Secondary psychotic symptoms in a patient with biphasic meningo-encephalitis

1993 ◽  
Vol 8 (6) ◽  
pp. 325-328 ◽  
Author(s):  
S Modell ◽  
G Kurtz ◽  
F Müller-Spahn ◽  
E Schmölz
Keyword(s):  
Psychotic Symptoms ◽  
Organic Psychosis ◽  
Acute Meningitis ◽  
Diagnostic Difficulties ◽  
Endogenous Psychosis ◽  
Catatonic Syndrome

SummaryWe report on the case of a patient who developed an acute meningitis and, after a period of about two weeks, without any neuropsychiatric problems, an acute paranoid-hallucinatory and catatonic syndrome. The symptomatology is discussed, in relation with the diagnostic difficulties of differentiating between a biphasic meningo-encephalitis with an organic psychosis or a first manifestation of an endogenous psychosis.

scholarly journals A Case of Psychosis Due to Acute Hypocalcemia From Hypoparathyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A172-A173
Author(s):  
Joseph Theressa Nehu Parimi ◽  
John Chen Liu ◽  
Rajani Gundluru ◽  
Sowjanya Naha ◽  
Timur Gusov ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Case Reports ◽  
Severe Depression ◽  
Altered Mental Status ◽  
Auditory Hallucinations ◽  
Psychotic Symptoms ◽  
Organic Psychosis ◽  
Neuropsychiatric Manifestations ◽  
History Of ◽  
Gait Abnormalities

Abstract A 61-year-old female with past medical history of depression, hypoparathyroidism (hypoPtH), and hypothyroidism had disappeared from her home and was found wandering a few hours away with persecutory delusions, visual and auditory hallucinations. Serum calcium (Ca) was 6.3 mg/dL (range 8.6–10.2), albumin 3.7 g/dL (range 3.5–5.2) and ionized Ca 0.89 mmol/L (range 1.12–1.30). She was admitted and treated with Ca and calcitriol. Work-up for altered mental status was negative except for hypocalcemia (hypoCa) and scattered bilateral basal ganglia calcifications (BGC) with cortical and subcortical frontal lobe calcifications on CT. Psychiatry diagnosed delirium due to hypoCa. Acute psychosis resolved once Ca levels improved. Diagnosis of idiopathic hypoPtH was in 1997. Her regimen included Ca citrate 1500mg daily and 10 mcg of Forteo twice daily. She had skipped her medications for at least 2 days prior to presentation. Her medical records revealed that she was seen for severe depression, progressive gait abnormalities, slowed movements, and imbalance, in 2015. CT scan and MRI brain showed BGC. Her son gave a history of multiple admissions for psychosis, violence, delusions with agitation, and wandering at times when the patient was hypoCa, which was diagnosed as schizophrenia. Neuropsychiatric disturbances are commonly associated with hypercalcemia. Review of literature found a few case reports of psychosis and hypoPtH 1,2 BGC is common in hypoPtH. Psychotic symptoms due to BGC include auditory hallucinations, delusions of influence, paranoid states, and complex perceptual distortions.3,5 HypoCa is associated with cognitive impairment. Neurological manifestations tend to improve with Ca correction, but psychiatric symptoms do not improve substantially.4,5 Further studies are needed in hypoPtH with BGC to appropriately diagnose organic psychosis. This is important in management of the vicious cycle of psychiatric illness leading to noncompliance resulting in psychosis. Prevention of BGC will play a key role. References: 1. Finan M, Axelband J. This is your brain on calcium: psychosis as the presentation of isolated hypoparathyroidism. Am J Emerg Med. 2014;32:945.e1-4. 2. Ang AW, Ko SM, Tan CH. Calcium, magnesium, and psychotic symptoms in a girl with idiopathic hypoparathyroidism. Psychosom Med. 1995;57:299–302. 3. Burns K, Brodaty H. Fahr’s disease and psychosis. In: Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University; 2010. p. 358–66. 4. Maiti A, Chatterjee S. Neuropsychiatric manifestations and their outcomes in chronic hypocalcaemia. J Indian Med Assoc. 2013;111:174–7. 5. Amara A, Novais C, Coelho M, Silva A, Curral R, Brandao I, Torres A. Organic psychosis due to hypoparathyroidism in an older adult: a case report. Braz. J. Psychiatry; 2016; 38(4)

scholarly journals Trials and tribulations of diagnosing and managing psychosis secondary to non-convulsive epilepsy

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S114-S114
Author(s):  
Mahmoud Awara ◽  
Joshua Smalley ◽  
Matt Havenga ◽  
Manal Elnenaei
Keyword(s):  
Seizure Activity ◽  
Epileptic Activity ◽  
Psychotic Symptoms ◽  
Visual Hallucinations ◽  
Divalproex Sodium ◽  
Extensive Investigation ◽  
Treatment Resistant ◽  
Organic Psychosis ◽  
Course Of Illness ◽  
History Of

ObjectiveTo highlight the importance of reviewing diagnosis and management of refractory psychosis and to share that with the scientific community; and to also shed some light on the dilemma and challenges that professionals may face to diagnose and treat organic psychosis. In addition, to look at the possible similarity/dissimilarity in psychopathology between organic and primary psychosis and differences in opinions through presenting the history and course of illness of this patient.Case reportWe present the case of a 51-year-old female who had a 28-year history of treatment-resistant schizophrenia. She did not report or display any seizure activity, and an extensive investigation was unremarkable. The unusual nature of her psychopathology, which was predominantly visual hallucinations and somatic delusions, and the difficult to treat nature of her symptoms, prompted investigation with Electroencephalograph which demonstrated bilateral temporal lobe epileptic activity.DiscussionTreatment with divalproex sodium and discontinuation of antipsychotic medication achieved an excellent response, where her visual hallucinations and somatic delusions were both remarkably ameliorated.ConclusionThe differentiation between organic/secondary and functional/primary psychosis is an area of contention between psychiatrists and neurologists and also within each of these specialties.The myriad of psychopathology and associated treatment resistant psychotic symptoms that patients with non-convulsive epilepsy may experience should result in building a long desired bridge between neurology and psychiatry to collaborate in managing such cases.

Differential Diagnosis Based on Age. Diagnostic Difficulties

2016 ◽  
Vol 33 (S1) ◽  
pp. S473-S473
Author(s):  
S. Rodrígue Vargas
Keyword(s):  
Differential Diagnosis ◽  
Literature Review ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Review Of The Literature ◽  
Diagnostic Difficulties ◽  
Diagnostic Hypothesis ◽  
Competing Interest

IntroductionFollowing a case presented in our inpatient unit as well as various interdepartmental from internal medicine and other emergencies, we decided to conduct a literature review on the different organic causes that can trigger the onset of psychotic symptoms in elderly.ObjectivesA correct differential diagnosis of psychiatric symptoms in elderly.AimsLiterature review of the literature on the presentation of psychotic symptoms in the elderly.MethodsDescription of a clinical case and development of diagnostic hypotheses.Results and conclusionsFor several decades are experiencing a gradual aging of the population, which means that we are at the onset of clinical symptoms not described by classical authors. Furthermore, scientific advances make infectious causes (such as neurosyphilis was our first diagnostic hypothesis) are increasingly rare. The elderly usually has multiple comorbidities, which are receiving various treatments that must be ruled out possible adverse effects.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Brucella-Induced Acute Psychosis: A Novel Cause of Acute Psychosis

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Chi-Chi Obuaya ◽  
Gayathri Thivyaa Gangatharan ◽  
Efthimia Karra
Keyword(s):  
Case Report ◽  
East Asia ◽  
General Hospital ◽  
Psychotic Symptoms ◽  
South East Asia ◽  
Acute Psychosis ◽  
Organic Psychosis ◽  
Quadrant Pain ◽  
Serological Tests ◽  
Case Presentation

Background. Infections have long been linked to psychosis and categorised within “secondary” psychoses. To date, there have been few reports of psychosis linked to brucellosis. This case report aims to present one such case. Case Presentation. A 31-year-old man was admitted to a general hospital with pyrexia, severe right upper quadrant pain, and an acute psychosis following a two-week holiday in South East Asia and the Mediterranean. Serological tests revealed that he had brucellosis. Following antibiotic treatment, the psychotic symptoms abated and he was discharged within ten days of hospitalisation. Conclusions. This case of organic psychosis highlights the importance of considering brucellosis as a rare cause of acute psychosis. The exact mechanism of Brucella-induced psychosis remains unclear.

scholarly journals Lorazepam-Resistant Catatonia in an Antipsychotic-Naïve 24-Year-Old with Psychotic Symptoms

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Juan Pablo Lucchelli ◽  
Stamatia Kourakou ◽  
Laia Pérez de Lucia Bové ◽  
Daniel Diaz Rodriguez
Keyword(s):  
Psychotic Disorders ◽  
Clinical Syndrome ◽  
Psychotic Symptoms ◽  
Consensus Guidelines ◽  
Clozapine Treatment ◽  
Dsm 5 ◽  
Diagnostic Hypothesis ◽  
Psychomotor Symptoms ◽  
Catatonic Syndrome ◽  
Underlying Pathology

Catatonia is a complex identifiable clinical syndrome characterized primarily by psychomotor symptoms. In recent decades, some authors have considered that catatonia can be presented as a catatonic syndrome in several pathologies such as bipolar disorder, schizophrenia and other psychotic disorders and not only in schizophrenia. Prior to DSM 5, there were two conceptions of catatonia: one in which clinical characterization seemed to play a determining role (a categorical view) and another in which a dimensional perspective advocated the existence of catatonia as a clinical entity in its own right, detached from the underlying pathology. Although there are no definitive consensus guidelines for the treatment of catatonia, some studies show that in the schizophrenic form of catatonia, benzodiazepines are partially effective, as well as treatment with ECT. We present the case of a 24-year-old man with severe catatonia and psychotic symptoms, resistant to lorazepam treatment, who achieved complete remission with clozapine treatment according to our diagnostic hypothesis of schizophrenia.

scholarly journals The Development of Kraepelin’s Mature Diagnostic Concept of Catatonic Dementia Praecox: A Close Reading of Relevant Texts

2019 ◽  
Vol 46 (3) ◽  
pp. 471-483 ◽  
Author(s):  
Kenneth S Kendler
Keyword(s):  
Psychotic Symptoms ◽  
Close Reading ◽  
Dementia Praecox ◽  
Poor Outcome ◽  
Clinical Relationship ◽  
Catatonic Syndrome

Abstract Through a close reading of texts, this essay traces the development of catatonia from its origination in Kahlbaum’s 1874 monograph to Kraepelin’s catatonic subtype of his new category of Dementia Praecox (DP) in 1899. In addition to Kraepelin’s second to sixth textbook editions, I examine the six articles referenced by Kraepelin: Kahlbaum 1874, Brosius 1877, Neisser 1887, Behr 1891, Schüle 1897, and Aschaffenburg 1897 (Behr and Aschaffenburg worked under Kraepelin). While Brosius and Neisser confirmed Kahlbaum’s descriptions, Behr, Schüle, and Aschaffenburg concluded that his catatonic syndrome was nonspecific and only more narrowly defined forms, especially those with deteriorating course, might be diagnostically valid. Catatonia is first described by Kraepelin as a subform of Verrücktheit (chronic nonaffective delusional insanity) in his second to fourth editions. In his third edition, he adds a catatonic form of Wahnsinn (acute delusional-affective insanity). His fourth and fifth editions contain, respectively, catatonic forms of his two proto-DP concepts: Psychischen Entartungsprocesse and Die Verblödungsprocesse. Kahlbaum’s catatonia required a sequential phasic course. Positive psychotic symptoms were rarely noted, and outcome was frequently good. While agreeing on the importance of key catatonic signs (stupor, muteness, posturing, verbigeration, and excitement), Kraepelin narrowed Kahlbaum’s concept, dropping the phasic course, emphasizing positive psychotic symptoms and poor outcome. In his fourth to sixth editions, as he tried to integrate his three DP subtypes, he stressed, as suggested by Aschaffenburg and Schüle, the close clinical relationship between catatonia and hebephrenia and emphasized the bizarre and passivity delusions seen in catatonia, typical of paranoid DP.

Factitious bereavement with psychotic features in a patient with borderline personality disorder and opium dependence

2011 ◽  
Vol 26 (S2) ◽  
pp. 1020-1020
Author(s):  
A. Ghaffarinejad ◽  
V. Shahriari
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Final Diagnosis ◽  
Borderline Personality ◽  
High Rate ◽  
Psychotic Symptoms ◽  
Factitious Disorder ◽  
Bam Earthquake ◽  
Diagnostic Difficulties ◽  
Psychotic Features

Factitious disorder, whilst uncommon, is not rare in patients referring to clinics and psychiatric hospital.Concerning high rate of grief reactions in this province after the Bam earthquake in the year 2004, we believe that this condition is Under diagnosed, mainly because of diagnostic difficulties. In current article an unusual case who came with psychotic symptoms accompanied by symptoms of complicated grief is reported. The final diagnosis is supposed to be factitious bereavement.Reported case is a 27 years old man with approved diagnosis of borderline personality disorder and opium dependence. At the last session of hospitalizing in 2010, his symptoms include : irritability, aggression and emphasis on visiting his relatives and some strange people who died in the Bam earthquake about six years ago, in which the patient took part in finding their corpses in collaboration with safety guards.From onset of disturbance, patient claimed that those deceased people are continuously present around him, talk to him and blame him because of his insufficient effort to save them. He also believes that the experiences are real and those people are alive at present. Relationship between factitious disorder with bereavement symptoms is not well-described in literatures, so this patient and influences of personality structure and opium dependence on forming patient's symptoms are discussed in this article.

Psychosis in Anorexia Nervosa and Bulimia

1984 ◽  
Vol 145 (4) ◽  
pp. 420-423 ◽  
Author(s):  
James I. Hudson ◽  
Harrison G. Pope ◽  
Jeffrey M. Jonas
Keyword(s):  
Anorexia Nervosa ◽  
Affective Disorder ◽  
Psychotic Symptoms ◽  
Organic Psychosis ◽  
Lifetime Diagnosis

SummaryIn a sample of 130 consecutive patients with a lifetime diagnosis of anorexia nervosa and/or bulimia, 17 displayed psychotic symptoms. In 16 patients, these symptoms appeared attributable to major affective disorder or schizo–affective disorder, while in one, they appeared to represent factitious psychosis. No cases of schizophrenia or organic psychosis were identified.

scholarly journals Catatonia due to systemic lupus erythematosus

2014 ◽  
Vol 63 (2) ◽  
pp. 177-181 ◽  
Author(s):  
Francisco de Assis Pinto Cabral Júnior Rabello ◽  
Daniel Calich Luz ◽  
Evânia Claudino Queiroga de Figueiredo ◽  
Edmundo de Oliveira Gaudêncio ◽  
Larissa Cristina Queiroga Mendonça Coutinho ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Lupus Erythematosus ◽  
Negative Impact ◽  
Single Case ◽  
Psychotic Symptoms ◽  
Systemic Lupus ◽  
Serological Tests ◽  
Metabolic Encephalopathy ◽  
Catatonic Syndrome

Objectives Discuss neuropsychiatric aspects and differential diagnosis of catatonic syndrome secondary to systemic lupus erythematosus (SLE) in a pediatric patient. Methods Single case report. Result A 13-year-old male, after two months diagnosed with SLE, started to present psychotic symptoms (behavioral changes, hallucinations and delusions) that evolved into intense catatonia. During hospitalization, neuroimaging, biochemical and serological tests for differential diagnosis with metabolic encephalopathy, neurological tumors and neuroinfections, among other tests, were performed. The possibility of neuroleptic malignant syndrome, steroid-induced psychosis and catatonia was also evaluated. A complete reversal of catatonia was achieved after using benzodiazepines in high doses, associated with immunosuppressive therapy for lupus, which speaks in favor of catatonia secondary to autoimmune encephalitis due to lupus. Conclusion Although catatonia rarely is the initial clinical presentation of SLE, the delay in recognizing the syndrome can be risky, having a negative impact on prognosis. Benzodiazepines have an important role in the catatonia resolution, especially when associated with parallel specific organic base cause treatment. The use of neuroleptics should be avoided for the duration of the catatonic syndrome as it may cause clinical deterioration.

Ultrastructural Studies of Bovine Respiratory Disease Complex

1975 ◽  
Vol 33 ◽  
pp. 428-429
Author(s):  
James C.S. Kim
Keyword(s):  
Michigan State University ◽  
State University ◽  
Diagnostic Laboratory ◽  
Ultrastructural Studies ◽  
Bovine Respiratory Diseases ◽  
Etiologic Agents ◽  
Diagnostic Difficulties ◽  
The Subject ◽  
Capillary Walls ◽  
Alveolar Capillary

Bovine respiratory diseases cause serious economic loses and present diagnostic difficulties due to the variety of etiologic agents, predisposing conditions, parasites, viruses, bacteria and mycoplasma, and may be multiple or complicated. Several agents which have been isolated from the abnormal lungs are still the subject of controversy and uncertainty. These include adenoviruses, rhinoviruses, syncytial viruses, herpesviruses, picornaviruses, mycoplasma, chlamydiae and Haemophilus somnus.Previously, we have studied four typical cases of bovine pneumonia obtained from the Michigan State University Veterinary Diagnostic Laboratory to elucidate this complex syndrome by electron microscopy. More recently, additional cases examined reveal electron opaque immune deposits which were demonstrable on the alveolar capillary walls, laminae of alveolar capillaries, subenthothelium and interstitium in four out of 10 cases. In other tissue collected, unlike other previous studies, bacterial organisms have been found in association with acute suppurative bronchopneumonia.

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