Organic Delusional Disorder Research Articles

Case Report: Experience with Cariprazine in Organic Delusional Disorder in an Elderly with Concomitant Somatic Pathology, Brief Report

Background: Organic disorder remains one of the most pressing issues in practical psychiatry, especially a disorder dominated by persistent or recurrent delusions. The difficulty for practitioners is often due to the older age of patients and the burden of concomitant therapeutic diseases. Modern and potentially promising pharmacological drugs developed in recent years include partial agonists of D2 and D3 receptors. Currently, there are insufficient publications of studies on Cariprazine use in various disorders that are not associated with endogenous pathology. Case Presentation: The author presented the results of the patient’s clinical examination with a complex of psychodiagnostic techniques, instrumental research methods, observation data in the department, and an analysis of the patient’s medical history. The paper describes the experience of treating a patient with the latest generation antipsychotic drug Cariprazine. Results: The author presents a case report on Cariprazine therapy in a 71-year-old female patient with a persistent organic delusional disorder with concomitant severe somatic illness. Conclusion: Cariprazine showed good efficacy in this case. Delusional symptoms were significantly reduced, and the author noted a reduction in negative symptoms. Mild side effects of the drug quickly resolved in the course of treatment. The key point is that the description of this case may be relevant to justify the need for further clinical studies on Cariprazine. Further clinical studies of the drug in the treatment of various mental pathologies may be in demand by specialists around the world.

Huntington’s disease associated with psychotic features

Abstract: Huntington’s disease (HD) is a rare, progressive, fatal, and autosomal dominant neurodegenerative disorder characterized by a triad of abnormal choreatic movements, cognitive disorders, and psychotic symptoms. A very small group presents with psychotic features. In this report, we present a case of HD with psychotic features and a diagnosis of HD. We describe a 29-year-old male with a history of behavior changes, delusions of persecution, and auditory hallucinations, which on mental status examination were suggestive of organic delusional disorder (schizophrenia-like).

Psychotic Disorders in the Veterans of Local Wars

Objectives. To determine the frequency of leading psychopathological syndromes, dynamics, and comorbidities of schizophrenia and other endogenous psychoses in Russian veterans of local wars receiving hospital treatment. Materials and methods. A total of 685 patients receiving treatment in the psychiatric departments of a military hospital were studied: 264 veterans of local wars (the study group), 296 servicemen (personnel and reserves) who had not taken part in military engagements (reference group 1), whose mean age differed from that of the study group, and 125 servicemen (personnel and reserves) who had not taken part in military engagements and had the same mean age and age distribution as patients of the study group (reference group 2). Results and conclusions. Among veterans (patients of the study group), the frequency of delusional (schizotypic) psychoses was somewhat lower (7.2%) than among patients who had not taken part in military engagements (14.5% and 8.8%, respectively). Patients of all three groups were mainly diagnosed with schizophrenia (ICD-10 F20): 3.8% in the study group, 4.4% in reference group 1, and 4.0% in reference group 2. Other acute and chronic psychotic disorders (F22–F23) were rarer and were seen in 0.8%, 5.4%, and 3.2% of patients, respectively. Organic delusional disorders were diagnosed in 1.5% of veterans and 3.7% of patients in reference group 1 but were not seen in patients of reference group 2. Comorbidity with post-traumatic stress disorder (PTSD) and psychotic symptoms in veterans was less than 2% but was seen in 26.3% of patients with diagnoses of schizophrenia and other disorders. The incidence of PTSD symptoms in veterans with diagnosed schizophrenia and other delusional disorders was significantly lower than the incidence among all veterans (20% and 46.9%, respectively). No link was found between hallucinatory and delusional experiences and the actions of military stress factors in the study group. In most patients of the study group, psychotic symptomatology became manifest after combat stress ended, and the subsequent development and relapse of psychotic symptomatology occurred independently of the effects of wartime factors.

Meningioma Infiltrative Accompanied by Organic Delusional Disorders

A B S T R A C TIntroduction. Meningiomas are primary extra-axial tumours of the central nervoussystem (CNS) with an incidence of 2 in 100,000 in adults. There is an estimate of a3: 1 female predominance of these tumours mainly due to the action of estrogen.Meningiomas are commonly associated with headaches, imbalances, visualdisturbances, and other neurological problems which can be very debilitating. Thiscase report will describe a case of a brain tumour accompanied by psychiatricdisorders. Case presentation. Mrs W, a 37 years old woman, a housewife, Javanese,Moslem, married, lower socioeconomic background, came with her family to theNeurology polyclinic because she experienced changes in behaviour since sevenmonths ago in the form of much silence, daydreaming, cannot communicate,sometimes talking to herself, eating drinking and bathing must be helped and served.Four months before being admitted to the hospital, because the patient's headachesworsened and the patient became increasingly withdrawn, accompanied by weaknessin both legs. From the results of CT-scan with contrast, the results showed that themeningioma infiltrates and perifocal oedema, which caused subfalcine herniation asfar as 2.73 cm to the right. Conclusion. Infiltrative meningioma is often accompaniedby mental disorders in the form of personality changes, depressive-like symptomsand neurological symptoms. Clinicians should be able to detect a brain mass so thatmanagement can be undertaken immediately.

Perfil epidemiológico dos usuários de um Centro de Atenção Psicossocial

Objetivo: analisar as características clínicas e sociodemográficas dos usuários do Centro de Atenção Psicossocial II (CAPS II) do município de Paulo Afonso – Bahia. Método: trata-se de um estudo quantitativo e transversal, realizado a partir do levantamento de dados dos pacientes frequentadores do CAPS II de Paulo Afonso, no ano de 2018. Aspectos clínicos e sociodemográficos foram obtidos a partir dos prontuários médicos dos usuários ativos do serviço cujos anos de cadastramento variaram de 2006 a 2018. Resultados: prevaleceram o sexo feminino, o estado civil solteiro, o Ensino Fundamental incompleto e o analfabetismo, a faixa etária entre 40 e 49 anos, os indivíduos ocupados, a assistência não intensiva e a admissão por encaminhamento. O diagnóstico mais frequente foi do grupo dos transtornos esquizofrênicos, esquizotípicos e delirantes. Os diagnósticos associaram-se significativamente à variável “sexo”, sendo o gênero masculino com maior prevalência de transtornos nos grupos dos transtornos mentais orgânicos, esquizofrenia, transtornos esquizotípicos e delirantes e retardo mental. Já o feminino obteve maior proporção nos transtornos do humor e transtornos neuróticos relacionados com o estresse e somatoformes. Conclusão: os dados obtidos neste estudo possuem relevância para contribuir com o direcionamento de estratégias de aprimoramento e organização do Centro de Atenção Psicossocial de Paulo Afonso.

Schizophrenia-like disorder in Wilson's disease

Wilson's (Wilson–Konovalov) disease (WD) is a chronic progressive disease resulting from impaired body copper metabolism with damages to target organs (liver, brain, and kidneys). The paper describes a clinical case of organic delusional (schizophrenia-like) disorder in a patient with WD. The characteristic feature of its psychiatric onset in the patient is schizophrenia-like disorders in the absence of neurological and gastroenterological symptoms. Because of this onset of WD, patients have not received specific treatment for a long time (frequently before the appearance of the Kayser–Fleischer rings or the occurrence of cirrhosis). Thus, the diagnostic search should include WD in young patients with a primary psychotic episode. The search for early effective methods for WD verification is of interest for further investigations.

Tuberous sclerosis: its neurological and neuropsychiatric aspects and a case report

Tuberous sclerosis (TS) is an autosomal dominant, neurocutaneous disorder. Mutations of TSC1 and TSC2 genes which lead to the mechanistic target of rapamycin (mTOR) pathway dysregulation have been identified. In addition to the neurological and neuropsychiatric manifestations, the disease can have many other systemic manifestations affecting skin, kidneys, lungs, heart and eyes. The psychiatric manifestations can be broadly considered under neurodevelopmental, behavioural, intellectual, and psycho ocial symptoms. The diagnosis is often confirmed after a detailed evaluation. Treatment options include symptomatic management, prevention of loss of function of the affected organs and the etiological approach through mTOR inhibitors. Researches are being conducted using mTOR inhibitors like Rapamycin, everolimus and sirolimus on this regard. A case of organic delusional disorder with paranoid schizophrenia like symptomatology in a patient with TS is also described at the end.

Tuberous sclerosis: its neurological and neuropsychiatric aspects and a case report

Tuberous sclerosis (TS) is an autosomal dominant, neurocutaneous disorder. Mutations of TSC1 and TSC2 genes which lead to the mechanistic target of rapamycin (mTOR) pathway dysregulation have been identified. In addition to the neurological and neuropsychiatric manifestations, the disease can have many other systemic manifestations affecting skin, kidneys, lungs, heart and eyes. The psychiatric manifestations can be broadly considered under neurodevelopmental, behavioural, intellectual, and psycho ocial symptoms. The diagnosis is often confirmed after a detailed evaluation. Treatment options include symptomatic management, prevention of loss of function of the affected organs and the etiological approach through mTOR inhibitors. Researches are being conducted using mTOR inhibitors like Rapamycin, everolimus and sirolimus on this regard. A case of organic delusional disorder with paranoid schizophrenia like symptomatology in a patient with TS is also described at the end.

F229. THE BIOLOGICAL UNDERPINNINGS OF TREATMENT RESPONSE IN DELUSIONAL DISORDER: A SYSTEMATIC REVIEW OF QUALITATIVE EVIDENCE-TO-DATE

BackgroundThe dopamine hypothesis of schizophrenia has been extensively proposed as a neurobiological mechanism that explains the relationship between schizophrenic symptoms and hyperdopaminergic states. This hypothesis is supported by direct and indirect evidence, and it mainly postulates that antipsychotics act blocking dopamine receptors. When focusing on delusional disorder patients, especially delusional disorder somatic type, a great effort towards the search for a biological basis of treatment response has been recently demonstrated. Thus, the main goal of this systematic review was to examine the evidence explaining the biological underpinnings of treatment response in delusional disorder.MethodsA systematic review was performed using Pubmed, Scopus and PsycINFO databases (from 1990 to October 2017), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The following search terms were used: [(‘treat*’ OR ‘therap*’ OR ‘biol*’) AND (‘delusional disorder’)]. This systematic computerized search was completed by additional studies hand-checked through reference lists from the included studies and review articles. Studies were only included if the met our inclusion criteria: (a) the International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis for delusional disorder, (b) be published in peer-reviewed journals, (c) in English, German or Spanish, (d) and reporting a hypothesis for the biological basis of treatment response in delusional disorder, irrespective of method and study design. Exclusion criteria were: (a) studies including organic delusional disorder or (b) somatic delusions secondary to other psychiatric diagnoses. The literature search strategy, data extraction and synthesis was conducted independently by two authors (A.G.R, F.E.). When disagreement, it was solved by consensus.ResultsA total of 59 articles were identified, of which 12 met our inclusion criteria. Four hypotheses were addressed: (1) Dopaminergic dysfunction (n=4): ziprasidone-induced supersensitivity psychosis by chronic blockade of D2 Dopamine Receptor (DRD2) (n=1); pretreatment levels of plasma homovallinic acid (pHVA) (n=1); dopamine transporter (DAT) dysfunction (n=1) and effectiveness of aripiprazole (DRD2 agonist) (n=1). (2) Serotonergic dysfunction (n=6): drug occupancy in 5-HT1A and 5-HT2A receptors (n=3) and efficacy of 5-HT2 antagonists (n=3). Brain dysfunction (n=7): hypoperfusion in cerebral blood flow in temporal and parietal lobes, left side (n=5), right side (n=1) and lack of basal ganglia and subcortical gray matter lesions (n=1). Genetic evidence (n=1): implications of DRD2 Ser311Cys, DRD3 Ser9Gly and TH VNTR polymorphisms.DiscussionThe strongests biological contributors for treatment response in delusional disorder seem to be those implicating monoaminergic systems, particularly dopamine and serotonergic neurotransmitters. Although the low level of evidence, the serotonergic dysfunction may be associated with response rates, especially in delusional disorder somatic type. The link between genetic variants of dopamine receptors and neuroimaging findings in delusional disorder may open new avenues for the search of the biological underpinnings of treatment response. The evidence for an integrated model involving dopamine and serotonin systems bears further investigations.

Organiczne zaburzenia urojeniowe u pacjentki po przeszczepie nerki – opis przypadku

ABSTRAKTWstęp: W niniejszym artykule przedstawiono przypadek pacjentki chorującej na organiczne zaburzenia urojeniowe. Początek objawów psychiatrycznych następował stopniowo w okresie kilku tygodni po przeszczepieniu pacjentce nerki od zmarłego dawcy.Opis przypadku: 42-letnia pacjentka została przyjęta na oddział psychiatrii w celu obserwacji stanu psychicznego oraz ewentualnej modyfikacji postawionego wcześniej rozpoznania klinicznego.Komentarz: Objawy psychotyczne o charakterze urojeń ksobnych, prześladowczych oraz omamów słuchowych pojawiły się u pacjentki w okresie kilku tygodni po przeszczepie nerki od zmarłego dawcy. Objawy te miały tendencję do stopniowego nasilania się. Zgodnie ze standardami postępowania potransplantacyjnego pacjentka przyjmowała zwiększone dawki leków immunosupresyjnych, jednak mimo redukcji dawek objawy psychotyczne nie uległy zmniejszeniu. Pacjentka obciążona była somatycznie chorobą Hashimoto, nadciśnieniem tętniczym, wirusowym zapaleniem wątroby typu B, zakrzepicą tętnicy szyjnej wewnętrznej, cukrzycą typu 2 powikłaną nefropatią, retinopatią i neuropatią.Wnioski: Przedstawiony przypadek stanowi przykład wielo­czynnikowej etiologii objawów psychopatologicznych oraz wskazuje na konieczność uwzględniania wielu aspektów stanu somatycznego przy ustalaniu diagnozy psychiatrycznej i planowaniu leczenia pacjenta.

A case report of dyskeratosis congenita associated with both psychosis and mood disorder

Dyskeratosis congenita (DC) is a rare heritable skin disorder with progressive bone marrow failure. Psychiatric manifestations could also be a presentation of this rare skin condition. Although it has been associated with psychiatric manifestations, there is a dearth of information regarding mood symptoms in this condition. We report a 41-year-old male who had presented with predominant psychotic followed by affective symptoms and was diagnosed with DC and comorbid organic delusional and mood disorder. He was also worked up for other physical manifestations of DC.

Pre-operative and post-operative psychiatric manifestations in patients with supratentorial meningiomas

ObjectivesIn the present study, we have tried to delineate the nature of psychiatric abnormalities caused by supratentorial meningiomas and the effect of surgery on them. We have tried to find the patient and tumor characters influencing the psychiatric abnormalities and their post-operative outcome. Materials and methodsThis is a prospective study conducted on patients with supratentorial meningiomas, admitted and operated in neurosurgery department, Nizam’s Institute of Medical Sciences, India, from July 2006 to July 2009. We have included fifty-seven patients aged between 15 and 65 years with a clinico-radiological diagnosis of supratentorial meningioma in our study. We later confirmed the diagnosis by histopathological examination of the tumor. We have evaluated the patients for psychiatric manifestations before and after surgery and also analyzed the various clinical and radiological factors influencing the psychiatric status. ResultsWe have enrolled 57 patients into the study. Frontal group had 22 patients (38.6%), parietal group had 10 patients (17.5%), temporal group had 10 patients (17.5%), occipital group had 6 patients (10.5%), and suprasellar group had 9 patients (15.8%). Twenty patients (35.1%) presented with psychiatric symptoms. The frequency of psychiatric symptoms was highest in the temporal group (60%) followed by the frontal group (45.5%). Frontal convexity meningiomas presented predominantly with depression, basifrontal and sphenoid wing meningiomas presented with mania or depressive symptoms, Suprasellar lesions and temporal convexity lesions presented with organic delusional disorder. Basifrontal meningiomas also caused organic personality disorders. The frequency of psychiatric symptoms was much higher in meningiomas with volume greater than 35cc compared to the smaller ones, in the frontal group. None of the patients developed new psychiatric symptoms after surgery. Among the twenty patients with psychiatric symptoms, 3 (15%) didnot improve, 8 (40%) improved partly and 9 (45%) improved completely. ConclusionsMeningiomas, although extra-axial, cause significant psychiatric symptoms up to 35.1%. Frontal and temporal group of meningiomas have the highest frequency of psychiatric symptoms. The frequency of psychiatric symptoms was significantly higher in meningiomas with volume greater than 35cc compared to the smaller ones, in the frontal group. Surgical excision of meningiomas ameliorates the psychiatric symptoms, either completely or partly, in the majority of the patients.

Changes in organic mental disorders features in persons who have repeatedly committed socially dangerous acts

Aim. Comparative analysis of the changes in clinical manifestations of organic mental disorders in persons who have repeatedly committed socially dangerous acts, and in patients without recurrence of misconduct.Methods. 93 patients with organic mental disorders who have committed socially dangerous acts and were declared as mentally insane and in whom compulsory medical measures assigned to them by the court were used were examined. Patients who have committed repeated socially dangerous acts after treatment were included in the main group (30 persons), patients who does not commit repeated socially dangerous acts were allocated to the comparison group (63 persons).Results. In the main group, patients with organic delusional disorder (F06.2, 20% vs 11.1%) dominated. In the control group, the share of patients with dementia of mixed origin (F02) was 22.2%, and in the main group - only 3.3%. In the main group, the prevalence of patients with psychotic conditions within the organic mental disorder was 43.3% versus 30.2% in the comparison group. At that, the rate of progression varied only slightly. The proportion of patients with no previously recorded episodes of decompensation was higher in the control group - 46.0% versus 13.3% in the study group. A few patients in both groups (10%) were supervised and regularly visited a psychiatrist. The number of patients who were not supervised or who attended psychiatrist rare was almost the same (46.7 and 47.6% in the study group and control group, respectively). At that, in the control group 12.7% of patients were not supervised due to the short disease duration (patients with dementia). There were a few more patients with a disease duration of more than 10 years in the comparison group - 54.0%, whereas in the study group - 43.3%.Conclusion. There is a number of differences in clinical manifestations of organic mental disorder and their changes over time, affecting the criminogenic risk of this population; an integrated approach to disease prevention, which can lead to an improvement in the criminal forecast, is needed.

Comparison Between Outpatients of Private and Public Psychiatric Hospitals in Georgia

Since 1995, Georgia has a State Program of Mental Health Care. The Program provides free outpatient and inpatient care for patients with psychosis. The program is limited. Treatment of mental disorders of neurotic register and behavioral disorders are not provided by the State Program. Since 2009, in Georgia is working the private psychiatric clinic – 'Mentalvita”. Contingent of patients is not limited to their mental health state. The purpose: comparison of longitudinal outpatient contingent in public and private clinics. The method: clinical and statistical analysis of statistic data in 2011 and 2012. Diagnostic cryteria is ICD-10. The analyze of 3965 case of 'public” patients: ~ 34% had schizophrenia and schizoaffective disorder, ~ 31% – mood disorders, ~ 25% anxiety disorders, only ~ 2% eating disorders, ~ 4% – organic delusional disorder and ~ 2% – mental retardation. The analyze of 7849 case 'private patients: ~ 27% had schizophrenia and schizoaffective disorder, ~ 43% – mood disorders, ~ 21% anxiety disorders and ~3% eating disorders. Study showed the dominance of neurotic register disorders in the private. Patients with neurotic disorders and not severe mood disorders and are forced to turn to private doctors. The data indicate the inadequacy of the State Program of Mental Health Care and need for its revision.

Organic delusional disorder in a case suggesting Huntington′s disease

Huntington's Disease (HD) is an autosomal dominant progressive degenerative disorder of the basal ganglia characterized by motor, cognitive, and psychiatric manifestations, with an estimated prevalence of 1.75 per 100,000. It can present any time between infancy and senescence. Mood disorders, obsessive compulsive symptoms, psychosis, delirium, sexual disorders, and 'frontal' syndromes, have been reported in patients with HD. Delusions are seen in only about 5-12%. Indian data on HD has been largely through case reports. Given this background, we present an uncommon case with clinical features suggestive of HD and organic delusional disorder. This case report presents the psychiatric and neurological features of a 39-year-old male, who presented with abnormal choreiform movements since eight years, followed by a delusion of infidelity, and a family history suggestive of HD. Differential diagnosis and laboratory results, including neuroimaging and treatment, are presented. Delusions are the common manifestation of psychosis in patients with brain disorders, occurring more often than a formal thought disorder. Lesions of the temporal lobes or caudate nuclei and bilateral brain involvement are common in disorders manifesting psychosis. However, reasons for the infrequent occurrence of delusions in HD, in comparison to other neurodegenerative disorders, are unknown.

Clinical and criminological characteristics of patients with organic mental disorders who had repeatedly committed socially dangerous acts

Aim. To perform the comparative analysis of clinical and criminological characteristics of patients with organic mental disorders who had repeatedly committed socially dangerous acts. Methods. 79 patients with diagnosed organic mental disorders who had committed socially dangerous acts, declared insane by the court and underwent compulsory treatment determined by the court as out-patients or in general or specialized mental hospital. Patients who had repeated socially dangerous acts after treatment, were included in the group A (19 patients), patients who had not committed any socially dangerous act after treatment, were included in the group B (60 patients). Results. Patients with organic delusional disorder (21 vs 11.6%) and non-psychotic organic disorders (10.5 vs 5%) were more commonly seen in group A compared to group B. The share of patients with dementia was higher in group B (23.3 vs 5.2%). 8 (42.1%) patients of group A were never prosecuted before, compared to 40 (66.7%) patients from group B. Some crimes were registered only in patients who repeatedly committed crimes: sexual crimes - 1 (5.2%), crimes against administrative order - 2 (10.5%), crimes against public security 5.2% (patient was convicted in illicit firearms manufacturing). Psychopathy-like syndrome was the leading syndrome in patients who committed a socially dangerous act in both A and B groups: 11 (57.9%) and 33 (55%) cases respectively. Hallucinatory delusion was diagnosed in 7 (36.8%) of group A patients and in 17 (28.3%) of group B patients. Majority of the group A patients had further committed only one crime after treatment - 11 (57.9%), 5 (26.3%) committed 2-3 crimes, 3 (15.8%) patients - over 3 crimes. The time gap between the first and further compulsory treatment was between 1 and 3 years in most of the cases (11 patients, 57.9%). 4 (21%) patients were readmitted for repeated compulsory treatment within 1 year, 3 (15.8%) were readmitted from 3 to 5 years and 1 (5.3%) from 5 to 8 years after the initial treatment. Conclusion. There are a number of factors influencing the criminal behavior and re-committing socially dangerous acts in future. Despite the small sample size, it should be noted that patients with dementia do not repeat socially dangerous acts.

Psychosis in an adolescent with Wilson's disease: A case report and review of the literature.

Neuropsychiatric manifestations are common in Wilson's disease and mainly include extrapyramidal and cerebellar symptoms. Presentations with psychotic symptoms have been described less frequently. In this report we present the case of a young boy with Wilson's disease who developed psychotic symptoms. A 12-year-old boy was diagnosed with Wilson's disease on the basis of the physical examination findings and low ceruloplasmin levels (8.1 mg/dl). After 2 weeks of being diagnosed with Wilson's disease, he developed an acute onset illness, characterized by delusion of persecution, fearfulness, hypervigilence and decreased sleep. These symptoms were not associated with any confusion, clouding of consciousness, hallucinations and affective symptoms. There was no past or family history of psychosis. One week after the onset of the symptoms he was prescribed tab penicillamine, initially 250 mg/day, which was increased to 500 mg/day after 3 days. After increase in the dose of penicillamine, his psychiatric symptoms worsened and led to hospitalization. A diagnosis of organic delusional disorder (F06.2) due to Wilson's disease was considered. Tab risperidone 1 mg/day was started, and the dose of penicillamine was reduced with which symptoms resolved. Whenever a young adolescent develops psychosis, especially of delusional type, the possibility of Wilson's disease must be considered.

Low-Dose Quetiapine for the Treatment of Delusional Disorder in a Patient With Von Hippel-Lindau Disease

Low-Dose Quetiapine for the Treatment of Delusional Disorder in a Patient With Von Hippel-Lindau Disease

Organic causation of morbid jealousy

This article describes the organic contribution to morbid jealousy. Although the true prevalence of morbid jealousy is unknown, organic factors contribute significantly to its development. We present an assortment of five case histories to highlight the importance of organic causation in this phenomenon. The first two cases portray organic delusional disorder arising as an aftermath of cerebral infarcts. They are both associated with left sided brain lesions. Though organic processes generally respond poorly to treatment, case 3 (patient with head injury), is unusual as it describes a young man whose symptoms resolve on recovering from the effects of a head injury. Likewise, case 4 (patient with a meningioma) who made a complete recovery following surgery, emphasizes the need for early detection of reversible causes. The difficulty in identifying the common substrate for a phenomenon with such a wide variety of causations is amply displayed by the abundance of theories forwarded. The blurred demarcation between normal jealousy and pathological jealousy leads to further uncertainty. The excess representation of morbid jealousy in organic conditions is not enlightened by these theories. Organic pathology, by affecting the higher centers of the brain, may remove the control over instinctual behaviour. Evidence for this is hard to establish but the evolutionary perspective of jealousy akin to that of the animal kingdom alludes to possible explanations.

Psychosis and epilepsy in young people

The aim of this study was to describe the clinical characteristics of children and young people under 19 with both epilepsy and a psychotic state (schizophrenia-like psychotic episode, organic delusional disorder, or other brief psychotic episode). In total, the clinical case notes for 17 young people with these characteristics were identified retrospectively from three different sources. Compared with a group of young people with psychosis without epilepsy, children with epilepsy and psychosis more frequently had other neuropsychological problems like learning disability and autism. Both groups had a high rate of family histories of mental illness and social disability. Contrary to the findings in adults with psychosis and epilepsy, in this group of young people, psychosis was associated neither with temporal lobe epilepsy nor with mesial temporal sclerosis. The children with psychosis and epilepsy had a variety of seizure types and structural abnormalities.