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

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.

Delayed post-hypoxic leukoencephalopathy: Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s839-s839 ◽  
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.

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

2016 ◽  
Vol 33 (S1) ◽  
pp. S150-S150
Author(s):  
G. Martinez-Ales ◽  
V. Baena ◽  
I. Rubio ◽  
B. Rodriguez-Vega ◽  
V. Bonan ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Schizoaffective Disorder ◽  
Neuropsychiatric Symptoms ◽  
Clinical History ◽  
Psychotic Symptoms ◽  
Antiepileptic Medication ◽  
Complex Motor ◽  
History Of ◽  
Competing Interest ◽  
Symptomatic Remission

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.

Autoimmune limbic encephlitis. A rising differential diagnosis between diseases with psychiatric symptoms

2016 ◽  
Vol 33 (S1) ◽  
pp. S636-S636
Author(s):  
C. Martín Álvarez ◽  
F. Cadenas Extremera ◽  
V. Alonso García ◽  
M. del Valle Loarte ◽  
M. Bravo Arraez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Limbic Encephalitis ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Brain Mri ◽  
Caucasian Woman ◽  
Type I ◽  
Manic Symptoms ◽  
Hyperintense Signal

IntroductionIn psychiatric clinical practice, we can face numerous organic diseases in the differential diagnosis between primary psychiatric disorders. As an example of this, we can see the autoimmune limbic encephalitis(LE), which in a significant percentage of cases begins with psychiatric symptoms. Currently, one of the theories of the origin of the LE is as a idiopathic autoimmune entity, leaving behind the idea of been generated only by a viral or paraneoplastic etiology.ObjectiveTo achieve a better knowledge about this underdiagnosed entity, presenting a case of an anti-LGI1 limbic encephalitis.CaseA 60-year-old Caucasian woman who starts with neuropsychiatric symptoms as: behavioral disorders, manic symptoms, memory impairment and attention deficit.ResultsFinally, the diagnosis was confirmed when the patient had positive results in both serum and CSF samples for anti-LGI1 antibodies. Gastric neuroendocrino tumour type I was discovered. Neither paraneoplasic syndrome nor onconeuronal antibodies were shown. A thin hyperintense signal was identified in the left hippocampus using a brain MRI. Despite the patient had been treated with corticosteroids, immunosuppressants and immunoglobulins, she still showed positive antibodies in CSF samples with poor clinical results, especially psychiatric symptoms. The patient required one psychiatric hospitalization due to reference and persecutory delusions and manic symptoms.ConclusionOur patient had an unsatisfactory evolution with little response to immune treatment. Given the possible underdiagnosis of this condition, the importance of a differential diagnosis and an early treatment, we consider that there is an important need for a greater knowledge and scientific divulgation of this clinical entity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Isolated Hallucination as a Consequence of SARS-CoV-2 Infection in a 10-year-old Child

2021 ◽  
pp. 135910452110618
Author(s):  
Apollónia Pleszkó ◽  
Annamária Pauleczki ◽  
Ignác Óvári ◽  
József Óvári ◽  
Péter Hauser
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Psychiatric Disorders ◽  
Healthy Child ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Corticosteroid Treatment ◽  
Age Group

Spectrum of childhood symptoms caused by SARS-CoV-2 (severe acute respiratory syndrome-2) infection is widening. In contrast to adulthood, where psychiatric disorders caused by SARS-CoV-2 infection are widely known, recognition of such cases in childhood is still quite rare. Recurrent isolated hallucinations caused by SARS-CoV-2 infection in the absence of other neuropsychiatric symptoms are not yet described in this age group. SARS-CoV-2 infection was confirmed as a cause of recurrent isolated hallucinations in a 10-year-old child, which have most likely disappeared as a consequence of corticosteroid treatment. SARS-CoV-2 infection should also be considered in case of an otherwise healthy child with emerging psychiatric symptoms, which may be cured by corticosteroids.

The New Great Imitator – Neuropsychiatric Symptoms of Lyme Disease

2017 ◽  
Vol 41 (S1) ◽  
pp. S232-S232
Author(s):  
M.C. Cochat Costa Rodrigues ◽  
I. Moreira ◽  
M.J. Peixoto ◽  
C. Silveira
Keyword(s):  
Nervous System ◽  
Lyme Disease ◽  
Antibiotic Treatment ◽  
Mental Health Professionals ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Psychiatric Disease ◽  
The Central Nervous System ◽  
Competing Interest ◽  
Possible Cause

IntroductionLyme disease, caused by the spirochete Borrelia burgdorferri as recognized as a possible cause of multisystemic signals and symptoms, including symptomatology of the central as well as the peripheral nervous system.ObjectivesIdentification of neuropsychiatric symptoms associated with Lyme disease.MethodsLiterature review in the light of researched articles published in Pubmed/Medline as well as related bibliography.ResultsSince the identification of the etiology of syphilis in the early twentieth century, mental health professionals consider the fact that serious psychiatric symptoms can be caused by infections of the central nervous system and that early antibiotic treatment can prevent permanent neurological/psychiatric damage. Syphilis was known as “the great imitator” because its multiple manifestations mimic other known diseases. In recent years, a new epidemic, also with multiple manifestations emerged–Lyme disease, also known as the “new great imitator”. Like syphilis, Lyme disease may be associated with neuropsychiatric symptoms, which means that often these cases are initially referred for psychiatric services, before another diagnosis is made. The incorrect assessment of these patients as individuals with functional psychiatric disease can result in a delay in the start of antibiotic treatment and may cause serious neurological and psychiatric damage.ConclusionsAccording to the review, the authors propose that in the evaluation of acute psychiatric disease or atypical chronic disease, with poor therapeutic response, Lyme disease should be considered and ruled out, especially if there is epidemiological context and absence of psychiatric family antecedents.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Occurrence of neuropsychiatric symptoms and psychiatric disorders in mild Alzheimer's disease and mild cognitive impairment subtypes

2010 ◽  
Vol 22 (4) ◽  
pp. 629-640 ◽  
Author(s):  
Fulvia Di Iulio ◽  
Katie Palmer ◽  
Carlo Blundo ◽  
Anna Rosa Casini ◽  
Walter Gianni ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Psychiatric Disorders ◽  
Neuropsychiatric Symptoms ◽  
Neuropsychiatric Disorders ◽  
Structured Interviews ◽  
Night Time ◽  
Amnestic Mci

ABSTRACTBackground: Neuropsychiatric disorders are common in cognitively impaired older persons, and associated with institutionalization and caregiver stress in Alzheimer's disease (AD). Few studies have compared the occurrence of both psychiatric disorders and neuropsychiatric symptoms in patients with AD and mild cognitive impairment (MCI) subtypes. We aimed to investigate the frequency of psychiatric disorders and neuropsychiatric symptoms in AD and MCI patients, compared to controls.Methods: We included 245 outpatients of a memory clinic in Rome, Italy (119 AD; 68 multidomain-MCI; 58 amnestic-MCI) and 107 controls. Categorical disorders of depression and apathy were diagnosed with structured interviews. Symptoms were evaluated with the Neuropsychiatric Inventory (NPI). The odds ratios (OR) of patients having neuropsychiatric symptoms compared to controls were calculated with logistic regression, adjusted for sociodemographic and clinical variables.Results: A large proportion of AD (49.6%) and multidomain-MCI (44.1%) patients had depression disorder. Apathy disorder was common in AD (51.3%) but less frequent in amnestic-MCI (6.9%) and multidomain-MCI (14.7%). AD patients were three times more likely to have depression disorders (OR = 3.0, CI = 1.1–7.6) or apathy (OR = 16.9, CI = 4.6–61.8) compared to amnestic-MCI, and seven times more likely to have apathy disorder than multidomain-MCI (OR = 7.5, CI = 3.0–19.2). After apathy and depression, the most prevalent neuropsychiatric symptoms in AD and MCI were anxiety, agitation, irritability, night-time behaviors, and appetite disturbances. There was an increasing prevalence of many neuropsychiatric symptoms with increasing severity of cognitive syndromes.Conclusions: Clinicians should consider the relevance of neuropsychiatric disorders and symptoms in patients with cognitive disturbances, and incorporate a thorough psychiatric examination in the evaluation of patients.

scholarly journals Acute Psychosis as Major Clinical Presentation of Legionnaires’ Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Ricardo Coentre ◽  
Amílcar Silva-dos-Santos ◽  
Miguel Cotrim Talina
Keyword(s):  
Legionella Pneumophila ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Lower Lobe ◽  
Epidemiological Data ◽  
Clinical History ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Legionnaires Disease ◽  
The Right

We report a case of a 61-year-old woman who presented with acute psychosis as a major manifestation of Legionnaires’ disease in the absence of other neuropsychiatric symptoms. Clinical history revealed dry cough and nausea. Observation showed fever and auscultation crackles in the lower lobe of the right lung. Laboratory testing demonstrated elevated C-reactive protein and lung chest radiograph showed patchy peribronchial and right lower lobe consolidation. Soon after admission, she started producing purulent sputum. Epidemiological data suggestedLegionella pneumophilaas possible cause of the clinical picture that was confirmed by urinary antigen detection and polymerase chain reaction of the sputum. She was treated with levofloxacin 750 mg/day for 10 days with complete remission of pulmonary and psychiatric symptoms. She has not had further psychotic symptoms.

Psychiatric consultations in the emergency room: Focus on suicide attempters with and without longitudinal psychiatric disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S599-S599 ◽  
Author(s):  
C. Delicato ◽  
S. Di Marco ◽  
E. Gattoni ◽  
I. Coppola ◽  
A. Venesia ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Disorders ◽  
Psychiatric Symptoms ◽  
Statistical Significance ◽  
Clinical History ◽  
Suicide Attempters ◽  
History Of ◽  
Previous Contact

IntroductionThe role of mental illness in the pathway leading to suicide is widely discussed in the literature. Nonetheless, the debate about this issue is open, both from a clinical and philosophical point of view.AimsThe purpose of the present study was to compare suicide attempters with and without a history of psychiatric disorder, in order to highlight the possible differences between the two groups, with a specific focus on intent to die and methods of the attempt.MethodsData from all ER referrals undergoing a psychiatric consultation in the period 2008–2015 at the Maggiore della Carità Hospital, Novara, Italy, were gathered. Comparison of qualitative data was performed by means of the Chi2 test. Statistical significance was set at P ≤ 0.05.ResultsWe have already gathered data from more than 2000 ER psychiatric consultations, including 495 suicide attempters. Preliminary results suggest that these kinds of behaviours are more common in subjects without psychiatric disorders but with clinical history of previous contact with mental health services and in psychopharmacological therapy. Reasons for self-harming are associated with relational problems rather than psychiatric symptoms. Among Axis II diagnoses, almost half of cases are affected by histrionic personality disorder.ConclusionsThe results described above should be considered as preliminary, as data collection and statistical analyses are still ongoing. Anyway, the observed correlation between previous contact with mental health services, socio-relational issues and suicide attempt, and the significant frequency of attempts in histrionic personality disorders seem to be particularly interesting. Implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case report of mansonellosis with neuropsychiatric symptoms

2017 ◽  
Vol 41 (S1) ◽  
pp. s505-s505
Author(s):  
R. Sánchez González ◽  
D. Maia Asseiceiro ◽  
R. Torres Miravet
Keyword(s):  
Medical History ◽  
Clinical Case ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Physical Symptoms ◽  
Blood Film ◽  
World Population ◽  
The European Union ◽  
Tropical Regions ◽  
Wbc Count

IntroductionAccording to the WHO, tropical diseases affect 1/5 of the world population, being increasingly frequent in Europe. Most of these diseases produce mainly physical symptoms, but the appearance of accompanying neuropsychiatric symptoms are not uncommon.ObjectiveTo present a clinical case of mansonellosis with neuropsychiatric symptoms.Clinical caseTwenty-two-year-old man from Equatorial Guinea, resident in the European Union for 3 years without psychiatric history. His medical history included recurrent malaria, syphilis treated with penicillin and he was HBsAg carrier.He presented with a 10 month history of headache, pruritus, retrograde amnesia, episodes of anxiety and persecutory delusions. Previously he had gone to the emergency room several times. Cranial CT scan showed no abnormalities. Anxiolytic treatment with benzodiazepines was started, with partial response of the symptoms.The blood tests revealed a WBC count of 62 × 10E9/L leukocytes with 11% eosinophils, IgE 5242 IU/mL and IgG 1740 mg/dL. Given the suspicion of filarial infection, a thick blood film was done, the result being positive for mansonella perstans. He was administered treatment with albendazole 400 mg/12 h for 10 days and ivermectin in single dose. One month after start of treatment the patient was asymptomatic with complete resolution of the neuropsychiatric symptoms and correction of eosinophilia.ResultsThe patient's origin, his medical history and the typical symptoms of parasitosis should raise the suspicion of an infectious origin of the neuropsychiatric symptoms.ConclusionsThe patients from tropical regions with neurological and/or psychiatric symptoms should undergo comprehensive diagnostic workup to rule out an infectious disease as a possible cause.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Atypical cognitive dysfunction due to brain damage: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S536-S536
Author(s):  
C.A. Welte-Santana ◽  
A.F. Macedo de Queiroz ◽  
N. Merola Fontoura ◽  
C. Lima de Melo ◽  
M. Ribeiro Garcia de Rezende ◽  
...  
Keyword(s):  
Retrograde Amnesia ◽  
Brain Mri ◽  
Brain Lesion ◽  
Clinical History ◽  
Public Hospitals ◽  
Patient Reported ◽  
History Of ◽  
Organic Brain ◽  
Competing Interest ◽  
One Year

IntroductionThe diagnosis of a primary psychiatric disorder requires the exclusion of an organic etiology. However, Brazilian public hospitals commonly lack resources. Diagnostic precision requires also the congruence of the clinical history and the natural history of the investigated disorder.ObjectivesThis study reports a rare case of hallucinations and retrograde amnesia, due to organic brain lesion but without other cognitive impairments.Case presentationFifty-three-years-old male Brazilian, was evaluated after one year in Brazil after being missing for 25 years in USA. Encountering his family, he did not recognize his mother, did not remember his life in Brazil, including his infancy, nationality and mother language. He was found as a homeless in poor hygiene. In the exam, he only presented retrograde amnesia, without any disturbances of fixation memory, intelligence, formal thought, affect or psychomotor function. Patient reported hallucinations. Blood tests showed no abnormalities. EEG showed diffuse slow rhythms. Brain MRI showed cortical and hippocampal atrophy. After weekly evaluations for 5 months, he remained stable despite lack of prescription. Some weeks after MRI, patient reported frequent alcohol and inhalant use when missing. No hints of secondary gain were found until present.DiscussionOrganic etiology was suspected due to atypical presentation: hallucinations, evocative amnesia, with no further cognitive and affect disturbances. This is not compatible with schizophrenia, dementia or dissociative disorder. The brain abnormalities and recent data highly suggest this etiological hypothesis.ConclusionSince this clinical presentation does not fit into any specific psychiatric category, the case will continue to be studied.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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