Klinefelter's Syndrome and Epileptic Psychosis: A Case Report

Abstract: We present here a case of Klinefelter's syndrome with epileptic psychosis. The patient was a 30-year-old male, who suffered from epilepsy for 23 years. He showed auditory hallucination, delusion of reference and delusion of grandeur. At present there are some cases of Klinefelter's syndrome with various psychiatric symptoms, but there are few cases of Klinefelter's syndrome with epileptic psychosis. These various neuropsychiatric symptoms of the present case are thought to be associated with a specific effect of chromosomal abnormality through the cerebral dysfunction.     

Testing the Psychopathology of Psychosis: Evidence for a General Psychosis Dimension

Background: Psychiatric taxonomists have sometimes argued for a unitary psychosis syndrome and sometimes for a pentagonal model, including 5 diagnostic constructs of positive symptoms, negative symptoms, cognitive disorganization, mania, and depression. This continues to be debated in preparation for impending revisions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. We aimed to identify general and specific dimensions underlying psychopathological features of psychosis. Methods: The samples comprised 309 patients admitted to psychiatric services in the acute phase of their first or second episode of psychosis and 507 patients with enduring psychosis recruited from community mental health teams. Patients’ symptoms were assessed on the Positive and Negative Symptom Scale. Analyses compared unitary, pentagonal, and bifactor models of psychosis. Results: In both samples, a bifactor model including 1 general psychosis factor and, independently, 5 specific factors of positive symptoms, negative symptoms, disorganization, mania, and depression gave the best fit. Scores of general and specific symptom dimensions were differentially associated with phase of illness, diagnosis, social functioning, insight, and neurocognitive functioning. Conclusions: The findings provide strong evidence for a general psychosis dimension in both early and enduring psychosis. Findings further allowed for independent formation of specific symptom dimensions. This may inform the current debate about revised classification systems of psychosis.     

The Phenomenology of Psychosis Associated with Complex Partial Seizure Disorder

Psychosis commonly occurs as a direct result of complex partial seizure disorder (CPSD). This organic mental disorder is indeed complex and is easily and frequently misdiagnosed as a variety of functional disorders, including schizophrenia, schizoaffective disorder, bipolar illness, psychotic depression, and, at best, atypical psychosis. However, this important clinical syndrome has several clinical features that suggest its presence and which often permit it to be distinguished from other forms of psychosis. Furthermore, this disorder can be successfully treated with limbic anticonvulsants, with or without neuroleptics and/or lithium, but it is generally refractory to neuroleptic medications alone. In this paper, the author reviews the available literature relevant to the clinical phenomenology and treatment of this topic and illustrates the clinical profiles of 10 treatment-refractory patients admitted to a state hospital with previously undiagnosed psychoses secondary to CPSD. This illness needs to be seriously considered in the differential diagnosis of severely ill patients with atypical psychoses refractory to traditional treatments.     

Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors

BACKGROUND: There is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes. AIMS: This study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE-AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter-relationships between different types of BPSD, as measured by subscales of the BEHAVE-AD. RESULTS: Over 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated. CONCLUSIONS: BPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psychosis and/or depression. The findings suggest the need for psychogeriatric services to nursing homes and smaller facilities.     

Hoofbeats and zebras: neurodegenerative disorder presenting as a “first episode” of psychosis

Neurodegenerative disorders can include diverse neuropsychiatric symptoms. Here we present a case referred to a “first-episode” psychosis clinic with socio-occupational decline, auditory hallucinations and paranoid ideation who subsequently exhibited a rapid, severe cognitive and behavioral decline. The brain magnetic resonance imaging findings of the patient have shown a progressive cortical atrophy prominent in the frontal lobes due to a neurodegenerative disorder.     

Psychosis following chloroquine ingestion: a 10-year comparative study from a malaria-hyperendemic district of India

Objectives

Serious adverse effects such as acute psychoses have been reported following treatment with chloroquine. Chloroquine can cause cell death, including neurons. We aimed to identify the most frequent type of psychiatric manifestation and symptomatological characteristics of psychosis following chloroquine ingestion (PFC).

Method

Out of a total of 4471 randomly selected recent-onset psychosis patients, 3610 consecutive patients who had responded to standard treatment were screened for entry in the study. We compared background clinicodemographic profile information and psychopathology of 51 PFC patients, who were either drug free or drug naive, to 51 brief psychotic disorder (BPD) patients who were matched in terms of age, sex and education. Only those patients who remitted within 8 weeks (PFC patients) or 4 weeks (BPD patients) were included. Cranial computed tomography, electroencephalography and lumbar puncture of the entire experimental group were normal, and none had Mini Mental Status Examination score < 22. Group difference and correlational statistics (parametric and nonparametric) have been used to test the hypotheses and explain the results.

Results

The most common (76.2%) type of psychiatric disturbance in PCF group was mood disorder (mixed episode) accompanied by predominant irritability with little blunting of affect. PFC patients characteristically had prominent positive symptoms with visual hallucination and derealization experiences. They were more restless, agitated and anxious and had more disturbed thought content and orientation, but better preserved insight. There was no linear relationship between the amount of chloroquine consumed and the severity of psychosis.

Conclusion

Considering the large number of patients still receiving chloroquine especially in developing countries, this study has been presented to draw attention of the psychiatrists and other health professionals to the hazardous effect of chloroquine on mental health.     

The Heterogeneity of Category-Specific Semantic Disorders: Evidence from a New Case

We report a new case of category-specific semantic impairment, affecting living entities, in a patient with traumatic brain damage. In the present investigation we attempted to replicate as closely as possible the testing procedures which have been developed by Caramazza and Shelton (1998) to evaluate EW, a patient with a selective semantic disorder for the animal category. The results in our patient indicated a different performance profile, characterised by a more extensive semantic disorder for living entities, and by a more severe loss of specific visual rather than functional knowledge. These findings concur with other evidence indicating that category-specific semantic disorders are heterogeneous, reflecting different mechanisms of impairment, most likely associated with different neurobiological underpinnings.     

Duration of Untreated Psychosis in First-Episode Psychosis is not Associated With Common Genetic Variants for Major Psychiatric Conditions: Results From the Multi-Center EU-GEI Study

Duration of untreated psychosis (DUP) is associated with clinical outcomes in people with a diagnosis of first-episode psychosis (FEP), but factors associated with length of DUP are still poorly understood. Aiming to obtain insights into the possible biological impact on DUP, we report genetic analyses of a large multi-center phenotypically well-defined sample encompassing individuals with a diagnosis of FEP recruited from 6 countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. Genetic propensity was measured using polygenic scores for schizophrenia (SZ-PGS), bipolar disorder (BD-PGS), major depressive disorder (MDD-PGS), and intelligence (IQ-PGS), which were calculated based on the results from the most recent genome-wide association meta-analyses. Following imputation for missing data and log transformation of DUP to handle skewedness, the association between DUP and polygenic scores (PGS), adjusting for important confounders, was investigated with multivariable linear regression models. The sample comprised 619 individuals with a diagnosis of FEP disorders with a median age at first contact of 29.0 years (interquartile range [IQR] = 22.0–38.0). The median length of DUP in the sample was 10.1 weeks (IQR = 3.8–30.8). One SD increases in SZ-PGS, BD-PGS, MDD-PGS or IQ-PGS were not significantly associated with the length of DUP. Our results suggest that genetic variation does not contribute to the DUP in patients with a diagnosis of FEP disorders.     

Acute Psychosis as the Initial Presentation of MS: A Case Report

Psychiatric disorders have been commonly recognized to be associated with multiple sclerosis (MS) during the course of the illness or as a result of the side effects of the drugs used for its management. There have been reports of MS patirents, presenting initially with pure psychiatric symptoms. Amongst these, atypical psychosis has been infrequently reported to be a feature of MS; presentation with typical features of acute psychosis associated with stress appears to be very rare. Hence, this should always prompt for consideration of other diagnoses, including functional psychosis. Nonetheless, as illustrated by the following case report, acute onset of demyelinating diseases with the clinical phenotype of acute psychosis associated with stress may.     

A Qualitative Research Study of the Evolution of Symptoms in Individuals Identified as Prodromal to Psychosis

Because schizophrenia is difficult to treat and exacts large personal and societal costs, there is an effort underway to identify adolescents and young adults at high risk for psychosis. Theory-derived criteria of subthreshold positive symptoms identify a prodromal or clinically at-risk population who have conversion rates to psychosis of 40 to 50% within one to two years. However, further characterization of the psychosis prodrome by qualitative research methods could increase the predictive value of the prodromal designation. We conducted open-ended interviews with 20 parents of prodromal adolescents that focused on changes observed. The narratives fell into two thematically distinct subgroups, identified as declining and never normal. The prodromal adolescents described as declining had a higher subsequent rate of conversion to psychosis than did the never normal group. Although preliminary, these results suggest that a trajectory of change in personality, relationships, and behavior from an essentially normal baseline may be consistent with increased risk for psychosis among prodromal adolescents.     

Quetiapine as an Alternative to Clozapine in the Treatment of Dopamimetic Psychosis in Patients with Parkinson's Disease

There are many difficulties associated with the late stages of Parkinson's disease (PD), but psychosis and agitation may be the most disturbing for both patients and care givers, and often precipitate the pivotal decision for long-term nursing home placement. While the addition of antipsychotic drugs or the withdrawal of antiparkinsonian drugs may improve the behavioral problem, these strategies usually worsen the motor difficulties. Clozapine has been studied in PD for over a decade, and while it appears to be effective, there are safety and tolerability concerns associated with it. In addition, in New Jersey, Medicaid no longer pays for the home blood draws that are required for home-bound patients. This led to a situation in which we had patients who needed to stop clozapine and begin an alternative therapy. Because quetiapine seems particularly well suited to patients with PD based on in vitro and in vivo studies we have begun to try this medication in PD patients who need to stop clozapine. This article reports three case histories of patients with PD, confusion and dopamimetic psychosis who had been previously managed with clozapine and who were successfully switched to quetiapine. At doses from 12.5 to 150 mg/day quetiapine was well tolerated, resulting in behavioral improvement and no real increase in parkinsonism. These case histories raise the possibility that quetiapine may represent a viable alternative to clozapine in PD patients with dopamimetic psychosis and behavioral disturbances.     

Eugen Bleuler: centennial anniversary of his 1911 publication of Dementia Praecox or the group of schizophrenias

In 1911, a book was published in Europe by Eugen Bleuler describing in detail asylum patients under his care who met clinical criteria for the psychotic disorder named Dementia Praecox by Emil Kraepelin. Bleuler's voluminous publication, now a classic to world psychiatry, validated Kraepelin's observations and extended them in ways that remain familiar to us a full century later in how we describe, diagnose, treat, and understand psychosis.     

From Real-World Events to Psychosis: The Emerging Neuropharmacology of Delusions

The earliest stages of delusion are characterized by an overabundance of meaningful coincidences impinging on the sufferer''s existing worldview. Successive events are seen by him as pointing to, and then confirming, a fundamentally new reality that takes him over and engulfs his everyday life. Research over the last 4 decades has revealed the importance of dopamine (DA), D2 receptors, and the basal ganglia in psychotic thinking. Recent work has implicated the aberrant reward learning initiated by the excess release of striatal DA in the attribution of excessive importance or “salience” to insignificant stimuli and events. But our knowledge of what is happening beyond D2 receptors has remained scant. The gap is especially apparent at the cellular and microcircuit levels, encompassing the plastic changes, which are believed to be essential for new learning, and whose processes may go awry in major mental illness. Now new pharmacological findings are advancing our understanding of information processing and learning within the striatum. DA has an important role in setting the strength of individual striatal connections, but it does not act in isolation. Two other modulator systems are critical, the endocannabinoids and adenosine. Thus, at medium spiny neurons belonging to the indirect pathway, D2 stimulation evokes endocannabinoid-mediated depression of cortical inputs. Adenosine acting at A2A receptors elicits the opposite effect. Remarkably, drugs that target the endocannabinoid and purinergic systems also have pro- or antipsychotic properties. Here, we discuss how the 3 modulators regulate learning within the striatum and how their dysfunction may lead to delusional thinking.     

Role of aripiprazole in the management of behavioural and psychological symptoms of dementia: a narrative review

Behavioural and psychological symptoms of dementia affect in a great way quality of life of both patients and their caregivers, which increases the risk of patient institutionalisation when such symptoms are poorly controlled. One of the drugs that are used for controlling behavioural and psychological symptoms of dementia (BPSD) is aripiprazole. This narrative review aims to solve three basic questions. Is aripiprazole useful for the management of these symptoms? Does aripiprazole play a substantial role regarding safety and efficacy, compared with the other pharmacological options available for the same purpose? Has aripiprazole gained importance in treatment regimens of these symptoms, in current clinical practice? We conclude that aripiprazole is effective to manage BPSD. Moreover, it has shown a good safety profile compared with other antipsychotics in advanced disease and frail patients. Thus, aripiprazole has gained importance in current management algorithms for dementia patients mainly due to its efficacy regarding rapid control of agitation and aggressiveness.