Late-Onset Schizophrenia: a Case Report

Introduction

Late-onset psychoses are a heterogeneous group of disorders whose nosology has been controversial throughout history. Several methodological limitations have made difficult the comparison among studies and, as a consequence, the research interest has been little, leading to the absence of late-onset schizophrenia and paraphrenia in current official classifications.

Aims and methodology

To highlight the specific symptoms of late-onset schizophrenia as well as its differences with other psychoses though the study of a case report.

Results

A 70-year-old woman developed psychotic symptoms during the last seven years, consisting of auditory and olfactory hallucinations, telepathic phenomena and injury delusions, erotomania and thought control, with a high level of systematization and fantasy. She was admitted in an inpatient unit. She was treated with risperidone and the psychotic symptoms got better. At the time of hospital discharge, hallucinations and delusional thoughts had disappeared and no behavioral or emotional disorder was observed. Some weeks later, risperidone had to be substituted by paliperidone due to side effects, such as tremor, sialorrhea and parkinsonism.

Conclusions

Late-onset schizophrenic psychosis is not as exceptional as it has been traditionally considered. One of the main problems is that current classifications do not include specific diagnostic categories for cases of late or very-late-onset psychoses. It would be necessary that future ICD-11 and DSM-V classifications will include different-age criteria when diagnosing mental disorders.

Pediatric obsessive-compulsive disorder: A case report

Introduction

Obsessive compulsive disorder (OCD) in childhood was first described by Legrand du Saulle in late XIX century, however, a systematic study in pediatric population was not made until 1986, by Rapoport. It is has been documented in scientific literature that younger patients usually hide their symptoms because of shame or that they do not find their obsessions and compulsions excessive, so that they feel them in an egosyntonic way, delaying diagnosis until several years after their first symptoms.

Aims and methodology

To highlight the specific symptoms in Pediatric OCD and review its treatment and approach through the study of a case report.

Results

A 11-year-old boy was referred by his paediatrician to a child mental outpatient service for behavioural disturbances in the last few months. For the last three years, he had been performing rituals of cleaning, order and checking, increasingly complex and with a significant impact on his life, to the point of not being able to go to school and have other members of his family involved. He also had religious and catastrophic obsessions that generated him important distress. He was treated with high doses of sertraline and low doses of risperidone, and cognitive-behavioral psychotherapy with exposure response prevention and training in relaxation techniques were associated to the treatment. The patient improved partially.

Conclusions

This case illustrates the delay in the diagnosis of Pediatric OCD itself as well as the complexity when treating this disorder.

Psychoactive substance abuse and personality disorders in psychiatric inpatients

Introduction

Comorbidity between Substance Use Disorder (SUD) and other psychiatric disorders, known as Dual Diagnosis, is an issue of growing interest in Mental Health. The high association between Personality Disorders (PD) and substance use is reported in scientific literature. However, not many studies have been published regarding the prevalence of this disorder in a psychiatric unit. AIMSTo determine the prevalence of substance abuse among patients with a Personality Disorder in a psychiatric unit.

Methodology

A retrospective descriptive study was carried out among all patients admitted to our psychiatric unit during one year. The data collected from the discharge clinical records of patients were: demographic variables, personal psychiatric history and substance use, urine tests and clinical diagnoses at discharge.

Results

We obtained a sample of 334 patients. There was comorbidity between Mental Disorder and SUD in 10.17% of subjects; including 4% diagnosed with Personality Disorder (80% belong to Cluster B). 53.3% of patients with PD substance abuse was reported. Excluding nicotine dependence and benzodiazepines, the most common substances used were cannabis (50%), alcohol (37.5%) and cocaine (25%).

Conclusions

This study shows that Personality Disorder is the Mental Disorder most commonly associated with SUD, among inpatients in our psychiatric unit. In order to detect cases of Dual Diagnosis, we suggest optimize recording in clinical history substance use and systematic urine tests in all patients admitted, which would benefit from specific treatment for their condition.

[Aniridia, congenital glaucoma and white corneas in a newborn baby]

CASE REPORT

We present the case of a newborn baby in whom we observed aniridia, congenital glaucoma and edematous corneas, without clearance of the cornea after glaucoma surgery, and in whom a keratoplasty was considered. The patient had no evidence of systemic diseases and no deletion of chromosome 11.

DISCUSSION

It is important to perform a thorough ophthalmological and systemic exploration in newborn patients with aniridia due to other diseases that can be associated with it. We present the unusual case in which aniridia, congenital glaucoma and white corneas coexisted in a newborn baby. To our knowledge, such cases have only been reported twice before in the literature (Arch Soc Esp Oftalmol 2009; 84: 573-576).

Long-term results of surgical treatment of high myopia with Worst-Fechner intraocular lenses

This retrospective study evaluated the results in 90 eyes that had a minuspower anterior chamber intraocular lens implanted to correct high myopia. Preoperative myopia ranged from -7.00 to -24.00 D. Postoperative spherical equivalent was -0.50 D; 80.5% of eyes were within 1.00 D of emmetropia. Two years postoperatively, no cataract formation, retinal detachment, glaucoma, or significant endothelial damage had occurred. We conclude that minus-power lenses can rapidly, safely, and predictably correct high myopia in phakic patients.

Extracapsular cataract extraction and implantation of a low power lens for high myopia

A comparative study of two groups of patients with cataracts and high myopia was made. The percentage of patients with a visual acuity equal to or better than 20/40 (P less than .01) and normocorrections +/- 1 diopter (P less than .01) was significantly greater in the group with extracapsular cataract extraction and intraocular lens implantation.

Iris and macular angiography in intraocular implants

We performed an angiographic study of the iris and retina of 121 implanted eyes and 94 aphakic eyes 15 days, three months, six months, and 12 months postoperatively to determine the incidence of cystoid macular edema (CME) and iris leakage and the relationship between them. The angiographic study shows that iris leakage is a common feature of cataract surgery in the immediate postoperative period. Apparently the type of extraction (extracapsular or intracapsular) does not influence the appearance of these iris angiographic findings. However, the percentage of observed CME after three months is less (P less than 0.05) in patients with an intraocular lens (IOL) who have had extracapsular cataract extraction (ECCE) than in patients who have had intracapsular cataract extraction (ICCE) and the presence of CME is closely related to the angiographically observed iris leakage.

The SRK regression formula in calculating the dioptric power of intraocular lenses

One hundred and seventy one eyes with intraocular lenses were studied to compare the predictive accuracy of the Fyodorov and Van der Heijde theoretical formulae of the Sanders-Retzlaff-Kraff (SRK) regression formula. The SRK regression formula was the most accurate. Our personal calculations of the A constants of this formula are given for several types of implants and manufacturers.