syndrome it was unresponsive to treatment with desvenlafaxine and lorazepam. In psychopathological exploration we found overvalued ideas of suffering some kind of injury and damage by the family, which oriented the diagnostic hypothesis of delusional disorder with secondary mood symptoms, although the clinical suspicion of abuse of alcohol was proposed as a differential diagnosis. The continuing minimization and denial of consumption by the patient as well as their reluctance to incorporate an external informant made that the workup was a key element to elucidate the diagnosis. We found a discrete increase in transaminases, gamma glutamyl transferase and alkaline phosphatase. Magnetic resonance imaging showed cerebellar atrophy (vermian and, in a lesser extent, in both hemispheres). Once the patient was confronted with these results, he agreed to disclose his problem, which fulfilled alcohol dependence criteria. After that, he accepted to initiate treatment and detoxification in a specialized unity.ConclusionsAlthough psychiatric diagnosis is based on the clinical features and the exclusion of associated medical conditions, in this case the workup provided support to our clinical suspicion, favouring recognition of the problem and willingness to treatment by the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Chronic psychiatric changes in a severe post-traumatic brain injury patient

2016 ◽  
Vol 33 (S1) ◽  
pp. S318-S318
Author(s):  
J. Silva ◽  
J. Mota ◽  
P. Azevedo
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Social Impairment ◽  
Mood Stabilizers ◽  
Work Related ◽  
Randomized Controlled Studies ◽  
Injury Patient ◽  
Post Traumatic ◽  
Competing Interest

IntroductionSevere traumatic brain injury (TBI) causes neuropsychiatric disturbances. Emotional and personality disturbances seem to cause much more seriously handicap than residual cognitive or physical disabilities. The prognosis may be poor associated with marked social impairment, so a multidisciplinary approach team is required in order to improve patient's quality of life and reintegration in family and society.ObjectivesTo summarize the latest literature about this field and to present a case report.AimTo explore and learn more about chronic psychiatric changes in severe post-traumatic brain injury and share with the scientific community how challenging the approach of this entity can be.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “traumatic brain injury” and “psychiatric changes”. A case report is presented.ResultsAlthough SSRI, benzodiazepines, mood stabilizers and antipsychotics are commonly used, new options are reported such as methylphenidate and cholinesterase inhibitors. The presented patient, a 27-year-old male, began with neuropsychiatric disturbances after a work-related fall from 9 meters high: convulsions and alcohol compulsive drinking. Three years have passed and his changes are still difficult to approach. Besides other medication, such as benzodiazepines and mood stabilizers, flufenazine injections and naltrexone seemed to be determinant in his behaviour and mood stabilization. He is also on a long-term alcoholism programme.ConclusionsAlthough the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed, such as randomized-controlled studies to study new pharmacological and non-pharmacological approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Multiple Faces of Carcinoid Tumor: Performance Characteristics of Low-Grade Neuroendocrine Carcinoma Metastatic to the Liver in an Educational Interlaboratory Slide Comparison Program

2011 ◽  
Vol 135 (3) ◽  
pp. 354-360
Author(s):  
Amy C Clayton ◽  
Patricia G Wasserman ◽  
Rhona J Souers ◽  
Beth Anne Chmara ◽  
Andrew Renshaw ◽  
...  
Keyword(s):  
Single Cell ◽  
Neuroendocrine Carcinoma ◽  
Benign Neoplasm ◽  
Poor Performance ◽  
Specific Reference ◽  
Low Grade ◽  
Cell Pattern ◽  
Not Otherwise Specified ◽  
Glass Slides ◽  
Large Clusters

Abstract Context.—Cytologic features of low-grade neuroendocrine carcinoma are well described in primary sites. There are fewer reports of the cytologic features specific to metastatic liver lesions or the frequency of misdiagnosis. Objective.—To identify discriminating cytologic features and characterize the rate of misdiagnosis of low-grade neuroendocrine tumors metastatic to the liver in an educational interlaboratory slide comparison program. Design.—Glass slides with the specific reference diagnosis of metastatic low-grade neuroendocrine tumor involving liver were circulated to 175 laboratories, with 575 participant responses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Eight specific cytologic features were assessed to identify predictors of poor performance (>10% misdiagnosis). Results.—There was an exact match diagnosis in 496 of 575 responses (86%); 555 of 575 responses (96.5%) were correctly identified as malignant. Incorrect responses included adenocarcinoma (27), hepatocellular neoplasm (21), small cell carcinoma (11), benign neoplasm not otherwise specified (6), benign liver (3) and inflammation (3). Three features were significantly associated with the misdiagnosis of adenocarcinoma: presence of large clusters (P  =  .02), lack of single-cell pattern (P  =  .02), and lack of stripped nuclei (P  =  .01). Conclusion.—Participants often recognize metastatic low-grade neuroendocrine carcinoma in an educational glass-slide program. Adenocarcinoma was the most common incorrect diagnosis, especially in the presence of large cellular clusters or absence of a single-cell pattern or stripped nuclei.

Case report: Hallucinations as depressive equivalents

2016 ◽  
Vol 33 (S1) ◽  
pp. S154-S154
Author(s):  
E. Garcia ◽  
I. Vicente ◽  
R. Martínez
Keyword(s):  
Social Support ◽  
Case Report ◽  
Affective Disorder ◽  
Normal Development ◽  
The Other ◽  
Social Intervention ◽  
Common Symptom ◽  
Difficult Diagnosis ◽  
Competing Interest ◽  
Short Time

We comment the case of a 12 years old girl who started with visual and auditive hallucinations. Hallucinations are not a common symptom between children. They may also be linked to many conditions, some of them with poor outcome as schizophrenia. Symptoms appeared in a short time, after a previous normal development. She talked about a man who followed her and that was always behind, she also had heard some insults of undeterminated voices. These symptoms were just of one-month duration and made her feel anxious and very afraid. After a normal organical study and a first proposal of medication they asked for our consultation. We found that the patient was alone at home every afternoon. Family, from other country, hadn’t any social support, and the father had had to travel away some days before the child began to suffer hallucinations. Suspecting an affective disorder as the basis of anxious symptoms, and hallucinations as a cultural presentation of them, we started with a social intervention mixed with support therapy. After some sessions the patient could talk about her loneliness and fears, disappearing the other symptoms. We will resume this case and literature about other cultural presentations that may difficult diagnosis or treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Incest in the Schizophrenic patient: Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S588-S588
Author(s):  
M. Mezghani ◽  
F. Fekih-Romdhane ◽  
F. El Ghali ◽  
M. Zghal ◽  
G. Jmii ◽  
...  
Keyword(s):  
Case Report ◽  
Sexuality Education ◽  
Clinical Observation ◽  
Criminal Responsibility ◽  
Patient Case ◽  
Annihilation Anxiety ◽  
Psychiatric Expertise ◽  
Competing Interest ◽  
The Individual ◽  
The Relationship

IntroductionIncest may be defined as sexual relations between close blood relatives. Legally, incest and sexual aggression toward minors are classified as a criminal behaviour. Tunisia is among the countries from which incest cases are rarely reported.Objectives and methodThe aim of this study is to investigate the relationship between the psychotic structure and incest, and to describe the individual, clinical, and criminal traits of the incestuous father through clinical observation.Case reportMr T.G is 46 years old. He is married and has six daughters. His wife appears to be passive, and largely dependent on her husband. Mr T.G has had incestuous relationships, initially, with his two eldest daughters. The acts were followed by the mother's complicit silence and the non-denunciation of the daughters. Two years later, he starts an incestuous behavior with his third daughter. Incest took place in the context of delusion. The patient was convinced that he is responsible of his daughters’ sexuality education. He develops an incoherent theory of purification with a tendency towards morbid rationalism. It is only after four years of insufferable paternal incestuous relationships that the third daughter filed a complaint to the police. A psychiatric expertise concluded that the accused is exempt from criminal responsibility.ConclusionIncest is a multi-faceted phenomenon, which makes its approach, comprehension, and treatment quite complex. For a psychotic patient incest is a means to deny alterity by crushing other. It also allows him to find, in this complete power, control over his annihilation anxiety.Disclosure of interestThe authors have not supplied their declaration of competing interest.

No effect of cognitive performance on post-intervention improvement in emotion recognition

2017 ◽  
Vol 41 (S1) ◽  
pp. S190-S190
Author(s):  
V.P. Bozikas ◽  
S. Tsotsi ◽  
A. Dardagani ◽  
E. Dandi ◽  
E.I. Nazlidou ◽  
...  
Keyword(s):  
Emotion Recognition ◽  
Cognitive Performance ◽  
Neuropsychological Test ◽  
Emotion Perception ◽  
First Episode ◽  
Psychotic Episode ◽  
Post Intervention ◽  
Basic Emotions ◽  
The Difference ◽  
Competing Interest

Deficits in emotion perception in patients with first episode of psychosis have been reported by many researchers. Till now, training programs have focused mainly in patients with schizophrenia and not in first psychotic episode (FEP) patients. We used a new intervention for facial affect recognition in a group of 35 FEP patients (26 male). The emotion recognition intervention included coloured pictures of individuals expressing six basic emotions (happiness, sadness, anger, disgust, surprise, fear) and a neutral emotion. The patients were trained to detect changes in facial features, according to the emotion displayed. A comprehensive battery of neuropsychological tests was also administered, measuring attention, memory, working memory, visuospatial ability and executive function by using specific tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). We tried to explore whether cognitive performance can explain the difference noted between the original assessment of emotion recognition and the post-intervention assessment. According to our data, overall cognitive performance did not correlate with post-intervention change in emotion recognition. Specific cognitive domains did not correlate with this change, either. According the above mentioned results, no significant correlation between neuropsychological performance and post-intervention improvement in emotion recognition was noted. This finding may suggest that interventions for emotion recognition may target specific processes that underlie emotion perception and their effect can be independent of general cognitive function.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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