Prolonged mannerism as an isolated, interesting, and old symptom in a schizophrenic patient with poor response to clozapine: a clinical image

The concept of catatonia was first described by a German psychiatrist, Kahlbaum, in 1874. Catatonia is a serious neurological disorder associated with a wide range of psychiatric, neurological, medical conditions, and drug-induced disorders. Nevertheless, there is no absolute guideline for treating catatonia patients in whom the cause of the disorder is unknown. Clozapine is the first atypical antipsychotic used for the treatment of catatonia. Our case was a 51-year-old single, right-handed man with schizophrenia and a specific symptom of catatonia. Despite previous studies findings revealing the efficacy of clozapine in relieving catatonia symptoms, our patient did not show a definite response to this medication. Hence, follow-up of these patients to evaluate other treatments and possible incidence or manifest of other catatonic features like waxy flexibility, echo phenomenon, and negativism are suggested.

The Importance of Family Support in Successful Treatment Adherence of Schizophrenic Patient

Background: Schizophrenia is a treatable disease but requires patient’s high adherence to treatment. Family support of a schizophrenic patient plays an important role in encouraging the patient to continue his treatment. This report aims to enhance the importance of family support of schizophrenic patient in patient’s adherence to achieve a good mental health for all family member.Case: A hospitalized male paranoid schizophrenic patient who was admitted and observed in Dr. Soetomo General Hospital from September 15th-25th, 2020. Patient came to the hospital with chief complaint could not stop talking (rambling) since 1 day before admission. Patient could neither eat nor sleep for that day. Patient relapsed after stopping taking medication from the psychiatrist.Discussions: The patient in this case suffered a relapse of his paranoid schizophrenia because he stopped taking medication. Lack of support from family is the most important factor in a schizophrenia patient. Psychoeducation to patient’s family about schizophrenia and the importance of medication would be a great help for patient’s adherence to treatment.Conclusions: Schizophrenia needs a long-life treatment. High adherence to treatment could improve schizophrenia’s symptoms and prevent relapse. Family support is important to make sure the patient keeps taking his medicine regularly.

Delayed brain reexpansion in schizophrenic patient affected by trabecular type chronic subdural hematoma

Background: Chronic subdural hematoma (cSDH) represents a complex and unpredictable disease, characterized by high morbidity and mortality, especially in elderly patients. Factors affecting the postoperative brain reexpansion along to cSDH recurrence have not been yet adequately investigated. The authors presented the case of a schizophrenic patient affected by trabecular type cSDH that presented a delayed brain reexpansion despite a craniotomy and membranotomy. Case Description: A 51-year-old female patient with diagnosis of schizophrenia was admitted to the emergency department with GCS score of 5/15 and right anisocoria. An urgent brain CT revealed a trabecular right cSDH (35 mm in maximum diameter) with recent bleeding. After surgery, a brain CT scan showed a markedly reduced brain reexpansion and pneumocephalus. Nevertheless, postoperative 7-day brain CT documented a progressive brain reexpansion with reduced midline shift. Conclusion: According to our opinion, anatomopathological alterations in schizophrenia reduce normal brain compliance and increasing elastance, thus modifying the normal timing of reexpansion after cSDH drainage, also after craniotomy and membranotomy. Although postoperative pneumocephalus is a well-known cause of hindered reexpansion, this could be due to anatomical alterations in schizophrenia. Such factors must be considered in the preoperative planning but mostly in the postoperative management.

Primary nonessential cutis verticis gyrata with acne keloidalis nuchae

Cutis verticis gyrata is a rare disorder characterized by redundant skin forming deep furrows and convolutions. It has been associated with several systemic and cutaneous disorders. We report a case of primary non-essential cutis verticis gyrata in association with acne keloidalis nuchae in a schizophrenic patient.

Main characteristics of dermatoglypics associated with schizophrenia and its clinical subtypes

Dermatoglypic patterns are extensively investigated to apply in disease-related risk assessment due to an obvious association between morphological and genetic characteristics. In the current study, we aimed to determine whether the fingerprint and palmar patterns vary between case population with schizophrenia and general population. A cross sectional study was conducted in people diagnosed with schizophrenia (cases) and a control population between 2016 and 2019. In this study, 252 people were participated. Ink and paper method was used to evaluate the difference of fingerprints palm prints between patients with schizophrenia and participants in control group.93 participants were analyzed in schizophrenic group and 142 participants were investigated in the control group. The percentage of arches on the right ring finger was significantly different between the schizophrenic patient group and control group (p = 0.011). The whorl pattern type (U-W-U-W-W-W-W-U-W-U) was dominantly observed in both of the schizophrenic patient group and control group. A-B ridge count in schizophrenic patient group and control group produced a markedly significant difference (p<0.05). Interestingly, a strong significant difference was produced in comparing of A-B ridge count in catatonic schizophrenia group with residual schizophrenia group (p<0.005). In comparison, index of pattern intensity in control group was slightly higher than that in schizophrenic patient group. Taking together, these results showed that the dermatoglypic characteristics might be a valuable tool to describe the nature of schizophrenia and its clinical subtypes and further studies are needed in clinical application.