Delusions and Hallucinations as First Symptoms of Frontotemporal Dementia: A Case Report of a 48-Year Old Male

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Malta ◽  
C. Torres ◽  
T. Faria ◽  
S. Almeida
Keyword(s):  
Differential Diagnosis ◽  
Frontotemporal Dementia ◽  
Frontotemporal Lobar Degeneration ◽  
Psychotic Disorders ◽  
Functional Neuroimaging ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Psychiatric Ward ◽  
Personality Changes ◽  
Behavior Impairment

Frontotemporal dementia (FTD) generally has a presenile onset, behavioral manifestations dominate the clinical picture during which cognitive functions are still relatively intact. Therefore, particularly in the early stages of FTD it is difficult to differentiate this type of dementia from other types of dementia and psychiatric disorders.Although most patients with frontotemporal dementia (FTD) present with neuropsychiatric symptoms, the frequency of psychotic symptoms, assumed to be rare, is still unclear possibly due to limited temporal-limbic involvement in this disorder. We report the case of a 48-year old man admitted in a psychiatric ward with delusions and hallucinations.Significant behavior impairment was present related to social isolation and personality changes. Structural and functional neuroimaging methods disclosed asymmetric frontal and bitemporal damage, mainly on the left. Differential diagnosis consisted of psychotic disorders as well as one of the subtypes of the frontotemporal lobar degeneration group.

scholarly journals Neurofilaments as Emerging Biomarkers of Neuroaxonal Damage to Differentiate Behavioral Frontotemporal Dementia from Primary Psychiatric Disorders: A Systematic Review

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 754
Author(s):  
Vincent Davy ◽  
Julien Dumurgier ◽  
Aurore Fayosse ◽  
Claire Paquet ◽  
Emmanuel Cognat
Keyword(s):  
Psychiatric Disorders ◽  
Frontotemporal Dementia ◽  
Frontotemporal Lobar Degeneration ◽  
Social Cognitive ◽  
Functional Neuroimaging ◽  
Short Review ◽  
Clinical Syndrome ◽  
Light Chains ◽  
Neurofilament Light ◽  
Personality Changes

The behavioral variant of frontotemporal dementia (bvFTD) is a clinical syndrome resulting from various causes of neuronal demises associated with frontotemporal lobar degeneration. Symptoms include behavioral and personality changes, social cognitive impairment, and executive function deficits. There is a significant clinical overlap between this syndrome and various primary psychiatric disorders (PPD). Structural and functional neuroimaging are considered helpful to support the diagnosis of bvFTD, but their sensitivity and specificity remain imperfect. There is growing evidence concerning the potential of neurofilaments as biomarkers reflecting axonal and neuronal lesions. Ultrasensitive analytic platforms have recently enabled neurofilament light chains’ (NfL) detection not only from cerebrospinal fluid but also from peripheral blood samples in FTD patients. In this short review, we present recent advances and perspectives for the use of NfL assessments as biomarkers of neuroaxonal damage to differentiate bvFTD from primary psychiatric disorders.

scholarly journals Pathological laughing and psychotic disorder: the medical evaluation of the Joker

2020 ◽  
Vol 120 (6) ◽  
pp. 1379-1382
Author(s):  
Alexis Demas ◽  
David Tillot
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Social Withdrawal ◽  
Neuropsychiatric Symptoms ◽  
Public Health Problem ◽  
Psychotic Symptoms ◽  
Left Frontal Lobe ◽  
Physically Abused ◽  
Medical Evaluation ◽  
Origin Story

Abstract In the psychological thriller film Joker, released in 2019 and starring Joaquin Phoenix in the first role, another possible origin story for this iconic character is reported. Above all, it brings us medical elements for the understanding of the development of this complex character. Contrary to other interpretations, we discover a lonely, timid and uncharismatic man (Arthur Fleck). He seems to be suffering from psychobehavioral disorders and seems depressed. There is a strangeness in his behavior along with social withdrawal. He suffers from fits of laughter that occur at socially inappropriate times. He also suffers from psychotic symptoms with visual delusions. We learn through the film that he was a beaten child, psychologically and physically abused with severe traumatic brain injury (TBI). The uncontrollable outbursts of laughter, behavioral and psychotic disorders followed these elements. As a neurologist, I was intrigued by these symptoms. I have explored the neuropsychiatric symptoms complicating TBI from which he seems to suffer and which have been reported in the literature. We can assume that the Joker is suffering from neuropsychiatric sequelae related to childhood TBI involving the frontotemporal regions and, in particular, the lateral aspect of the left frontal lobe. The movie Joker has medical significance and covers social aspects of medicine and health care. First, it allows us to discuss whether psychotic disorder due to TBI should be considered a neurobiological syndrome. More broadly, albeit fictitious, it asks us about the management of patients with neuropsychiatric illness, which is a public health problem. It also reminds us that semiological descriptions of patients with neuropsychiatric disorders have served as inspiration for many authors.

Psychosis and dementia: risk factor, prodrome, or cause?

2017 ◽  
Vol 30 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Corinne E. Fischer ◽  
Luis Agüera-Ortiz
Keyword(s):  
Psychotic Disorders ◽  
Clinical Course ◽  
Late Onset ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Functional Psychosis ◽  
Dementia Risk ◽  
Treatment Considerations ◽  
The Impact

ABSTRACTBackground:Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course. Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied. Comparatively, there has been little focus on psychotic symptoms in PrD.Methods:The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations.Results:Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear. Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia. Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies. The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia.Conclusions:Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively. Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD.

scholarly journals Clinical Case of Goldenhar Syndrome in Psychiatric Practice

2020 ◽  
Vol 5 (3) ◽  
pp. 36-40
Author(s):  
A. V. Kovaleva
Keyword(s):  
Clinical Case ◽  
Psychotic Disorders ◽  
Cognitive Activity ◽  
Goldenhar Syndrome ◽  
Psychiatric Ward ◽  
Personality Changes ◽  
Disability Group ◽  
Control Education ◽  
Psychopathological Disorders ◽  
Emotional Immaturity

A clinical case of a rare genetic oculo-auriculo-vertebral syndrome (Goldenhar syndrome) is presented in a young man of 18 years old, who was first sent for examination and treatment to the psychiatric ward. A retrospective analysis of anamnestic information indicates the emergence of psychopathological disorders in childhood in the form of a delay in psychoverbal development, emotional immaturity, and delays in the development of social behavior. Subsequently, persistent encephalasthenic and neurosis-like disorders were complicated by the addition of affective disorders of the depressive-dysphoric type and psychotic disorders. The lack of a timely integrated therapeutic approach with the addition of psychopharmacotherapy, psychotherapy and social therapy led to the formation of specific personality changes in organic etiology with significant disorders in the emotional sphere (lability of emotions, irritability, outbursts of anger, constant resentment and dissatisfaction with others), a decrease in the level of cognitive activity and a tendency to chronic course of neurosis-like and affective disorders. A statement of persistent pronounced violations of mental functions during follow-up observation caused severe restrictions in the main areas of life (communication, behavior control, education, work) and social maladaptation of the patient, which was the basis for referral to medical and social examination with the establishment of a disability group.

Assessing Diagnosis and Symptoms Profiles of Late-Life Psychosis

GeroPsych ◽  
2013 ◽  
Vol 26 (4) ◽  
pp. 205-209 ◽  
Author(s):  
Ali Javadpour ◽  
Maryam Sehatpour ◽  
Arash Mani ◽  
Ali Sahraian
Keyword(s):  
Differential Diagnosis ◽  
Mood Disorders ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Late Life ◽  
Psychotic Symptoms ◽  
Elderly Persons ◽  
Visual Hallucinations ◽  
Symptom Profiles ◽  
Symptom Profile

Background: There are many controversies with regard to the nosology and conditions causing psychosis in old age people. This study defines a symptom profile and differential diagnosis of late-onset psychosis. Method: 201 elderly persons with psychotic symptoms were recruited. All patients were interviewed based on SCID-1 to confirm the possible diagnosis. Results: The most delusional symptom reported by the subjects was persecutory delusion, and visual hallucinations were the most common hallucination. The most repeated diagnosis was dementia, followed by psychosis due to mood disorders, primary psychotic disorders, delirium, and psychosis due to medical conditions. Conclusions: Results from the current study indicate that late-life psychoses form a heterogeneous group of disorders with varying symptom profiles and etiologies.

A late form of neurosyphilis manifesting with psychotic symptoms in old age and good response to ceftriaxone therapy

2010 ◽  
Vol 23 (4) ◽  
pp. 666-669 ◽  
Author(s):  
Erdem Güler ◽  
Thomas Leyhe
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Old Age ◽  
Antibiotic Treatment ◽  
Affective Disorders ◽  
Elderly Woman ◽  
Psychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Personality Changes ◽  
Late Form

ABSTRACTNeurosyphilis can present with psychiatric symptoms. The late form can occur in old age with psychosis, paranoid delusions, affective disorders or cognitive impairment. Here we present a case of neurosyphilis in an elderly woman who, over six months, progressively manifested personality changes and paranoid delusions which were initially suspected as Alzheimer's disease. Psychotic symptoms showed a good response to antibiotic treatment. We conclude that neurosyphilis is a relevant differential diagnosis in patients developing severe psychiatric symptoms in old age. As a causal antibiotic treatment is possible this infectious disease should be considered seriously in gerontopsychiatric patients.

Remission of manic disorder in a hepatitis c virus (HCV) infected patient receiving pegylated-interferon (PEGIFN) plus ribavirin (RBV)

2011 ◽  
Vol 26 (S2) ◽  
pp. 881-881
Author(s):  
C.L. Ortiz Sánchez-Expósito ◽  
M. Machín Vazquez-Illá ◽  
L. Gallego Deike ◽  
J.J. López-Ibor
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Infected Patient ◽  
Psychotic Disorders ◽  
Neuropsychiatric Symptoms ◽  
Pegylated Interferon ◽  
Psychotic Symptoms ◽  
Hcv Rna ◽  
Antipsychotic Therapy

IntroductionPegylated-interferon (pegIFN) plus ribavirin (RBV) is for the moment the licensed therapy for chronic hepatitis C. Neuropsychiatric symptoms are frequent side effects due to the treatment with pegIFN, registered in 30 to 80% of instances, with mood rather than psychotic disorders usually observed.ObjectiveA manic profile with psychotic symptoms in a HCV infected patient receiving pegIFN-RBV is presented to discuss management strategies and outcome.MethodsA 47 year-old male patient, former IDU and alcohol abuser, without past psychiatric history, was under therapy for chronic hepatitis C (genotype 1a, HCV-RNA 6.2 log IU/mL, Child A5). After 14 weeks of pegIFN-RBV treatment the patient attends ER with insomnia, uneasiness, expansive mood, irritability, extravagant and disinhibited behaviour, and detrimental and self-referential delusion.ResultsThe patient was admitted at the Psychiatric Unit to receive amisulpride (400 mg/12h) plus lorazepam (1 mg/8h), with psychotic symptoms regressing over following days. It was agreed that psychotropic drugs would be maintained at the same doses until the end pegIFN-RBV therapy, intended for 48 weeks.ConclusionAntipsychotic therapy may be effective and allows VHC infected patients with manic symptoms related to pegIFN-RBV therapy to continue their treatment.

scholarly journals Managing Acute Agitation and Psychotic Symptoms in the Emergency Department

2020 ◽  
Vol 9 (2) ◽  
pp. 118-128
Author(s):  
Nidal Moukaddam ◽  
Raymond Choi ◽  
Veronica Tucci
Keyword(s):  
Physical Activity ◽  
Emergency Department ◽  
Differential Diagnosis ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
Optimal Management ◽  
Emergency Physicians ◽  
Pharmacological Treatments ◽  
Antipsychotic Medications ◽  
Acute Agitation

Background and goals: It is fairly common for adolescents with a presenting problem of acute agitation to present to the Emergency Department. These patients present challenges with respect to both differential diagnosis and management. Furthermore, with many adolescents having extended stays in emergency departments, it is important for ED physicians to have a basic familiarity with diagnosis and treatment. Method: In this paper, we present a primer on the conditions underlying acute agitation and review approaches to management in the emergency department. Discussion: Psychotic disorders, such as schizophrenia, are distinct from other conditions presenting with psychotic symptoms, which can range from depression to substance use to non-psychiatric medical conditions. Agitation, a state of excessive verbal and physical activity, can accompany any of these conditions. Unlike the case for adults, practice guidelines do not exist, and there is no fully agreed upon expert consensus yet. Emergency physicians should have a working knowledge of antipsychotic medications and need to consider pharmacological as well as non-pharmacological treatments for optimal management.

scholarly journals Behavioural variant frontotemporal dementia – selected diagnostic dilemmas in neuropsychiatry

2020 ◽  
Vol 20 (2) ◽  
pp. 71-81
Author(s):  
Marta Kuklińska ◽  
◽  
Emilia J. Sitek ◽  
Bogna Brockhuis ◽  
Anna Barczak ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Psychiatric Disorders ◽  
Frontotemporal Dementia ◽  
Functional Decline ◽  
Psychotic Symptoms ◽  
Obsessive Compulsive ◽  
Behavioural Symptoms ◽  
Hyperactivity Disorder ◽  
Obsessive Compulsive Disorders ◽  
Work Up

Introduction: Differential diagnosis of behavioural variant frontotemporal dementia remains a challenge for neurologists and psychiatrists as some behavioural symptoms of this illness and psychiatric disorders, such as apathy, are not specific. Aim: The paper aims at presenting the differential diagnosis of behavioural variant frontotemporal dementia and primary psychiatric disorders. Discussion: Behavioural symptoms of behavioural variant frontotemporal dementia overlap with symptoms typical for primary psychiatric disorders. Psychotic symptoms, apathy and inappropriate behaviour are prominent in schizophrenia. Repetitive behaviours are typical for obsessive-compulsive disorders. Inattention and impulsivity are common in attention deficit and hyperactivity disorder. Disinhibition is typical of mania in the context of bipolar disorder. Thus, all these psychiatric diagnoses need to be considered in the differential diagnosis of behavioural variant frontotemporal dementia. This condition is associated with language deficits and more widespread executive and social cognition deficits. Also, the presence of neurological symptoms, such as oculomotor dysfunction, upper/lower motor neuron dysfunction or bradykinesia, may facilitate the diagnosis. Functional decline is observed during follow-up in behavioural variant frontotemporal dementia, but not in phenocopy syndrome. Conclusions: Differential diagnosis requires integration of behavioural and neuropsychological data with the results of neurological assessment and neuroimaging work-up. In ambiguous cases, if genetic testing is negative, only longitudinal observation can confirm the diagnosis of behavioural variant frontotemporal dementia or phenocopy syndrome.

Chronic Traumatic Encephalopathy: A Comparison with Alzheimer's Disease and Frontotemporal Dementia

2020 ◽  
Vol 40 (04) ◽  
pp. 394-410
Author(s):  
Orit H. Lesman-Segev ◽  
Lauren Edwards ◽  
Gil D. Rabinovici
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Differential Diagnosis ◽  
Frontotemporal Dementia ◽  
Psychotic Disorders ◽  
Chronic Traumatic Encephalopathy ◽  
Clinical Aspects ◽  
Neurocognitive Assessment ◽  
Patients At Risk ◽  
Neurodegenerative Dementias

AbstractThe clinical diagnosis of chronic traumatic encephalopathy (CTE) is challenging due to heterogeneous clinical presentations and overlap with other neurodegenerative dementias. Depending on the clinical presentation, the differential diagnosis of CTE includes Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), Parkinson's disease, amyotrophic lateral sclerosis, primary mood disorders, posttraumatic stress disorder, and psychotic disorders. The aim of this article is to compare the clinical aspects, genetics, fluid biomarkers, imaging, treatment, and pathology of CTE to those of AD and bvFTD. A detailed clinical evaluation, neurocognitive assessment, and structural brain imaging can inform the differential diagnosis, while molecular biomarkers can help exclude underlying AD pathology. Prospective studies that include clinicopathological correlations are needed to establish tools that can more accurately determine the cause of neuropsychiatric decline in patients at risk for CTE.

Sign in / Sign up

Export Citation Format

Share Document