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Restrepo-Martínez M, Ramirez-Bermudez J, So I, Coleman K, Finger E. Delusions of love and passion in the behavioral variant of frontotemporal dementia. Neurocase 2023; 29:37-45. [PMID: 38678305 DOI: 10.1080/13554794.2024.2345110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Erotomania (de Clérambault's syndrome) refers to the delusional belief that another person, usually socially unreachable, is in love with the holder of the delusion. The occurrence of erotomania in Frontotemporal Dementia has rarely been reported. We present the unique case of a 59-year-old woman with a strong family history of early-onset dementia in whom erotomania was the initial manifestation that led to a diagnosis of definite Behavioral Variant of Frontotemporal Dementia with a pathogenic missense mutation in the MAPT gene. Based on this case, we propose a hypothetical model for developing erotomania in patients with FTD.
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Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Isis So
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kristy Coleman
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Mendez MF. Cotard's Delusion From Subacute Encephalopathy With Seizures in Alcoholism. J Neuropsychiatry Clin Neurosci 2022; 35:202-205. [PMID: 36464976 DOI: 10.1176/appi.neuropsych.20220123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Mario F Mendez
- Departments of Neurology and Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, and Neurology Service, Neurobehavior Unit, U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
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Speir T, Zeitler C, Nguyen T, Nevitt N, Aragon R, Merhavy Z, Varkey T. Cotard’s Delusion with Sequelae of Adult Onset Failure to Thrive: A Case Report. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/21-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patients can present with chief complaints and symptoms that differ from the eventual diagnoses. The differences between aetiologies versus complications must be appreciated through careful evaluation and use of clinical investigations, laboratory testing, trial of hypotheses, and clinical gestalt. Herein, this article discusses the case of a 58-year old individual who presented with impaired physical functioning, malnutrition, depression, and cognitive impairment. These four symptoms are known collectively as failure to thrive, and they often portend adverse patient outcomes. The internal medicine care team initially attributed the failure to thrive to the combination of an ongoing cervicofacial infection and a pre-existing mood disorder, but its true aetiology was more complex. In the context of various physical and psychiatric health derangements, the patient displayed clear signs of a rare disorder called Cotard’s syndrome. Due to the concern of the care team and the patient’s acting medical power of attorney, the eventual working diagnosis was made, and electroconvulsive therapy and aripiprazole combination therapy initiated, resulting in significant and improved outcomes. In addition to discussing the patient’s course of care, this case report also addresses the caution inherent in prescribing medications, the evaluation of decision making capacity, and the utilisation of a medical power of attorney. The authors also present their thoughts on minimising inefficiencies in care delivery to better the patient’s health outcomes.
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Edelkraut L, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Dávila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry 2022; 12:450-469. [PMID: 35433325 PMCID: PMC8968505 DOI: 10.5498/wjp.v12.i3.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders.
AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.
METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416).
RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety.
CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.
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Affiliation(s)
- Lisa Edelkraut
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Diana López-Barroso
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - María José Torres-Prioris
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Sergio E Starkstein
- School of Psychiatry and Neurosciences, The University of Western Australia, Perth 6009, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jessica Aloisi
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Guadalupe Dávila
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
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Beyond motor recovery after stroke: The role of hand robotic rehabilitation plus virtual reality in improving cognitive function. J Clin Neurosci 2021; 92:11-16. [PMID: 34509235 DOI: 10.1016/j.jocn.2021.07.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/27/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022]
Abstract
Robot-assisted hand training adopting end-effector devices results in an additional reduction of motor impairment in comparison to usual care alone in different stages of stroke recovery. These devices often allow the patient to perform practical, attentive, and visual-spatial tasks in a semi-virtual reality (VR) setting. We aimed to investigate whether the hand end-effector robotic device AmadeoTM could improve cognitive performance, beyond the motor deficit, as compared to the same amount of occupational treatment focused on the hand. Forty-eight patients (aged 54.3 ± 10.5 years, 62.5% female) affected by either ischemic or hemorrhagic stroke in the chronic phase were enrolled in the study. The experimental group (EG) underwent AmadeoTM robotic training, while the control group (CG) performed occupational therapy involving the upper limb. Patients were assessed at the beginning and at the end of the rehabilitation protocol using a specific neuropsychological battery, as well as motor function tests. The EG showed greater improvements in different cognitive domains, including attentive abilities and executive functions, as well as in hand motor function, as compared to CG. Our study showed that task-oriented VR-based robotic rehabilitation enhanced not only motor function in the paretic arm but also global and specific cognitive abilities in post-stroke patients. We may argue that the hand robotic plus VR-based training may provide patients with an integration of cognitive and motor skill rehabilitation, thus amplifying the functional outcome achievement.
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Maggio MG, Maresca G, Stagnitti MC, Anchesi S, Casella C, Pajno V, De Luca R, Manuli A, Calabrò RS. Social cognition in patients with acquired brain lesions: An overview on an under-reported problem. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:419-431. [PMID: 32301351 DOI: 10.1080/23279095.2020.1753058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Social cognition (SC) consists of mental representations of interpersonal relationships, which are used flexibly by the individual to promote functional social behaviors and achieve the goals. SC is a multidimensional construct and is supported by the activity of distributed neural networks in which different cortical and subcortical regions of the brain are involved. The review aims to evaluate the current literature on SC taking into account how it is compromised in acquired brain injury. Studies performed between 2010 and 2019 and fulfilling the selected criteria were searched on PubMed, Scopus, Cochrane and Web of Sciences databases. Impairment of SC is a neglected but common consequence of ABI, often leading to disordered interpersonal functioning and poor regulation of personal behavior with impaired social adaptation and quality of life of both the patient and his/her family. This review supports the idea that SC could have an important role in the management of neurological patients by both clinicians and caregivers.
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Restrepo-Martínez M, Espinola-Nadurille M, Bayliss L, Díaz-Meneses I, Kerik NE, Mendez MF, Ramírez-Bermúdez J. FDG-PET in Cotard syndrome before and after treatment: can functional brain imaging support a two-factor hypothesis of nihilistic delusions? Cogn Neuropsychiatry 2019; 24:470-480. [PMID: 31597522 DOI: 10.1080/13546805.2019.1676710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Cotard syndrome is a neuropsychiatric entity recognised by the presence of nihilistic delusions. Although different models have been proposed for the development of monothematic delusions, including Cotard syndrome, functional neuroanatomical models are lacking.Methods: A case report of a 19-year old male with autoimmune encephalitis and Cotard syndrome, in whom Positron Emission Tomography (18F-FDG-PET) scans were performed before and after successful treatment with electroconvulsive therapy (ECT), is presented. Literature review on brain imaging is provided to discuss a functional neuroanatomical model of Cotard syndrome, in accordance with the two-factor theory of delusions.Results: The patient's 18F-FDG-PET showed marked insular and prefrontal metabolic abnormalities. Except for insular hypometabolism, metabolic abnormalities improved after ECT. Previously reported structural neuroimaging studies in Cotard syndrome showed a predominance of right hemisphere lesions, in which frontal lobes were more frequently involved, followed by parietal and temporal lesions. Functional neuroimaging studies reported abnormalities in frontoparietal circuits as well as midline structures included in the "default mode network".Conclusions: Abnormalities in the functioning of the insular cortex and the prefrontal cortex could be related to the development of nihilistic delusions when a two-factor theory of delusions is considered.
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Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, México
| | | | - Leo Bayliss
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, México
| | - Ivan Díaz-Meneses
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, México
| | - Nora E Kerik
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, México
| | | | - Jesús Ramírez-Bermúdez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, México
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Tan EJ, Fletcher K, Rossell SL. Exploring the relationship between fantasy proneness and delusional beliefs in psychosis and non-clinical individuals. Psychiatry Res 2019; 272:80-85. [PMID: 30579186 DOI: 10.1016/j.psychres.2018.12.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/19/2018] [Accepted: 12/16/2018] [Indexed: 12/15/2022]
Abstract
Delusions are a core feature of psychopathology while fantasy proneness (FP) is a trait that describes a predisposition towards fantastical thinking, vivid mental imagery and an overactive imagination. The relationship between FP and delusional experiences has not yet been examined in the literature. The current study hypothesised that FP would be significantly associated with and predict delusion severity as well as the associated delusional distress, preoccupation and conviction. Ninety-five patients with current psychosis (schizophrenia and bipolar I disorder) were assessed for overall delusional severity using the PANSS (clinician-rated) and the Peters Delusions Inventory (PDI; self-report). FP was assessed using the Creative Experiences Questionnaire (CEQ). Forty-six healthy control participants also completed the PDI and CEQ. Significant positive correlations were observed between FP and delusion severity in both groups; and distress, preoccupation and conviction in patients only. Linear regression analyses, controlling for manic and depressive symptoms, revealed that greater FP predicted higher levels of severity, distress, preoccupation, and conviction associated with delusions in patients, and higher severity only in healthy controls. The findings highlight the role of specific cognitive biases in delusional experiences, and empirically support models of unusual belief formation and maintenance.
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Affiliation(s)
- Eric J Tan
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, VIC, Australia.
| | - Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, VIC, Australia
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