scholarly journals 457 - VERY LATE-ONSET SCHIZOPHRENIA-LIKE PSYCHOSIS… A DIAGNOSTIC DILEMMA…

2020 ◽  
Vol 32 (S1) ◽  
pp. 178-178
Author(s):  
Joana Regala ◽  
Francisco Moniz-Pereira
Keyword(s):  
Case Report ◽  
Basal Ganglia ◽  
Negative Symptoms ◽  
Late Onset ◽  
Previous History ◽  
Psychotic Symptoms ◽  
Formal Thought Disorder ◽  
Diagnostic Dilemma ◽  
Ischemic Disease ◽  
Thought Disorders

Background:The nosology and etiological underpinnings of very late -onset schizophrenia-like psychosis (VLOSLP) have remained controversial. This case report highlights its diagnostic complexity.Case report:A 64-year-old woman, with a previous history of hypertension, diabetes, mild cognitive decline, right grade-4 hemiparesis as sequelae of an ischemic-stroke (three years before), started persecutory and partition delusions. After six months, the delusions were accompanied by complex visual hallucinations (scenic, lilliputian and holocampine), elementary auditory, tactile, olfactory, and gustatory hallucinations, causing a profound daily life impact, consequently she was hospitalized. Neither negative symptoms nor formal thought disorders were present. Electroencephalography and laboratorial evaluations were unremarkable (including thyroid function, folic acid, cyanocobalamin, infectious serologies and anti-gliadin/transglutaminase antibodies). Neuroimaging displayed subcortical microvascular lesions in the left centrum semiovale, bilateral thalamic and basal ganglia lacunes. Neuropsychological examination revealed mild/moderate impairment in working-memory, sustained-attention, executive functions, abstract thinking, and visuospatial abilities. Mini-mental state examination (MMSE) scored 20/30. Clozapine was started. As psychotic symptoms ameliorated cognitive deficits also improved (MMSE score: 25/30). She was discharged with residual symptoms.Discussion:Late-life psychosis implies a thorough investigation, bringing about challenges in diagnosis. Several medical causes, including neuroinflammatory/immunologic, were ruled out. This two-stage progression, with partition delusions and multimodal hallucinations, in the absence of formal thought disorder and negative symptoms is typical of VLOSP. It is arguable to ascribe our patient’s psychosis to a previous vascular dementia or to VLOSLP. Almost half of VLOSLP patients may develop dementia. It is still debatable whether this propensity is a true characteristic of VLOPSL or reflects an initial misdiagnosis. Some neuropathological studies suggest a restricted limbic tauopathy underlying VLOSP. Notwithstanding, cognitive impairment is common in VLOSLP, including in those patients who do not develop dementia. Neuroimaging studies evidence that lacunar infarction in the basal ganglia alongside chronic white matter small vessels ischemic disease, may underlie the pathophysiology of psychosis via a disruption in the frontal-subcortical pathways. Nevertheless, cases of post-stroke psychosis usually resolve in few months. In conclusion, the neurobiological underpinnings of VLOSLP are complex and multifaceted. More systematized studies using biomarkers and neuroimaging are needed so clinicians can perform a more accurate diagnosis of VLOSLP.

Symptoms of Psychoses

1995 ◽  
Vol 166 (2) ◽  
pp. 236-240 ◽  
Author(s):  
Toshinori Kitamura ◽  
Yuji Okazaki ◽  
Akira Fujinawa ◽  
Masahiro Yoshino ◽  
Yomishi Kasahara
Keyword(s):  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Current Knowledge ◽  
Psychiatric Patients ◽  
Psychotic Symptoms ◽  
Formal Thought Disorder ◽  
Affective Symptoms ◽  
Five Factors ◽  
Thought Disorders ◽  
Positive And Negative Symptoms

BackgroundThe literature on the statistical analysis of symptoms of psychoses was limited to positive and negative symptoms in schizophrenia. The present study explored the relationship between positive and negative symptoms as well as affective symptoms in a wider category of psychotic disorders.MethodThe symptoms of 584 psychiatric patients, consecutively admitted to any of the 95 mental hospitals in Japan, were studied. They manifested at least one of the following: (a) delusions, (b) hallucinations, (c) formal thought disorder, (d) catatonic symptoms, or (e) negative (defect) symptoms.ResultsFactor analysis yielded five factors interpretable as (a) manic symptoms, (b) depressive symptoms, (c) negative (defect) symptoms and formal thought disorders, (d) positive (psychotic) symptoms, and (e) catatonic symptoms.ConclusionThese results suggest that although major symptoms seen among psychotic patients can be categorised into positive, negative, manic, and depressive groups, corresponding to current knowledge of phenomenology, catatonic symptoms constitute a discrete syndrome, while formal thought disorders merge into the negative syndrome.

Psychosis – Different presentation for designer drugs compared to cannabis abusers?

2017 ◽  
Vol 41 (S1) ◽  
pp. S393-S393
Author(s):  
F. Dumitrescu
Keyword(s):  
Negative Symptoms ◽  
Endocannabinoid System ◽  
Positive Association ◽  
Designer Drugs ◽  
Drug Misuse ◽  
Designer Drug ◽  
Psychotic Symptoms ◽  
Bath Salts ◽  
Formal Thought Disorder ◽  
Thought Disorders

Introduction“Bath salts” target the endocannabinoid system in a similar manner to cannabis. In the case of designer drug misuse, subjects seem to be at higher risk of psychotic symptoms.AimsTo investigate the nature and frequency of psychotic symptoms associated with cannabis and/or bath salts misuse in a male inpatient population.MethodThe files of 107 patients admitted to the department of addictions, “Al. Obregia” Psychiatric Hospital Bucharest July 2015–July 2016 were reviewed. Cases had a diagnosis of psychotic disorder with recorded cannabis/bath salts abuse.ResultsMean age was 26.65 years old (STDV = 5.9). Mean duration of use was of 83.94 months – cannabis; 60.48 months – bath salts and 33.75 months – both substances (BS). Sixty-three patients (73.3%) presented disorganised behaviour; 55.8% (n = 48) formal thought disorder; 45% (n = 39) paranoid delusions. A strong positive association between the length of use of cannabis and disorganised behaviour (n = 33; r = 0.05; P < 0.05) was found. Grandiose ideation was frequent in cannabis users. (X2 = 4.1; n = 0.03; P < 0.05). Multidrug abuse was associated with increased formal thought disorders compared to subjects with cannabis abuse (X2 = 10.9; n = 0.001; P < 0.05). Negative symptoms were more frequent with bath salts users than with users of both substances (X2 = 13.4; X2 = 23.21; X2 = 16.8; P < 0.05).ConclusionPositive psychotic symptoms were associated with cannabis and BS abuse, while bath salts promoted negative symptoms.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Kraepelin's ghost: Late onset schizophrenia, dementia (non)praecox, or paraphrenia? (case report)

2016 ◽  
Vol 33 (S1) ◽  
pp. S535-S535 ◽  
Author(s):  
V. Vukovic ◽  
S. Nikolić Lalić ◽  
T. Voskresenski ◽  
S. Jokić
Keyword(s):  
Case Report ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Thought Disorder ◽  
Psychotic Symptoms ◽  
Causative Role ◽  
Visual Hallucinations ◽  
Formal Thought Disorder ◽  
Adequate Treatment

IntroductionIt is difficult to establish whether a patient has late onset schizophrenia or frontotemporal dementia. The object of the following case report is to point out the difficulty of making a differential diagnosis between these two entities.Case summaryA 49-year-old female patient was admitted to our hospital after presenting with auditory and visual hallucinations, formal thought disorder, persecutory delusions, ideas of reference, insomnia. Memory, executive function and attentional tasks were severely compromised. Computerized tomography showed incipient frontal lobe atrophy. There were no significant abnormalities found in blood and urine samples or physical and neurological examinations. After showing no response to olanzapine, and extrapyramidal side effects to fluphenazine, risperidone was initiated which subsequently led to complete withdrawal of positive symptoms.DiscussionPatients presenting with psychotic symptoms after the age of 40 presented a diagnostic quandary, as they were less likely to present with negative symptoms, formal thought disorder or affective blunting, and more likely to have systematised delusions and visual hallucinations. Frontotemporal dementia is a disorder that can present itself with cognitive decline and a large range of psychiatric symptoms. The risk of late onset schizophrenia is greater in women, possibly implicating a causative role of female sex hormones. Atypical antipsychotics risperidone and olanzapine seem to be an adequate treatment.ConclusionSchizophrenia is a heterogeneous disease with a large variety of clinical manifestations. Special care should be given to patients with age over 40, including neurocognitive assessment, laboratory and hormone tests, and a long-term follow-up.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Catatonia Associated With Late Paraphrenia Successfully Treated With Lithium: A Case Report

2020 ◽  
Author(s):  
Hiroko Sugawara ◽  
Junpei Takamatsu ◽  
Mamoru Hashimoto ◽  
Manabu Ikeda
Keyword(s):  
Case Report ◽  
Mood Disorders ◽  
Electroconvulsive Therapy ◽  
Late Onset ◽  
Treatment Strategies ◽  
Psychotic Symptoms ◽  
Case Presentation ◽  
Limited Efficacy ◽  
Cumulative Evidence ◽  
The Brain

Abstract Background: Catatonia is a psychomotor syndrome that presents various symptoms ranging from stupor to agitation, with prominent disturbances of volition. Its pathogenesis is poorly understood. Benzodiazepines and electroconvulsive therapy (ECT) are safe and effective standard treatments for catatonia; however, alternative treatment strategies have not been established in cases where these treatments are either ineffective or unavailable. Here, we report a case of catatonia associated with late paraphrenia classified as very-late-onset schizophrenia-like psychosis, which was successfully treated with lithium. Case presentation: A 66-year-old single man with hearing impairment developed hallucination and delusions and presented with catatonic stupor after a fall. He initially responded to benzodiazepine therapy; however, his psychotic symptoms became clinically evident and benzodiazepine provided limited efficacy. Blonanserin was ineffective, and ECT was unavailable. His catatonic and psychotic symptoms were finally relieved by lithium monotherapy.Conclusions: Catatonic symptoms are common in patients with mood disorders, suggesting that lithium may be effective in these cases. Moreover, lithium may be effective for both catatonic and psychotic symptoms, as it normalizes imbalances of excitatory and inhibitory systems in the brain, which underlies major psychosis. Cumulative evidence from further cases is needed to validate our findings.

scholarly journals Cognitive Behavioural Therapy for Auditory Hallucinations: Effectiveness and Predictors of Outcome in a Specialist Clinic

2010 ◽  
Vol 39 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Neil Thomas ◽  
Susan Rossell ◽  
John Farhall ◽  
Frances Shawyer ◽  
David Castle
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Negative Symptoms ◽  
Rating Scales ◽  
Behavioural Therapy ◽  
Auditory Hallucinations ◽  
Psychotic Symptoms ◽  
Predictors Of Outcome ◽  
Formal Thought Disorder ◽  
Behavioural Treatment ◽  
Cognitive Behavioural

Background: Cognitive behavioural therapy has been established as an effective treatment for residual psychotic symptoms but a substantial proportion of people do not benefit from this treatment. There has been little direct study of predictors of outcome, particularly in treatment targeting auditory hallucinations. Method: The Psychotic Symptom Rating Scales (PSYRATS) and Positive and Negative Syndrome Scale (PANSS) were administered pre- and post-therapy to 33 people with schizophrenia-related disorders receiving CBT for auditory hallucinations in a specialist clinic. Outcome was compared with pre-therapy measures of insight, beliefs about the origin of hallucinations, negative symptoms and cognitive disorganization. Results: There were significant improvements post-treatment on the PSYRATS and PANSS Positive and General Scales. Improvement on the PSYRATS was associated with lower levels of negative symptoms, but was unrelated to overall insight, delusional conviction regarding the origins of hallucinations, or levels of cognitive disorganization. Conclusions: Lack of insight and presence of formal thought disorder do not preclude effective cognitive-behavioural treatment of auditory hallucinations. There is a need to further understand why negative symptoms may present a barrier to therapy.

scholarly journals Adolescent Catatonia Successfully Treated with Lorazepam and Aripiprazole

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Aaron J. Roberto ◽  
Subhash Pinnaka ◽  
Abhishek Mohan ◽  
Hiejin Yoon ◽  
Kyle A. B. Lapidus
Keyword(s):  
Case Report ◽  
Children And Adolescents ◽  
Emotional Distress ◽  
Successful Treatment ◽  
Previous History ◽  
Treatment Modalities ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Significant Impairment ◽  
History Of

Catatonia is especially concerning in children and adolescents. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. In this case report, we discuss a patient with no previous history of neuroleptic medication or psychotic symptoms, presenting with first-episode catatonia in the presence of disorganized, psychotic thoughts. We then review the catatonia syndrome, citing examples in the literature supporting its underdiagnosis in children and adolescents, and discuss successful treatment modalities. It is important to diagnose and treat catatonia as efficiently as possible, to limit functional and emotional distress to the patient.

Very Late-onset Schizophrenia-Like Psychosis: Case Report and Current Status of the Issue

2016 ◽  
Vol 33 (S1) ◽  
pp. S471-S471
Author(s):  
R. Martín Aragón ◽  
M. Gutiérrez Rodríguez ◽  
S. Bravo Herrero ◽  
C. Moreno Menguian ◽  
N. Rodríguez Criado ◽  
...  
Keyword(s):  
Case Report ◽  
Age Of Onset ◽  
Late Onset ◽  
Current Knowledge ◽  
Age At Onset ◽  
Review Literature ◽  
Current Status ◽  
Diagnostic Systems ◽  
Formal Thought Disorder ◽  
Pubmed Database

IntroductionSchizophrenia has traditionally been considered to strictly be an early-onset disorder. Current nosologies, including DSMV, are not restrictive with age of onset in schizophrenia and all patients that satisfy diagnostic criteria fall into the same category. Since 1998, International Late-Onset Schizophrenia Group consensus, patients after 60 are classified as very-late onset schizophrenia-like psychosis. Female overrepresentation, low prevalence of formal thought disorder, and a higher prevalence of visual hallucinations are associated with later age at onset. Atypical antipsychotics represent the election treatment because of the reduced likelihood of EPS and tardive dyskinesias, and should be started at very low doses, with slow increases.ObjectiveTo review the current knowledge about very late-onset schizophrenia through systematic review of the literature and the analysis of a case.MethodsCase Report. Review. Literature sources were obtained through electronic search in PubMed database of last fifteen years.ResultsWe present a case of a 86-year-old woman suffering from delusions and hallucinations, diagnosed with very late-onset schizophrenia-like psychosis, after differential diagnosis with other disorders. We analyze ethiology, epidemiology, clinical features and treatment in geriatric patients with schizophrenia.ConclusionsReluctance to diagnose schizophrenia in old people is still present today, probably in relation with the inconsistency in diagnostic systems and nomenclature, and consideration of medical conditions in the diagnosis. Identification of these patients is really important in order to start an appropriate treatment, which can lead to patient clinical stability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The effectiveness of long-term aripiprazole injections to a patient with paranoid schizophrenia: a case report

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Anna Maria Szota ◽  
Aleksander Araszkiewicz
Keyword(s):  
Case Report ◽  
Negative Symptoms ◽  
Social Withdrawal ◽  
Paranoid Schizophrenia ◽  
Psychotic Symptoms ◽  
Suicidal Thoughts ◽  
Duration Of Hospitalization ◽  
History Of ◽  
Long Acting

AbstractParanoid schizophrenia is a chronic, psychotic disorder which can be treated with long-acting injectable (LAI) antipsychotic drugs. There are risperidone (Risperdal Consta®), olanzapine (Zypadhera®), paliperidone (Xepilon®) and aripiprazole (Abilify Maintena®) currently available.The aim of this study was to present a case history of the patient to whom monthly injections of aripiprazole effectively prevented both relapses of psychotic symptoms and hospitalizations.Case report: A 55-year-old male patient with a 13-year history of paranoid schizophrenia has been effectively treated with aripiprazole (LAI) (400mg, every 4 weeks). During the last 8 years of treatment his mental state has been stabilized, without any acute psychotic symptoms and without any anxiety, or violent behaviours. Moreover, there have been no psychotic symptoms, or suicidal thoughts, or tendencies recordered. Therefore, no hospitalization has been required. However, despite the treatment, negative symptoms such as blunted affect, cognitive dysfunction and social withdrawal have been sustained.Discussion: The available articles on aripiprazole (LAI) treatment indicate that it was effective in reducing the positive and negative symptoms of schizophrenia, as well as reducing the frequency and duration of hospitalization. However, the case report of a patient who has not had relapses of psychotic symptoms and suicidal thoughts and has not been hospitalized during 8 years of treatment with aripiprazole (LAI) has not yet been reported.Conclusions: Regular, long-term injections of aripiprazole (LAI) are very effective at preventing positive symptoms of schizophrenia development and preventing both suicidal thoughts and hospitalizations. Therefore, treatment with this drug in everyday practice should be increased.

FC02-04 - Assessment of schizophrenia in adults with intellectual disability and autism - an empirical study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1818-1818 ◽  
Author(s):  
T.L. Bakken ◽  
H. Martinsen ◽  
S. Friis ◽  
S. Lovoll ◽  
D.E. Eilertsen
Keyword(s):  
Case Report ◽  
Intellectual Disability ◽  
Statistical Analysis ◽  
Empirical Study ◽  
Negative Symptoms ◽  
Case Reports ◽  
Psychotic Symptoms ◽  
Global Functioning ◽  
Adequate Treatment ◽  
Report Data

IntroductionIn adults with intellectual disability and autism, psychosis is rarely detected due to misinterpretation of psychotic symptoms being autism or idiosyncratic communication. The patients can poorly communicate the delusions and hallucinations they experience. Observable indicators are therefore necessary.ObjectivesTo establish reliable and valid behavioural indicators of psychosis in adults with intellectual disability and autism.AimsThe aim was to investigate behavioural indicators of psychosis in adults with intellectual disability and autism.MethodsForty-three patients with intellectual disability and autism from a hospital-based study were recruited. Eight of these patients were assessed as having schizophrenia-like psychosis. They were further examined through a case-report study. Both statistical analysis and data from the case reports were included. Case report data were compared with scores from a validation study of the Psychopathology in Autism Checklist, PAC.ResultsBehavioural disorganisation, severe decreased global functioning, suspected hallucinations and decreased sociability were observed in the eight psychotic patients. The level of disorganisation was significantly higher in the psychotic patients than in the non-psychotic patients - this included patients with “plain” autism. Adequate treatment significantly decreased the level of disorganised behaviour.ConclusionsDisorganised behaviour, occurring concurrent with disorganised speech, severe decreased global functioning, suspected hallucinations and negative symptoms, were found to be reliable and valid indicators of psychosis.

Schizophrenia and familial idiopathic basal ganglia calcification: a case report

2001 ◽  
Vol 31 (4) ◽  
pp. 741-747 ◽  
Author(s):  
B. CHABOT ◽  
C. ROULLAND ◽  
S. DOLLFUS
Keyword(s):  
Case Report ◽  
Basal Ganglia ◽  
Computerized Tomography ◽  
Psychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Basal Ganglia Calcification ◽  
First Degree Relatives ◽  
Idiopathic Basal Ganglia Calcification ◽  
The Subject ◽  
The Relationship

Background. Familial idiopathic basal ganglia calcification (FIBGC) is generally associated with neurological and psychiatric symptoms. An association between FIBGC and schizophrenia has been described but it remains uncertain. We studied the relationship between the presence and extent of basal ganglia calcification and schizophrenia in a multiply affected family.Method. Symmetrical basal ganglia calcifications (BGC) were detected on computerized tomography (CT) in a schizophrenic proband and led us to carry out CTs and standardized psychiatric evaluations (SADS – Endicott & Spitzer, 1978) in all available first-degree relatives (mother and six siblings).Results. Five subjects had BGC, including three subjects diagnosed as schizophrenic. Three subjects had no BGC and none of them was diagnosed as schizophrenic. We subdivided the BGC into three groups: massive (pallidum, striatum and dentate nuclei affected); medium (pallidum and striatum); and mild (pallidum only). The two subjects with massive BGC and one of the two with medium BGC had schizophrenia. The subject with mild BGC had no psychotic symptoms.Conclusion. Our results are consistent with the hypothesis that BGC favours the occurrence of a schizophrenia-like syndrome and that the risk of occurrence of this syndrome is proportional to the extent of calcification. These findings support the hypothesis that schizophrenia is determined by a disruption of thalamo–cortico–striatal circuits.

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