Atypical Psychosis Research Articles

570 Adult Self-Inflicted Burn Demographics in West Texas

Abstract Introduction Self-inflicted burns (SIB) are a subset of burns defined based on self-injury, sometimes also referred to as self-immolation. The United States generally reports SIB in the context of psychiatric ailment. However, due to the difference in geographic locations, the West Texas burn coverage has never been checked for SIB patients. We hypothesize that patients with SIB have higher rates of psychiatric disorders and are generally older men. Methods We obtained a list of all patients admitted to the burn intensive care unit (BICU) with a Second/Third-degree burn. After, we verified the inclusion of patients meeting the study criteria from July 01, 2011, to July 01, 2021, ages between 18 and 89, and a completed Lund-Browder Chart. Data was collected from a mix of manual chart review from electronic health records and electronic data retrieval. Patients were split into two groups, SIB and non-intentional burns (NIB). Bivariate analysis was conducted using Mann Whitney U test and either Fisher’s exact test or Chi-square test when independent variables were categorical. Results The initial data set (n=2,875) decreased due to missing burn documentation, burn intensive care unit admission, and incomplete records and was split into two groups: SIB (n=49) and NIB (n=1,243). The average age and percentage of male patients compared between NIB and SIB were not significant (p=0.32, p=0.39). However, TBSA, frequency of inhalation injury, burn symmetry, suicidal ideation, history of drug abuse, history of self-harm, history of mental illness, past mental health hospitalization, and mortality were all significantly higher in the SIB group (p< 0.001). There was also a statistically significant higher frequency of psychological disorders in the SIB group for depression, acute schizophrenia, borderline personality disorder, bipolar disorder (p>0.001), anxiety disorders (p=0.02), post-traumatic stress disorder (p=0.006), atypical psychosis, drug-induced psychosis, and delirium (p=0.04). Conclusions The demographics of the West Texas SIB population are comparable to that of the United States, predominantly older male patients. Similarly, many psychiatric disorders occur at a higher frequency in SIB patients than NIB: depression, acute schizophrenia, borderline personality disorder, anxiety disorder, post—traumatic stress disorder, bipolar disorder, atypical psychosis, drug-induced psychosis, and delirium. Applicability of Research to Practice While SIB patients make a small portion of the total burn population, there burns are often associated with worse outcomes – mortality, larger burns, and length of stay. The severity of their injuries begs the need for further analysis and hopefully prevention of SIB. Addressing psychiatric facilities and preventing these incidents from occurring may offer preventative methods.

Atypical psychosis in a patient with intracranial hypertension: clinical case and review

IntroductionSeveral neurologic conditions can produce or mimic psychotic symptoms. It is important to make an exhaustive differential diagnosis between a psychiatric manifestation of an underlying neurological condition and a primary psychiatric one. We explore through the present clinical case of a young woman admitted to neurology the relationship between intracranial hypertension and a case of atypical psychosis that resolved itself with the treatment of the intracranial hypertension, without the need for antipsychotic medication.ObjectivesTo explore through the presented clinical case and the concerning literature the concept and management of psychotic-like symptoms in patients with intracranial hypertension.MethodsWe present a clinical case and a review of the existing literature concerning atypical psychosis or psychosis-like symptoms in cases of intracranial hypertension.ResultsWe report the case of a 24 year old woman with no relevant medical history hospitalised in the neurology unit due to suspected encephalitis. Native to New Zealand, she is brought from the airport due to behavioural alterations. During the last few days before admission she had presented with incoherent speech, derailment, religious and persecutory delusions, and erotomania towards her cousin. She described feelings of strangeness with her surroundings and of time moving at a different speed than usual, either faster or slower. She also had a headache and visual alterations, as well as memory errors concerning recent events, clouding of consciousness and inattention.No fever or other relevant physical symptoms. A lumbar puncture is done, which shows an opening pressure of 37mmHg but no other anomalies. Body CT scan shows no relevant findings. Empirical treatment with dexamethasone is initiated for suspected encephalitis, progressively reducing the dosage until suspension in the following days. During her stay at the hospital she is assessed by ophthalmology, which finds no abnormalities in the eye fundus examination, and psychiatry. A second evacuating lumbar punture is done to reduce intracraneal hypertension. No antipsychotic treatment is initiated: the symptomatology remitted with the lowering of intracranial pressure. At time of discharge, the patient remained asymptomatic without treatment and was able to return home to continue outpatient neurologic study of the etiology of the intracranial hypertension.Finally, we conduct a review ot the existing literature concerning psychotic and psychosis-like symptoms in patients with intracranial hypertension, to explore the diagnostic and management options of this rare finding.ConclusionsOur findings point to the existing relationship between intracranial hypertension and psychosis-like symptoms. Further studies on pathogenic mechanisms and therapeutic management are required.Disclosure of InterestNone Declared

Criminological and Psychiatric Profiles of Immigrant and Refugee Offenders: A Retrospective Analysis of Cases in a Forensic Setting.

This study aimed to scrutinize the characteristics of immigrant and refugee offenders within our institution, focusing on factors such as immigrant status, country of birth, duration of residence in Turkey, as well as psychiatric, socio-demographic, and criminal profiles. The data were obtained through a retrospective examination of case records referred to the Observation Department of the Council of Forensic Medicine for the assessment of criminal responsibility between 2017 and 2022. The study categorized the cases into two groups: refugees and immigrants, comprising 35 and 22 offenders, respectively. Significant differences in educational levels were identified between immigrants and refugees within our study group (p < .001). Notably, drug use disorders were more prevalent among refugees, whereas alcohol use disorders were more common among immigrants, with statistical significance (p < .005). During forensic psychiatric assessments, 57.1% of refugees and 54.5% of immigrants required interpretation services. The most prevalent offense in the refugee group was homicide (37.1%), followed by child sexual abuse (28.6%). In contrast, homicide (31.8%) and theft and extortion (22.7%) were the most common offenses for the immigrant group. Six cases (10.5%) were judged to have reduced or no criminal liability. Among the cases, 52.6% had a history of prior outpatient psychiatric referrals, with the most frequent diagnosis being atypical psychosis at 10.5%. The findings underscore the necessity for additional research and targeted interventions to address the mental health and criminological complexities confronted by this vulnerable population.

Atypical psychosis in a person living with HIV: A case report

Introduction: An organic disorder is defined as psychiatric syndromes, the fundamental manifestations of which are the direct consequence of a known anatomophysiological alteration of the brain. HIV is a neurotropic virus, which infects the central nervous system early. Despite the widely known high prevalence of HIV-related brain atrophy, the presence of psychotic symptoms is rare. Case report: This is a 28-year-old patient with a recent diagnosis of HIV with Western Blot in 2017, his diagnosis was made in a mental health center due to psychotic symptoms, an imaging study with simple tomography of the brain was performed with the result of frontal atrophy and occipital, in a young adult patient with no history of head trauma, hemorrhagic or ischemic events, as well as; Central nervous system infections are ruled out. Conclusions: This is a disorder with chronic psychotic symptoms in a patient with cortical atrophy secondary to HIV infection.

Creation and Implementation of a Multi-Disciplinary Clinical Workflow Aimed at Earlier Diagnostic Evaluation for Autoimmune Encephalitis for Patients Presenting With Atypical Psychosis: A Pilot Study

Objective To implement a clinical workflow that facilitates earlier diagnostic evaluation for autoimmune encephalitis (AE) among patients presenting with atypical psychosis (AP). Background Clinical features found to have positive predictive value for AE were recently identified.1 Early identification of "red flag” features was associated with a 58% reduction in time from symptom onset to AE diagnosis.2 “Yellow flag” features, while less specific, were also associated with AE, especially when multiple were present simultaneously.3 A workflow that utilizes these features would be of clinical significance. Design/Methods We created a standardized workflow to triage patients presenting to the psychiatric emergency department with AP using red/yellow flag features. The presence of one or more yellow flags (hyponatremia, first psychotic symptoms at age &gt;40, systemic/infectious prodrome, refractory symptoms, and malignancy history) results in neurology consultation. Following the consultation, there may be a recommendation for more involved testing such as CSF studies, imaging, and/or EEG. The presence of a red flag (seizure, dysautonomia, movement disorder, or focal finding on neurologic exam) results in admission to the neurology service. Results Since the implementation of the workflow in February 2022, 5 patients have been identified. All patients received neurology consultation within 24 hours of presentation, after which 3 underwent diagnostic evaluation for AE. Conclusions The implementation of a multi-disciplinary clinical workflow to triage patients presenting with AP is feasible. Preliminary evidence suggests a significant decrease in time from presentation to diagnostic evaluation for AE compared to the time prior to its implementation.

The validity of atypical psychosis diagnostic criteria to detect anti-NMDA receptor encephalitis with psychiatric symptoms

Anti-NMDAR encephalitis has a psychotic presentation that is difficult to distinguish from primary psychosis. An atypical psychosis that is similar to schizophrenia, mood disorder, and epilepsy is unique, and the original diagnostic criteria exist only in Japan. The clinical symptoms and courses of anti-NMDAR encephalitis and atypical psychosis are very similar. We investigated whether the diagnostic criteria of atypical psychosis are useful to increase the detection rate of anti-NMDAR encephalitis with psychiatric symptoms.The presence of anti-NR1/NR2B IgG antibodies in the cerebrospinal fluid of 218 newly admitted inpatients initially diagnosed with schizophrenia (n = 151), mood disorder (n = 47), or epilepsy with psychiatric symptoms (n = 20) was assessed by cell-based assay.Of 218 patients, 123 (36.3 years ± SD 17.2, 69.9 % females) fulfilled the diagnostic criteria of category B for atypical psychosis. All 12 patients (9.8 %, 12/123) with anti-NR1/NR2B IgG antibodies fulfilled category B of atypical psychosis statistically better than the patients without anti-NR1/NR2B IgG antibodies (P = 0.0009). Of the 12 patients with anti-NMDAR antibodies, two did not fulfill either criteria of catatonia (DSM-5) or Graus' diagnostic criteria of anti-NMDAR encephalitis during the time course, and 11 patients showed good prognosis with early immunotherapies. In ROC analysis, abnormal electroencephalogram findings showed the highest sensitivity (0.833) for detection of anti-NR1/NR2B IgG antibodies, and 31.3 % of patients with category B atypical psychosis and abnormal electroencephalogram findings had anti-NMDAR antibodies.Lumbar puncture and detection of anti-NMDAR antibodies should be considered for patients who fulfill atypical psychosis diagnosis criteria with an abnormal electroencephalogram.

From Akute Primäre Verruckheit to Bouffée Delirante: The background of Acute Transient Psychosis

IntroductionEver since the end of the 19th century that descriptions of acute and transient psychosis (ATP) have been found in the literature. Psychiatrists from different countries gave different names for these types of episodes, throughout the ages. Those early descriptions were an important part of the development of the concept of acute and transient psychotic disorders (F23: ICD-10).ObjectivesThis review aims to provide historical background of the development of different concepts to describe ATP.MethodsNon-systematic review of literature on acute and transient psychotic disorders, bouffee delirante, brief psychotic disorder, atypical psychosis.ResultsIn 1876, K.Westphal introduced the term akute primäre Verruckheit, refering to a sudden paranoia associated with delusion ideas and hallucinations. In 1895, Magnan described Bouffée delirante, characterized by a recorrent, sudden psychosis with polymorphic symptoms. Later (1924), the term cycloid psychosis was introduced by K.Kleist: phasic psychosis with good prognosis. Different concepts appeared throughout history: psychogenic psychosis (Wimmer,1916); atypical psychosis (Mitsuda,1942), holodisfrenia (Barahona,1957). Nowadays, the classification systems include many of these concepts in the same categories: Schizophreniform disorder, Brief psychotic disorder (DSM-5), and ATP (F23 in ICD-10).ConclusionsAll throughout the History of Psychiatry, there was an evolution of concepts associated to ATP. They were strongly influenced by different time epochs. It is important to have context on the historical background of the concepts used in the contemporaneous Psychiatry. Diagnosis is challenging due to their heterogeneous presentation. There are not many studies available, because of ATP’s low diagnostic stability.DisclosureNo significant relationships.

A Nightmare’s Lullaby: Exploring the concept and relevance of oneiroid cyclic psychosis through a clinical case and review

IntroductionAcute psychotic states characterized by clinical lability and dream-like qualities are a staple of classic psychopatology. An excessive focus on diagnostic criteria for bipolar or schizophrenia-spectrum disorders risks missing this particular set of patients; defined through their dynamic presentation as much as by any cluster of symptoms or types of course.ObjectivesTo explore the concept and relevance of oneroid-like cyclic psychosis through a clinical case and review.MethodsWe report the case of a 37 year old woman with bipolar disorder (three previous instances of manic episodes with psychotic symptoms) and various gynecological issues that required hormone therapy. After a couple of days having difficulty sleeping, the patient developed a clinical picture consisting of wide and sudden oscillations between hyperactive and inhibited psychomotor activity, moods of dread and ecstasy, and states of disorganized thought and childlike activities with perplexity and mutism. Frequent behaviors as if experiencing visual alucinations and repeated allusions to feeling as if in a dream. These symptoms lasted for 2-3 weeks, after treatment with risperidone and lithium. A narrative review concerning the case was also performed.ResultsKleist’s ‘innate instability’ permeates much of the previous literature. Similar entities highlight different issues closely related to various biological rhythms: atypical psychosis and epilepsy, puerperal psychosis and estrogen dysregulation, cyclic psychosis and sleep disorders, delirious mania and effectiveness of electro-convulsive-therapy, etc.ConclusionsOur findings point to the clinical relevance of oneiroid cyclic psychosis as innate instability. Further studies on the role of biological rhythms and its repercussions on daily practice are required.DisclosureNo significant relationships.

Psychotic symptoms in Cushing’s syndrome secondary to ACTH-secreting lung carcinoid tumor: report of a case

IntroductionCushing’s syndrome is a hormonal disorder caused by chronic exposure to excess glucocorticoids, either exogenous or endogenous. The bronchial carcinoid tumor is an extremely rare origin, described in less than 1% of cases. The most frequent psychiatric symptoms are depression and anxiety, with manic and psychotic symptoms being less frequent. Psychotic symptoms are difficult to manage, as they are usually resistant to antipsychotic treatment, which is why it is considered an indication for medical treatment of Cushing’s syndrome.ObjectivesTo give visibility to this type of psychotic disorders of organic origin to deepen their study as well as raise awareness among professionals dedicated to clinical care with the intention of improving their prevention.MethodsA description of a clinical case is made, accompanied by a bibliographic review on psychosis of endogenous corticosteroid origin.ResultsWe describe the case of a 44-year-old woman who was admitted to the charge of Internal Medicine due to Cushing’s syndrome. During her admission, she presented a debut of positive psychotic symptoms, so the liaison psychiatry team followed her up. She was diagnosed with an ACTH-secreting lung carcinoid tumor.ConclusionsThis entity should be taken into account in cases of atypical psychosis in patients with compatible phenotypic characteristics.DisclosureNo significant relationships.

Anti-N-methyl-D-aspartate receptor encephalitis presenting as atypical psychosis in multiple sclerosis: a case report

BackgroundAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder which often presents with neuropsychiatric symptoms. A large proportion of cases are associated with an identifiable tumor, most commonly ovarian teratoma. However, recent literature has also described an overlap of anti-NMDAR encephalitis and demyelinating syndromes. Cases have been reported of anti-NMDAR encephalitis in patients with ADEM, optic neuritis, myelitis and multiple sclerosis. This link is considered rare, however has important clinical implications as treatments and prognosis may differ.Case presentationA 33-year-old female with a history of multiple sclerosis presented with new-onset neuropsychiatric symptoms. After substance-induced psychosis was ruled out, she was admitted to the medical ward for work up of psychosis secondary to multiple sclerosis. However, the consultation-liaison psychiatry service noted atypical symptoms which were concerning for autoimmune encephalitis. Admission to a psychiatric inpatient ward was deferred. Anti-NMDAR encephalitis was diagnosed with CSF analysis demonstrating lymphocytic pleocytosis and anti-NMDAR antibodies. In addition to first-line treatment of encephalitis with steroids, second-line immunotherapies were also implemented given the patient’s underlining demyelinating syndrome. The patient’s neurologic and psychiatric symptoms began to improve.ConclusionsThere is literature to demonstrate a possible connection between anti-NMDAR encephalitis and demyelinating syndromes. As such, autoimmune encephalitis should be considered in patients with multiple sclerosis presenting with atypical symptoms. Determining the correct diagnosis is crucial to inform the appropriate treatment protocol, and to improve prognosis.

Anti-NMDA receptor encephalitis in the practice of a psychiatrist on the example of a clinical case

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disease of the central nervous system (CNS) with prominent neurologic and psychiatric features at disease onset. Anti-NMDAR encephalitis can occur in all ages. The disorder predominantly affects children and young adults, occurs with or without tumour association, and can relapse. The presence of a tumour (usually an ovarian teratoma) is dependent on age, sex, and ethnicity, being more frequent in women older than 18 years. Primarily presents in the form of mental disorders, seizures, and involuntary movement, and is often accompanied by sleep disorders and prominent speech difficulties. Anti-NMDAR encephalitis in children may present differently than in adults. Children are more likely to have abnormal movements (chorea, incoordination) early in the disease course and also may have atypical motor symptoms such as ataxia or hemiparesis. Children more often have seizures than adults. The classic symptoms of psychosis seen in adults are less common, but behavioral regression is frequently noted. The proper diagnosis and management of autoimmune encephalitis requires a multidisciplinary treatment approach. Ancillary testing with MRI, EEG, lumbar puncture and immunological assessment of cerebrospinal fluid and serum may further support a diagnosis of encephalitis and potentially suggest particular causes. Early immune-modulatory treatment can alleviate the severity of the disease and improve the cure rate. Further study of anti-NMDAR antibody and its related encephalitis would give essential clues for the research of schizophrenia, catatonia, and atypical psychosis.

Adrenal adenoma as a cause of atypical psychosis: Presentation, diagnosis, surgical technique and outcome (case report with a brief literature review).

Introduction and importancePsychiatric symptoms may be a mode of the revelation of several endocrinopathies, but rarely in primary hyperaldosteronism, which can increase psychiatric comorbidity, as well as cardiovascular risk.Case presentationWe report a case of a 26-year-old engineer, who suffered from atypical psychosis before being hospitalized for a state of agitation, he presented with high blood pressure and severe hypokalemia. An etiological assessment revealed a right adrenal adenoma, which was afterward resected, with a very good evolution.Clinical discussionIn this association, a high-level of aldosterone and hypokalemia can be behind these manifestations that present in an atypical form. Treatment is medical by anti-aldosterone or surgical by resection of the adenoma, but the challenge now is to know if we can or not stop psychotropic treatment after the treatment of the adenoma. In our case, the treatment was stopped six months after the resection of the adenoma, with very good outcomes until now.ConclusionDespite the high prevalence of psychiatric illnesses, it is always necessary to look for the organic causes that may be behind these pathologies, especially if they are in atypical forms.Learning points•The organic aetiologies of psychiatric pathologies are frequent but very underestimated, being able to threaten the vital prognosis (suicide).•A good detailed clinical examination can point to an organic etiology which, once treated, avoids complications and relapses.•Its management must be multi-disciplinary.

2021 American Neuropsychiatric Association Annual Meeting Abstracts

Background: COVID-19 has been linked to neuropsychiatric symptoms, including delirium, depression/anxiety, PTSD, and rarely, severe neuropsychiatric impairment. However, much remains unknown. We present a case of anti-NMDA receptor encephalitis in a patient with concurrent COVID-19 infection. Case History: A 27-year-old male who carried diagnoses of unspecified mood versus psychotic disorder was admitted with atypical psychosis and suicidal ideation. Patient initially presented to primary care with racing thoughts, delusions, depression (PHQ-9517), anxiety (GAD-7510), and new onset cognitive symptoms along with olfactory hallucinations. He endorsed daily suicidal ideations and reported using two cellphones to block suicidal waves and enhance his memory. He was admitted to inpatient psychiatry where he exhibited disorganized behavior and paranoid delusions, and reported visual hallucinations. Initial workup of EEG, brain MRI, and TSH were unremarkable. Two months after admission, he developed sore throat and fever and tested positive for COVID-19. Patient developed streaky opacites on chest X-ray, was transferred to the ICU, and intubated due to agitation. Once extubated, he experienced repeated epileptic seizures despite multiple antiepileptics, and lumbar puncture ultimately revealed anti-NMDA receptor antibodies. Symptoms slowly improved with plasmapheresis, steroids, and Rituximab. Conclusions: Case reports suggest that some patients may present with neuropsychiatric symptoms or experience neuropsychiatric sequelae following COVID-19 infection. Infection itself can precipitate an autoimmune encephalitis and may also cause neurological damage which can unmask other neuropsychiatric conditions. This case highlights that research is needed to understand the intersection between COVID-19 infection and mechanisms implicated in other neuropsychiatric disorders, including the spectrum of autoimmune encephalitides.

The universe of brief psychosis

IntroductionNowadays, ‘Acute and transient psychotic disorders’ in ICD-10 and ‘Brief psychotic disorders’ in DSM-5 are both classifications of the same clinical entity. Over the years, several concepts have been formulated to define the same syndrome.ObjectivesTo explore the historical evolution of brief psychotic disorders and relate them to current nosologies.MethodsLiterature review, using the most relevant papers, with the keywords “brief psychosis”, “bouffée délirante”, “cycloid psychosis”, “psychogenic psychosis”, “atypical psychosis” and “holodysphrenia”.ResultsInitially, in 1896, Kahlbaum coined the term ‘dysphrenia’, a group of severe form of psychosis that remitted without showing the typical sequence of disease states and without leaving a lasting alteration. Later, Kraepelin included this kind of disorder in manic depressive illness, which he first named as ‘periodic delirium’ and then as ‘delirious mania’. Magnan, in the pre-Kraepelinian era, created the term ‘bouffée délirante’, a sudden onset of delusional ideas with rapid evolution and intense symptomatology with complete remission usually followed after a short time. Later on, Henry Ey grabbed this entity and renewed it, contrasting it to the defined concept of schizophrenia. Other psychiatric schools have proposed numerous designations: ‘cycloid psychosis’ by Kleist from the German school, ‘psychogenic psychosis’ by Wimmer of the Scandinavian school and ‘holodysphrenias’ by Barahona-Fernandes from the Portuguese school. Cultural variants are also observed, as ‘amok’ seen in Malaysia or ‘shinbyung’ in Korea.ConclusionsThe intensity and polymorphism of brief psychosis present a clinical challenge. The historical evolution may be helpful on recognizing this entity in current clinical practice.

Clinical and psychological approaches to the diagnosis of children with autism spectrum disorders

IntroductionThe importance of clinical diagnosis of autism spectrum disorders (ASD) in childhood is due to the timely detection of ASD and the appropriate early start of patient care, depending on the form of ASD. The experience of multidisciplinary collaboration between medical psychologists and clinicians in child psychiatric practice allows us to more accurately determine the depth and severity of autistic manifestations, determine the dynamics of child development, and provide personalized effective care.ObjectivesDevelop diagnostic, clinical and psychological approaches to the diagnosis of ASD.MethodsClinical-psychopathological, clinical-dynamic, clinical-catamnestic, and psychological methods were used. 254 patients aged 4-17 years (average – 7.3 years) with different forms of ASD were examined.Results From the clinical and pathopsychological positions, profiles of six main forms of ASD are identified. Each of the selected profiles corresponds to a specific type of cognitive dysontogenezis. A distorted view of cognitive dysontogenezis in Asperger’s syndrome (F84. 5) and childhood autism dysontogenetic (F84.0). Distorted or deficient types of cognitive dysontogenezis in children’s psychosis (F84. 02). Deficient type of cognitive dysontogenezis in Kanner syndrome (F84. 01). Defecating type of cognitive dysontogenezis in atypical autism syndromal (F84. 11), deficient and regressive-defecating types of cognitive dysontogenezis in atypical child psychosis (F84.12).ConclusionsA three-dimensional model is obtained that allows the most accurate diagnosis of various forms of ASD and the development of personalized routes for patient care and rehabilitation, taking into account the type of cognitive dysontogenezis and based on the zone of the child’s immediate development.

It’s never lupus: A case of atypical psychosis and neuropsychiatric lupus

IntroductionSystemic lupus erythematosus (SLE) is a chronic autoimmune disease involving the production of autoantibodies with consequent involvement of multiple organ systems. Although not an uncommon condition, its pleomorphic neuropsychiatric manifestations imply consideration of SLE as a relevant differential diagnosis. As many as 50% of patients with SLE have neurological involvement throughout their disease course and it is associated with impaired quality of life, high morbidity and mortality rates.ObjectivesCase report study and discussion.MethodsThe authors present a case of a 50-year old woman without previous psychiatric history presenting to the psychiatric department with suicidal ideation in association with psychotic symptoms of rapid onset. She presented with various somatic symptoms including butterfly rash, alopecia, nail dystrophy and generalized myalgia and arthralgia. After conducting a thorough clinical investigation with subsequent unveiling of various alterations including those in the antibody panels and abnormal magnetic resonance imaging results, a diagnosis of neuropsychiatric lupus was established.ResultsImprovements in initial psychiatric symptoms were noted after completing pulse corticoid therapy for SLE with adjunct antipsychotic medication. On follow-up, the patient demonstrated a complete return to previous mental functioning with no reported relapses.ConclusionsThis case demonstrates the heterogeneous presentations that neuropsychiatric lupus can assume. The vast array of psychopathological signs and symptoms in SLE continue to exist as a significant diagnostic and therapeutic challenge. Timely identification resulting from a proactive approach in maintaining lupus as part of our differentials may prevent the significant morbidity and mortality commonly associated with the resultant central nervous system involvement in SLE.DisclosureNo significant relationships.

Diagnostic, Clinical, Psychopathological, Psychological Aspects of the Examination of Children with Autism Spectrum Disorders

Objective: recently, much attention has been paid to the problem of autism spectrum disorders (ASD) in childhood. Despite the abundance of psychometric approaches to the diagnosis of autism in childhood, questions remain about the validity of their use in everyday practice. In recent years, works began to appear in the United States calling into question the practice of mandatory use of the “gold standard” methods for diagnosing ASD. Russia has many years of experience in multidisciplinary cooperation of medical psychologists and clinicians in child psychiatric practice, which makes it possible to more accurately determine the depth and severity of autistic manifestations, as well as to determine the dynamics of a child’s development, which will make it possible to provide targeted effective assistance. Aim: to develop diagnostic, clinical-psychopathological, psychological approaches to the diagnosis of autism spectrum disorders in childhood.Patients and methods: the sample consists of 254 patients aged 4–17 years (average age 7.3 years) with different forms of ASD according to ICD-10 (heading F84). The patients were examined by clinical-psychopathological, clinical-dynamic, clinical-follow-up, psychological methods.Results: the study made it possible to define the profiles of six main forms of ASD from a clinical and psychological standpoint: Asperger’s syndrome (F84.5); childhood autism dysontogenetic (F84.0); childhood psychosis (F84.02); Kanner’s syndrome (F84.01), syndromic atypical autism (F84.11),and atypical childhood psychosis (F84.12).Conclusion: the results obtained are presented in a multidisciplinary aspect, which allows the most accurately diagnose one form or another of autism spectrum disorders and to develop personalized routes of patient management.

Atypický Charles Bonnetov syndróm a psychóza pri Parkinsonovej chorobe: dvaja hráči u jednej pacientky

Psychoza pri Parkinsonovej chorobe sa manifestuje najcastejsie zrakovými halucinaciami a bludmi u pacientov s Parkinsonovou chorobou. Výskyt iných typov halucinacii je omnoho nižsi a može poukazovať na inu diagnozu. Zriedkavo sa u pacientov možu vyskytnuť bimodalne halucinacie. V nasej kazuistike prezentujeme pripad pacientky s Parkinsonovou chorobou, u ktorej sa popri zrakových halucinaciach vyskytovali sucasne aj sluchove halucinacie, ktorých pricinou je vzacny atypický Charles Bonnetov syndrom vznikajuci pri dlhodobej a zavažnej poruche sluchu.

Significance of Autoantibodies in Autoimmune Encephalitis in Relation to Antigen Localization: An Outline of Frequently Reported Autoantibodies with a Non-Systematic Review.

Autoantibodies related to central nervous system (CNS) diseases propel research on paraneoplastic neurological syndrome (PNS). This syndrome develops autoantibodies in combination with certain neurological syndromes and cancers, such as anti-HuD antibodies in encephalomyelitis with small cell lung cancer and anti-Yo antibodies in cerebellar degeneration with gynecological cancer. These autoantibodies have roles in the diagnosis of neurological diseases and early detection of cancers that are usually occult. Most of these autoantibodies have no pathogenic roles in neuronal dysfunction directly. Instead, antigen-specific cytotoxic T lymphocytes are thought to have direct roles in neuronal damage. The recent discoveries of autoantibodies against neuronal synaptic receptors/channels produced in patients with autoimmune encephalomyelitis have highlighted insights into our understanding of the variable neurological symptoms in this disease. It has also improved our understanding of intractable epilepsy, atypical psychosis, and some demyelinating diseases that are ameliorated with immune therapies. The production and motility of these antibodies through the blood-brain barrier into the CNS remains unknown. Most of these recently identified autoantibodies bind to neuronal and glial cell surface synaptic receptors, potentially altering the synaptic signaling process. The clinical features differ among pathologies based on antibody targets. The investigation of these antibodies provides a deeper understanding of the background of neurological symptoms in addition to novel insights into their basic neuroscience.

High diagnostic value of plasma Niemann-Pick type C biomarkers in adults with selected neurological and/or psychiatric disorders.

Late-onset Niemann-Pick type C (NP-C) is a rare, underdiagnosed lysosomal disease with neurological manifestations. A specific treatment, miglustat, can stabilize the disease if given early. Recently, three plasma screening biomarkers (PSBs) were developed [cholestane3β,5α,6βtriol (C-triol), 7-ketocholesterol (7-KC), and lysosphingomyelin-509 (LSM-509)], allowing a simpler and quite robust screening of patients suitable for genetic testing. The objective of our study was to evaluate practical utility and feasibility of large-scale PSB screening for NP-C in selected adult patients. Patients were prospectively enrolled if they showed, starting from 12years of age, at least one of the three initial neuro-psychiatric manifestations described in NP-C: (1) gait disorder (cerebellar and/or dystonic); (2) cognitive decline with frontal lobe syndrome; (3) atypical psychosis. PSBs were measured in plasma of all patients and, if positive (LSM-509 and/or C-triol + 7-KC elevated), sequencing of NPC1 and NPC2 genes was performed. A total of 251 patients [136 males, 115 females; median age 42.1 (range 12.2-85.6) years] were screened. Six patients had positive PSBs. Two were confirmed to have NP-C (0.8% diagnostic yield, both with all three PSBs highly increased, especially LSM-509). False-positive rate was 1.2%, which was identical if only considering LSM-509. By contrast, false-positive rates were 8.1% and 5.7% for 7-KC and C-triol, respectively. We showed that selecting patients with neurologic and/or psychiatric symptoms consistent with NP-C for large-scale PSB screening is a simple and valid strategy to identify new adult NP-C patients, and would probably lead to earlier diagnosis and treatment administration if widely applied.