A case presenting with persecutory delusions as an initial symptom of elderly bipolar disorder

ABSTRACT Patients with Bipolar Disorder (BD) usually display cognitive deficits with aging. However, the correlation between BD and dementia syndromes is inconclusive, despite the similarity with behavioral variant frontotemporal dementia. We report a 78-year-old female patient who had bipolar type 1 disorder since adolescence. Her symptoms ranged from apathy to psychotic mania. She had had three hospitalizations, and since her last stay 10 years ago, her symptoms had remained stable. However, in the past 2 years, she displayed different symptoms, such as irritability manifested as verbal and physical aggression, cognitive impairment, repetitive pattern of behavior, perambulation, persecutory delusions, disorientation, and hyporexia. Treatment with anticholinesterases or mood stabilizers promoted no improvement. She scored 17/30 points on the Mini-Mental State Examination. Neuropsychological assessment suggested deficits in executive function, attention, and memory. Neuroimaging tests revealed frontotemporal degeneration and hypoperfusion. Diagnostic and therapeutic approaches for this type of patient represent a significant challenge for clinicians.

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Genotype-Phenotype Studies in Bipolar Disorder Showing Association Between the DAOA/G30 Locus and Persecutory Delusions: A First Step Toward a Molecular Genetic Classification of Psychiatric Phenotypes

American Journal of Psychiatry ◽

10.1176/appi.ajp.162.11.2101 ◽

2005 ◽

Vol 162 (11) ◽

pp. 2101-2108 ◽

Cited By ~ 97

Author(s):

Thomas G. Schulze ◽

Stephanie Ohlraun ◽

Piotr M. Czerski ◽

Johannes Schumacher ◽

Layla Kassem ◽

...

Keyword(s):

Bipolar Disorder ◽

Molecular Genetic ◽

Genetic Classification ◽

Persecutory Delusions

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Does recurrent catatonia manifest in a similar fashion in all the episodes of mood disorder? A case series with literature review

General Psychiatry ◽

10.1136/gpsych-2021-100494 ◽

2021 ◽

Vol 34 (5) ◽

pp. e100494

Author(s):

Santanu Nath ◽

Rosali Bhoi ◽

Biswaranjan Mishra ◽

Susanta Padhy

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Case Series ◽

Signs And Symptoms ◽

Initial Symptom ◽

Relative Paucity ◽

Holistic Management ◽

Mood Episode ◽

Psychiatric Conditions ◽

Over Time

Catatonia, originally conceptualised by Kahlbaum in 1868, is a neuropsychiatric condition that has been found to occur concomitantly with several organic and psychiatric conditions. Starting from the era of Kraepelin and Bleuler, this condition was faultily linked with schizophrenia alone; however, over time, greater associations have been found between catatonia and mood disorders. Despite the availability of several reports supporting this finding, there is a relative paucity of studies that specifically focus on catatonia to be the first symptom manifestation heralding a subsequent mood episode. In addition, there is scant literature to determine whether there are specific presentations of catatonia that show greater associations with mood disorders and whether these signs and symptoms recur in a stereotypical fashion in the subsequent mood episodes in the lifetime of an individual. We hereby report two cases with a diagnosis of mood disorders (bipolar disorder and recurrent depressive disorder) who had catatonia as the initial symptom not only at presentation but also at subsequent episodes. The report emphasises that recurrent catatonia can be the initial clinical manifestation of an underlying mood episode, which appears otherwise masked behind the catatonic presentation. These catatonic symptoms can be interestingly similar in all the subsequent episodes. A detailed clinical evaluation is thus warranted after catatonia has been duly treated to provide a holistic management.

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