Improved Treatment Acceptance and Adherence Following the Diagnosis of Multiple Malformations of Cortical Development in a Patient with Psychosis

Rachit Patel,Kathleen M Stuarta

doi:10.4172/2168-975x.1000192

Abstract

The increased use of neuroimaging has revealed a variety of malformations of cortical development (MCDs) presenting with a range of neuropsychiatric disorders, including psychotic illnesses. Non-adherence with antipsychotic medication is a common barrier to the effective treatment for psychosis. This case illustrates improved treatment acceptance and adherence following the diagnosis of two separate MCDs (bilateral periventricular heterotopia and focal cortical dysplasia) in a 48-year-old Caucasian male with psychosis. By incorporating the neuroimaging findings into a cognitive behavioral therapy approach, the patient was more amenable to accepting psychotropic medications including long-acting risperidone injection. This in turn led to an improvement in his overall functioning. Furthermore, this case adds to the literature by describing the first instance of psychotic symptoms occurring in the setting of both bilateral periventricular heterotopia and focal cortical dysplasia.

Highlights

Malformations of cortical development (MCDs) are macroscopic or microscopic abnormalities of the cerebral cortex that arise as a consequence of an interruption to the normal steps of formation of the cortical plate [1]
This case illustrates improved acceptance of and adherence to treatment following the diagnosis of two separate MCDs in a patient with psychosis
The patient demonstrated an improvement in the positive symptoms of his illness with a concurrent improvement in his overall functioning. This case demonstrates improved treatment acceptance and adherence in a patient with psychiatric symptoms following the appropriate diagnosis of a neurological disorder with the use of neuroimaging

Summary

Background

Malformations of cortical development (MCDs) are macroscopic or microscopic abnormalities of the cerebral cortex that arise as a consequence of an interruption to the normal steps of formation of the cortical plate [1]. The increased use of neuroimaging has revealed a variety of MCDs presenting with a range of neuropsychiatric disorders, including psychotic illnesses [2,3,4]. Non-adherence with antipsychotic medication is a common barrier to the effective treatment for psychosis [5]. This case illustrates improved acceptance of and adherence to treatment following the diagnosis of two separate MCDs (bilateral periventricular heterotopia and focal cortical dysplasia) in a patient with psychosis. CT Head revealed bilateral nodular periventricular heterotopia (Figure 1). By incorporating the neuroimaging findings into a cognitive behavioral therapy approach, the patient was more amenable to accepting psychotropic medications including long-acting risperidone injection. Patient reported better familial relationships and was in the process of resuming his previous employment

Discussion

Conclusion