1
|
Arıkan MK, İlhan R, Ozulucan MT, Aşık M. qEEG in the Diagnosis and Prognosis of a Case with Delusional Infestation. Clin EEG Neurosci 2024; 55:214-218. [PMID: 36945781 DOI: 10.1177/15500594231163383] [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] [Indexed: 03/23/2023]
Abstract
Stroke can have neuropsychological consequences, such as poststroke psychosis. One aspect of poststroke psychosis is delusional infestation (DI), also known as delusional parasitosis. Patients with DI have fixed sensations that they get infested by lice. Some explanations of DI indicate that striatal and fronto-cortical structural and functional abnormalities are related to DI symptomatology. In this case report, we present a patient with DI due to right intracarotid artery occlusion, which is detected radiologically. Before treatment with escitalopram and risperidone, the case had a frontal slowing in quantitative electroencephalography activity, which was normalized after 2 weeks of treatment. At the end of treatment, psychotic symptoms and OCD symptoms evaluated by the Yale-Brown Obsessive Compulsive Scale, the Scale for the Assessment of Positive Symptoms, were remarkably reduced. These results revealed the role of brain imaging studies in the diagnosis and prognosis of DI.
Collapse
Affiliation(s)
| | - Reyhan İlhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | | | - Murat Aşık
- Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
2
|
Evagorou O, Arvaniti A, Angelopoulou C, Mavraki E, Mikellides G, Samakouri M. "Sleeping Beauty Syndrome" and Psychosis as Precursory Symptoms of Multiple Sclerosis: A Rare Case and Literature Review. J Nerv Ment Dis 2021; 209:933-935. [PMID: 34846357 DOI: 10.1097/nmd.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Frequently, patients with multiple sclerosis (MS) experience comorbid psychiatric symptoms. Mental disorders primarily occur simultaneously with or after an MS diagnosis; however, the probability of them being the initial manifestation of the disease is rare. We describe the case of a 22-year-old man who had previously been hospitalized because a single psychotic episode alongside symptoms of Kleine-Levin syndrome and a diagnosis of "acute and transient psychotic disorders." Two years later, he was diagnosed with MS. A literature review of the possibility of a psychiatric episode overshadowing an MS diagnosis is then presented. Clinicians should always consider the possibility of an underlying organicity in a case of psychiatric presentation with atypical features, with special attention being given during the investigation process. This approach will lead to the early diagnosis of an organic disease, which can be treated accordingly and as early as possible.
Collapse
Affiliation(s)
- Olympia Evagorou
- Department of Psychiatry, Medical School, Democritus University of Thrace
| | | | | | - Eleni Mavraki
- Neurology, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | |
Collapse
|
3
|
Lo Buono V, Corallo F, Allone C, Bonanno L, Sessa E, Todaro A, Pidalà A, Bramanti A, Marino S. Thought disorder in atypical schizophrenia-like psychosis after stroke: analysis of clinical cases. Neurocase 2019; 25:130-132. [PMID: 31138024 DOI: 10.1080/13554794.2019.1623266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Formal thought disorder refers to disorganized thinking and it represents a hallmark of schizophrenia and psychosis. Psychosis is a rare complication after stroke. We described two cases of female patients, who developed an atypical schizophrenia-like psychosis post-stroke, characterized by formal thought disorder, hallucinations, and delusion. Cerebrovascular disease affected the right temporal lobe, areas devoted to modulation of higher order cognitive processes. To date, the relation between stroke and psychosis remain unclear, maybe due to the involvement of a complex brain networks. However, the high impact of this disorder on physical, psychological and social wellbeing suggests the importance of improving specific treatments.
Collapse
Affiliation(s)
- Viviana Lo Buono
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Francesco Corallo
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Cettina Allone
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Lilla Bonanno
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Edoardo Sessa
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Antonino Todaro
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Alessandra Pidalà
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Alessia Bramanti
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| | - Silvia Marino
- a Department of Neurobioimaging , IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy
| |
Collapse
|
4
|
Baroud E, Hourani R, Talih F. Brain Imaging in New Onset Psychiatric Presentations. INNOVATIONS IN CLINICAL NEUROSCIENCE 2019; 16:21-26. [PMID: 31037224 PMCID: PMC6450676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report two cases of patients who presented with psychiatric symptoms and were found to have brain changes on magnetic resonance imaging. In the first case, a 19-year-old man presented with erratic behavior and odd, paranoid ideas. Imaging of the brain revealed a focus of high FLAIR signal involving the left globus pallidus. The second case was a 21-year-old woman who presented with irritability, racing thoughts, and suicidal ideation. Brain imaging revealed nodules of heterotopic grey matter in the right inferior frontal white matter and foci of subcortical heterotopia with thickening of the adjacent cortex. Both patients received psychotropic medications and showed improvement of their symptoms. Integrating neuroimaging in the evaluation of new onset or atypical psychiatric presentations might be of value in specific cases. It is important to develop clear guidelines for the use of imaging modalities in clinical psychiatric practice.
Collapse
Affiliation(s)
- Evelyne Baroud
- Drs. Baroud and Talih are with the Department of Psychiatry, American University of Beirut Medical Center in Beirut, Lebanon
- Dr. Hourani is with the Department of Diagnostic Radiology, American University of Beirut Medical Center in Beirut, Lebanon
| | - Roula Hourani
- Drs. Baroud and Talih are with the Department of Psychiatry, American University of Beirut Medical Center in Beirut, Lebanon
- Dr. Hourani is with the Department of Diagnostic Radiology, American University of Beirut Medical Center in Beirut, Lebanon
| | - Farid Talih
- Drs. Baroud and Talih are with the Department of Psychiatry, American University of Beirut Medical Center in Beirut, Lebanon
- Dr. Hourani is with the Department of Diagnostic Radiology, American University of Beirut Medical Center in Beirut, Lebanon
| |
Collapse
|
5
|
Joyce EM. Organic psychosis: The pathobiology and treatment of delusions. CNS Neurosci Ther 2018; 24:598-603. [PMID: 29766653 DOI: 10.1111/cns.12973] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 01/01/2023] Open
Abstract
Organic or secondary psychosis can be seen in diverse conditions such as toxic/metabolic disorders, neurodegenerative disease, and stroke. Poststroke psychosis is a rare phenomenon, but its study has significantly contributed to the understanding of delusion formation. The evidence from case studies of patients with focal strokes shows that delusions develop following unilateral damage of the right hemisphere. The majority of patients with right hemisphere stroke do not develop delusions however, and advanced neuroimaging analysis has elucidated why this symptom develops in only a small proportion. Lesions of the right lateral prefrontal cortex or lesions with connectivity to this area correlate with delusional beliefs in this subgroup. Studies of patients with primary psychosis, for example schizophrenia, or under the influence of the psychotogenic drug ketamine, also show abnormal function of this area in relation to the severity of their abnormal beliefs. The conclusion of these studies is that the right lateral prefrontal cortex is 1 hub in a neural network which includes the basal ganglia and limbic system and receives inputs from midbrain dopamine neurones. In patients with schizophrenia, or at risk of psychosis, dopamine is dysregulated and evidence suggests that faulty dopamine signaling is the precursor of delusion formation. It is therefore likely that the mechanism of delusion formation is the same in both primary and secondary psychosis. This is consistent with the mainstay of treatment of both conditions being antipsychotic medication. However, antipsychotic medication in people with cerebrovascular disease should be avoided if at all possible. This is because epidemiological studies have found that antipsychotic use is associated with an increased risk of stroke and will thus compound the possibility of a further cerebrovascular accident.
Collapse
|
6
|
Torrisi M, De Luca R, Pollicino P, Leonardi S, Marino S, Maresca G, Maggio MG, Piccolo A, Bramanti P, Calabrò RS. Poststroke delusions: What about the neuroanatomical and neurofunctional basis? APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:392-396. [DOI: 10.1080/23279095.2017.1421536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | | | | | | | | | | |
Collapse
|
7
|
Parallel changes in serum proteins and diffusion tensor imaging in methamphetamine-associated psychosis. Sci Rep 2017; 7:43777. [PMID: 28252112 PMCID: PMC5333148 DOI: 10.1038/srep43777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/30/2017] [Indexed: 11/09/2022] Open
Abstract
Methamphetamine-associated psychosis (MAP) involves widespread neurocognitive and molecular deficits, however accurate diagnosis remains challenging. Integrating relationships between biological markers, brain imaging and clinical parameters may provide an improved mechanistic understanding of MAP, that could in turn drive the development of better diagnostics and treatment approaches. We applied selected reaction monitoring (SRM)-based proteomics, profiling 43 proteins in serum previously implicated in the etiology of major psychiatric disorders, and integrated these data with diffusion tensor imaging (DTI) and psychometric measurements from patients diagnosed with MAP (N = 12), methamphetamine dependence without psychosis (MA; N = 14) and healthy controls (N = 16). Protein analysis identified changes in APOC2 and APOH, which differed significantly in MAP compared to MA and controls. DTI analysis indicated widespread increases in mean diffusivity and radial diffusivity delineating extensive loss of white matter integrity and axon demyelination in MAP. Upon integration, several co-linear relationships between serum proteins and DTI measures reported in healthy controls were disrupted in MA and MAP groups; these involved areas of the brain critical for memory and social emotional processing. These findings suggest that serum proteomics and DTI are sensitive measures for detecting pathophysiological changes in MAP and describe a potential diagnostic fingerprint of the disorder.
Collapse
|