Psychiatric Symptoms and Parietal Disease: Differential Diagnosis

IntroductionAnti-NMDA encephalitis normally appears as a characteristic syndrome with typical symptoms that undergoes with multiphase evolution. However, it sometimes develops atypical symptoms so we must perform a careful differential diagnosis.ObjectivesTo conduct a current review of detection and management of anti-NMDAr encephalitis, and psychiatric manifestations.MethodSystematic review of the literature in English (PubMed), with the following keywords: “Autoimmune encephalitis”, “psychosis”, and “NMDA receptor”.ResultsWe present the case of a 15-year-old boy referred to evaluation for a first psychotic episode. He had no past history of psychiatric illness or substance abuse. The only relevant antecedent is multiple sclerosis in a first degree relative. For the last months, he presented high levels of anxiety symptoms apparently related to college stressful events and fluctuating hypoesthesia of left cranial side. Days later, it appeared autolimited gastrointestinal symptoms, headache and fever. During the next days it appeared psychomotor retardation, choreic movements, suicide ideation and mood-congruent paranoid and nihilistic ideation, auditory and visual hallucinations, perplexity and catatonic symptoms so he was hospitalized. We observed cognitive functions impairment, unsteady gait, dysartria, dysphasia, clonus and left babinsky sign. EEG showed slow waves on right frontal area. CFS showed protein elevation and immunologic study revealed positive anti-NMDA antibodies. Treatment with methylprednisolone and gammaglobuline was started with partial response, needing addition of rituximab.ConclusionsIn this case, we highlight the importance of early detection and a detailed differential diagnosis, to determine whether the etiology of psychiatric symptoms in order to achieve an accurate and early treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Late-onset schizophrenia

Oxford Textbook of Old Age Psychiatry ◽

10.1093/med/9780198807292.003.0043 ◽

2020 ◽

pp. 671-694

Author(s):

Ellen E. Lee ◽

Baichun Hou ◽

Ipsit V. Vahia ◽

Dilip V. Jeste

Keyword(s):

Risk Factors ◽

Differential Diagnosis ◽

Life Events ◽

Genetic Risk ◽

Psychiatric Symptoms ◽

Late Onset ◽

Sociodemographic Factors ◽

Sensory Loss ◽

Adverse Life Events

Late-onset schizophrenia remains an understudied subtype of schizophrenia, despite growing recognition of its impact and distinction from early-onset schizophrenia. This chapter reviews the existing literature on late-onset schizophrenia including beginning with the nomenclature and epidemiology. Then we provide a review of key risk factors and correlates—including genetic risk, sex differences, comorbid sensory loss and physical illness, cognitive and psychiatric symptoms, sociodemographic factors, adverse life events, neuropathology, and inflammation. The chapter ends with clinical issues, including symptoms, differential diagnosis, treatments, and prognosis. Recent studies have examined the role of oestrogen treatments and a new therapy for tardive dyskinesia therapy as well as inflammatory mechanisms in schizophrenia.

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

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2392 ◽

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.

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Acute hypomania in systemic lupus erythematosus, differential diagnosis. A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1414 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S393-S393 ◽

Cited By ~ 1

Author(s):

D.K. Ochoa García ◽

G.M. Chauca Chauca ◽

L. Carrión Expósito

Keyword(s):

Systemic Lupus Erythematosus ◽

Bipolar Disorder ◽

Differential Diagnosis ◽

Case Report ◽

Lupus Erythematosus ◽

Depressive Episode ◽

Psychiatric Symptoms ◽

Brain Mri ◽

Systemic Lupus ◽

Neuropsychiatric Sle

IntroductionIt is well known that seizures and psychosis are diagnostic criteria for systemic lupus erythematosus (SLE), however, there could be many other neuropsychiatric symptoms. The American College of Rheumatology Nomenclature provides case definitions for 19 neuropsychiatric syndromes seen in SLE (NPSLE), including cognitive impairment, psychosis, mood and anxiety disorders. Lack of specific manifestations difficult diagnosis and treatment.ObjectivesTo address the diagnostic difficulties that involve the appearance of hypomanic symptoms in the course of SLE treated with high doses of corticoids in a patient with a depressive episode history.MethodDescription of case report and literature revision. We report the case of a 22-year-old woman who presented irritable mood, sexual disinhibition, insomnia and inflated self-esteem. The patient was recently diagnosed with SLE and was on treatment with 50 mg/d prednisone. She had familiar history for bipolar disorder and was taking 20 mg/d paroxetine since the last 6 months after being diagnosed with major depressive episode.ResultsWe proposed differential diagnosis between psychiatric symptoms secondary to central nervous system SLE involvement, a comorbid bipolar disorder or prednisone-induced mood symptoms. Fluctuation of hypomanic symptoms during hospitalization, poor relationship with variation in corticosteroid doses, findings on brain MRI compatible with vasculitis and positive antibodies, oriented this case to a neuropsychiatric manifestation of LES.ConclusionsWe should keep in mind that symptoms of neuropsychiatric SLE may vary from more established manifestations of NPSLE to mild diffuses ones. More studies are needed to expand knowledge in the relationship between mood disorders and neuropsychiatric SLE.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Heterogeneity in the psychiatric presentation of behavioural variant frontotemporal dementia (bvFTD)

Australasian Psychiatry ◽

10.1177/1039856219860031 ◽

2019 ◽

Vol 27 (5) ◽

pp. 491-495

Author(s):

Reece Bretag-Norris ◽

Lara Gallur ◽

Patrick Flynn

Keyword(s):

Differential Diagnosis ◽

Literature Review ◽

Psychiatric Disorder ◽

Frontotemporal Dementia ◽

Psychiatric Symptoms ◽

Case Reports ◽

Relevant Literature ◽

Important Differential Diagnosis

Objective: This article describes how the onset of bvFTD can be heralded by psychiatric symptoms. Method: Case reports are described with reference to the relevant literature review. Results: Three patients were admitted with psychiatric symptoms, including depression, mania, psychosis and catatonia. Two had been previously diagnosed with a psychiatric disorder. All three were diagnosed with probable bvFTD. Conclusion: bvFTD is an important differential diagnosis to consider when patients present with atypical psychiatric symptoms.

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Differential Diagnosis Based on Age. Diagnostic Difficulties

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1727 ◽

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.

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Findings of Fahr’s Syndrome in A Patient Suspected With Subarachnoid Hemorrhage: An Evidence-Based Case Report

SCRIPTA SCORE Scientific Medical Journal ◽

10.32734/scripta.v1i2.1244 ◽

2019 ◽

Vol 1 (2) ◽

pp. 8

Author(s):

Gilbert Sterling Octavius ◽

Theo Audi Yanto ◽

Nicholas Gabriel H.R. ◽

Eka Julianta Wahjoepramono ◽

Harsan

Keyword(s):

Computed Tomography ◽

Differential Diagnosis ◽

Case Report ◽

Parathyroid Hormone ◽

Basal Ganglia ◽

Psychiatric Symptoms ◽

Evidence Based ◽

Head Ct ◽

Fahr’S Syndrome ◽

Chief Complaints

ABSTRACT Fahr’s syndrome is an entity where there is symmetrical bilateral calcification of basal ganglia with parkinsonian and psychiatric symptoms. However, due to its rarity, clinicians tend not to include Fahr’s syndrome in their differential diagnosis. This article aims to raise awareness about the diagnosis of Fahr’s Syndrome through its unique presentation in this patient. Data was obtained primarily and secondarily. In this case, a 32 years old male was referred to our clinic with chief complaints of headache since a week prior and a seizure 5 days ago. A head CT and a CT angiography (CTA) of the circulus willisi were done and a bilateral and symmetrical calcification of the corona radiata, basal ganglia, thalamus, and nucleus dentatus were found. There is also hypocalcemia and low Parathyroid Hormone (PTH). Fahr’s Syndrome may manifest unusually and hence clinicians have to be aware of diagnosing this entity. Keywords: Fahr’s Disease, Fahr’s Syndrome ABSTRAK Sindroma Fahr’s merupakan sebuah penyakit yang ditandai dengan kalsifikasi bilateral sietris dari basal ganglia dengan gejala psikatri dan parkinsonisme. Namun, akibat jarangnya ditemukan penyakit ini, klinisi cenderung tidak memikirkan sindroma Fahr’s sebagai salah satu diagnosis banding. Artikel ini bertujuan untuk meningkatkan kewaspadaan terhadap diagnosis Sindroma Fahr’s melalui presentasi unik pada pasien ini. Data diambil secara primer dan sekunder. Pada kasus ini, seorang laki-laki berusia 32 tahun dirujuk dengan keluhan utama sakit kepala sejak satu minggu dan kejang 5 hari sebelum masuk rumah sakit. Computed Tomography (CT) scan kepala dan Computed Tomography Angiography (CTA) dari sirkulus willisi dilakukan dan ditemukan adanya kalsifikasi bilateral simetris pada korona radiata, basal ganglia, talamus dan nukleus dentatus. Pada pemeriksaan laboratorium ditemukan adanya hipokalsemia dan hormon paratiroid (PTH) yang rendah. Sindroma Fahr’s dapat datang dengan presentasi yang tidak khas sehingga para klinisi harus lebih tajam dalam mendiagnosis kasus ini. Kata kunci: Penyakit Fahr’s, Sindroma Fahr’s

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The Psychiatric Examination of the Neurologic Patient

Psychiatric Aspects of Neurologic Diseases ◽

10.1093/oso/9780195309430.003.0007 ◽

2008 ◽

Author(s):

Constantine G. Lyketsos

Keyword(s):

Differential Diagnosis ◽

Psychiatric Disorders ◽

Psychiatric Symptoms ◽

Chief Complaint ◽

Psychiatric Evaluation ◽

Cognitive State ◽

Psychiatric History ◽

Neurologic Disease ◽

History Of ◽

Cognitive Problems

A well-conducted psychiatric evaluation is central to the care of neurologic patients with psychiatric disorders. The evaluation is aimed at defining the psychiatric condition in the context of the patient’s past psychiatric history and current neurologic disease. The information derived from the evaluation is used to develop a formulation, establish a diagnosis, and form a basis for treatment planning. This chapter discusses the psychiatric evaluation of the neurologic patient in detail. It includes examination techniques and questions as well as practical approaches to conducting an assessment of the patient’s cognitive state. Along the way, common psychiatric symptoms encountered in neurologic patients are defined and differentiated from related symptoms. The chapter concludes by illustrating how to generate a formulation and differential diagnosis. The psychiatric evaluation consists of three parts: the history; the mental status examination (MSE); and the formulation, including the differential diagnosis. The history, which is essential to defining the problem, is taken from the patient and from one or more informants. The importance of taking a history from an informant is underscored in the context of neurologic disease because patients may be forgetful, lack insight, or have language and other cognitive problems that may limit their ability to provide a good history. History-taking begins with defining the psychiatric chief complaint and then obtaining the family and personal history. Starting in this way, rather than with the chief complaint followed by the history of present illness (HPI), makes it easier to see that the psychiatric symptoms may have been caused by, or influenced by, factors other than the neurologic disease—factors that can include psychiatric disorders as such, aspects of patients’ personalities, and responses patients have to the circumstances of their lives. Table 1–1 provides an outline of important elements of the psychiatric history for neurologic patients and can be used as a checklist in clinical practice. Defining the psychiatric chief complaint is the physician’s first task. ‘‘Psychiatric chief complaint’’ in this context refers to the occurrence of cognitive, affective, behavioral, or perceptual phenomena that are brought to the physician’s attention by the patient, a family member or other informant, or by the physician’s own observation.

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

International Psychogeriatrics ◽

10.1017/s104161021000181x ◽

2010 ◽

Vol 23 (4) ◽

pp. 666-669 ◽

Cited By ~ 8

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.

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