Psiquiatria Biologica最新文献

Aim

Challenge the idea that electroconvulsive therapy (ECT) is cognitively detrimental in the medium and long term in recurrent depressive disorder.

Clinical case

We introduce the case of a 75-year-old woman with recurrent major depressive disorder, resistant and intolerant to various antidepressant drugs, previously ruled out for ECT due to suspected cognitive decline, but included in June 2016 in the maintenance-electroconvulsive therapy (M-ECT program), after 10 sessions of acute ECT.

Outcomes

After more than 30 sessions of M-ECT, the patient remains euthymic, receiving a quarterly session of ECT and showing recovery from cognitive dysfunction both in the subjective assessment and through the screening test.

Main findings

M-ECT is effective in the elderly with major depression, and may improve and even normalize cognitive function.

Introduction

Clozapine-induced pericarditis is a rare but potentially serious condition for which discontinuation of clozapine treatment is recommended for resolution.

Presentation of the case

A 17-year-old male under treatment with clozapine due to failure of three previous antipsychotic lines, with good therapeutic response, who two months after starting the drug developed pericarditis.

Discussion

Clozapine-induced myocarditis and pericarditis are serious adverse effects that appear mostly in the first month of treatment. The generalized attitude towards clozapine-induced pericarditis is its withdrawal. This withdrawal may pose an ethical dilemma and should be carefully assessed, as the risk of psychiatric decompensation and loss of quality of life should be taken into account.

Conclusion

This case highlights the importance of performing a risk/benefit balance in each complex case, reflecting the ethical conflict of the management of clozapine adverse effects, since its withdrawal may negatively compromise the patient's psychopathological stability and quality of life.

Objectives

The purpose of this article is to review the available literature that links inborn errors of metabolism (IEM) with neuropsychiatry, highlighting some guiding points to facilitate suspicion, diagnosis, and treatment.

Case report

We describe the case of a male patient who was admitted to the psychiatric ward of a general hospital for presenting atypical psychiatric symptoms. He received treatment with valproic acid (VPA) and developed toxicity together with persistent adverse effects, which lasted even after the drug was withdrawn. Through different blood and urine analyses, it was possible to identify a state of chronic hyperammonemia. Together with the patient's clinical presentation, this result led to the presumptive diagnosis of a metabolic disease related to a urea cycle disorder.

Results

IEM can be suspected in young people or adults when they have a positive family history of the disease or when there is the presence of psychiatric symptoms together with neurological, cognitive, or motor signs.

Conclusions

IEMs represent a group of genetic diseases in which early diagnosis and treatment can improve the morbidity and mortality of affected patients.

Video game addiction disorder has generated significant controversy in recent years, being included in the next editions of the CIE and DSM within the section on behavioral disorders. The abusive use of video games can lead to a pattern of behavior that results in a significant clinical deterioration of the person. We present the case of a 19-year-old male with no psychiatric history, who, after confinement due to the COVID-19 pandemic, develops a video game addiction disorder.

Introduction

Gliomas are rare, slow-growing brain tumors. The insula is related to self-knowledge, theory of the mind, interpersonal relationships, distortion of reality and the appearance of positive symptoms. There is little current literature on these type of tumors in the insula and psychosis.

Clinical case

A 32-year-old male patient, diagnosed with Paranoid Schizophrenia with significant auditory hallucinations, and a low-grade glioma in the left insular region on routine brain MRI examination. We discuss the possible relationship between the persistence and refractoriness of psychotic symptoms with this finding.

Discussion

The insula may be the main affected brain region in schizophrenia. In psychotic patients, deficits in the insular structure are associated with the presence and severity of positive and negative symptoms. They had reduced volumes of bilateral gray matter from the insula, especially on the right side.

Objective

To underline the importance of thorough examination in diagnosing intraparenchymal processes in patients with a history of psychiatric disease.

Clinical case

A 56-year-old male with a history of schizophrenia was taken to the emergency department with somnolence, difficulty in walking and right-arm tremor. The internal medicine department suspected to be secondary neurological symptoms after attempted to self-harm through ingestion of drugs.

Results

After the psychiatric department had examined the patient's mental state, a CT scan was performed that revealed an acute subdural haematoma (ASH). Cortical atrophy in patients with schizophrenia favours the accumulation of intracerebral blood and a delay in the symptoms and diagnosis of these processes, increasing the risk to life.

Conclusions

Accurate anamnesis and brain imaging tests are essential for the differential diagnosis of ASH in patients with schizophrenia.

The relation among pain and depression is well documented in the scientific literature, however, the bibliography that associates mania and perception of pain is scarce.

In this article, a review of the aforementioned relationship is made regarding two cases. Is this about two patients diagnosed with bipolar disorder who were hospitalized for manic episodes, at the same time they were suffering a serious traumatic injury. The absence of pain was observed while the psychopathological alteration persisted, in turn, as the mood stabilized, the painful sensation increased.

For this reason, it is proposed the utility of the absence of pain or hypoalgesia as an assessment of part of the manic symptoms.

The presentation of affective disorders and psychosis in the context of hyperthyroidism is very rare. We present the case of a 65-year-old patient who presented an intense fear of the new coronavirus disease (COVID-19), depressed mood, anxious, nihilistic delusions, guilt, somatic and apathy. He was diagnosed with a major depressive disorder with psychosis which developed Cotard's syndrome in addition to having Graves-Basedow disease. Treatment consisted of venlafaxine 150 mg/day, quetiapine 50 mg/day, thiamazole 30 mg/day, and propranolol 60 mg/day. After two weeks of treatment, the patient improved and was discharged. The article is complemented with a literature review on the association between mental symptoms, Cotard's syndrome and hyperthyroidism.

Objective

The aim of this article is to outline the importance of carrying out a complete organic study when encountering a first psychotic episode by means of a case report showing a diagnosis of anti-NMDA receptor encephalitis.

Case report

A 35 year-old male, presented without a significant psychiatric history, starts to suffer from severe psychotic symptoms such as hallucinations and behavioural problems. The patient was on the lookout for a study of a syncope with secondary traumatic brain injury experienced one month prior to the beginning of the symptoms. Finally, the patient was diagnosed with anti-NMDAR encephalitis, showing symptom improvement with this immunosuppressive treatment.

Results

The approach from a neurological perspective has been of outmost importance in order to improve the aforementioned severe psychotic symptoms.

Conclusions

A close cooperation between the Psychiatry and Neurology departments is needed when encountering a first psychotic episode.