Rare Psychiatric Disorder Research Articles

A rare case of capgras syndrome: The impersonation delusion

Capgras syndrome is a rare psychiatric disorder characterized by the delusional belief that a person or people close to the affected individual have been replaced by identical impostors. This case report presents the unique clinical presentation and management of a 52-year-old male patient who exhibited classic symptoms of capgras syndrome. The patient’s delusion emerged following a traumatic brain injury, leading to significant distress and impaired social functioning. The assessment, diagnosis, and treatment approach are discussed, highlighting the interdisciplinary collaboration between psychiatry, neurology, and neuropsychology. This case report sheds light on the challenges associated with the management of capgras syndrome and emphasizes the importance of a comprehensive and individualized treatment plan.

Folie a Deux in 2 Elderly Sisters - Challenges in Diagnosis and Management

IntroductionFolie a deux is a rare psychiatric disorder where an identical or similar mental disorder affects two or more individuals usually with close emotional ties. Management of patients with folie a deux may require multiple types of treatment including separation, family therapy and antipsychotics.ObjectivesNarrative case of Folie a deux in 2 elderly sistersMethodsClinical case presentation through retrospective review of clinical notesResultsWe present a case of 2 sisters living together of 76 and 74 years of age. The elder sister, Sister A, presented to Singapore’s Institute of Mental Health on October 2021 after she was referred from court for disturbed behaviour with more than 10 years history of paranoid delusions against their neighbours, eventually extending to strangers in general. She was admitted and stayed in hospital from October 2021 to February 2022. She was referred to community psychiatric services to perform home visits due to her unwillingness to attend subsequent follow ups after discharge. During these home visits, it was determined that her sister, Sister B, was displaying delusional thinking as well. Sister A was started on antipsychotics while Sister B was managed non-pharmacologically. After commencement of antipsychotics, Sister A showed good response with improvement of symptoms, while Sister B continued to display delusional thinking. Discussion was made with the next-of-kin of both sisters, their nephew, and the decision was made to continue to observe these symptoms and monitor for their resolution with continued treatment of Sister A. A multidisciplinary approach was also used to attempt to reintegrate them into society to rebuild trust in the public. Currently both sisters still report vague paranoia of strangers in general and a multidisciplinary team is involved in improving their symptoms further.ConclusionsWith this case report, we hope to raise awareness of the different methods that are useful in the management of Folie a deux along with the challenges faced when managing these cases.Disclosure of InterestNone Declared

Down syndrome regression disorder, a case series: Clinical characterization and therapeutic approaches.

Down syndrome (DS) is one of the most frequent genetic disorders and represents the first cause of intellectual disability of genetic origin. While the majority of patients with DS follow a harmonious evolution, an unusual neurodevelopmental regression may occur, distinct from that described in the context of autism spectrum disorders, called down syndrome regression disorder (DSRD). Based on four patients, two males and two females, with age range between 20 and 24, treated at the Reference Center for Rare Psychiatric Disorders of the GHU Paris Psychiatry and Neurosciences [Pôle hospitalo-universitaire d'Évaluation Prévention et Innovation Thérapeutique (PEPIT)], we describe this syndrome, discuss its etiologies and propose therapeutic strategies. DSRD often occurs in late adolescence. There is a sudden onset of language disorders, loss of autonomy and daily living skills, as well as behavioral symptoms such as depression, psychosis, or catatonia. These symptoms are non-specific and lead to an overlap with other diagnostic categories, thus complicating diagnosis. The etiologies of the syndrome are not clearly identified but certain predispositions of patients with trisomy 21 have suggested an underlying immune-mediated mechanism. Symptomatic therapeutic approaches (serotonergic antidepressants, atypical antipsychotics, benzodiazepines) were not effective, and generally associated with poor tolerance. Etiological treatments, including anti-inflammatory drugs and corticosteroids, led to partial or good recovery in the four cases. Early recognition of regressive symptoms and rapid implementation of adapted treatments are required to improve the quality of life of patients and their families.

Prader-Willi syndrome: Symptoms and topiramate response in light of genetics.

Prader-Willi Syndrome (PWS) is a rare genetic condition, which affects one in 25,000 births and results in various phenotypes. It leads to a wide range of metabolic and endocrine disorders including growth delay, hypogonadism, narcolepsy, lack of satiety and compulsive eating, associated with mild to moderate cognitive impairment. Prognosis is especially determined by the complications of obesity (diabetes, cardiorespiratory diseases) and by severe behavioral disorders marked by impulsivity and compulsion. This heterogeneous clinical picture may lead to mis- or delayed diagnosis of comorbidities. Moreover, when diagnosis is made, treatment remains limited, with high interindividual differences in drug response. This may be due to the underlying genetic variability of the syndrome, which can involve several different genetic mutations, notably deletion or uniparental disomy (UPD) in a region of chromosome 15. Here, we propose to determine whether subjects with PWS differ for clinical phenotype and treatment response depending on the underlying genetic anomaly. We retrospectively included all 24 PWS patients who were referred to the Reference Center for Rare Psychiatric Disorders (GHU Paris Psychiatrie and Neurosciences) between November 2018 and July 2022, with either deletion (N = 8) or disomy (N = 16). The following socio-demographic and clinical characteristics were recorded: age, sex, psychiatric and non-psychiatric symptoms, the type of genetic defect, medication and treatment response to topiramate, which was evaluated in terms of eating compulsions and impulsive behaviors. We compared topiramate treatment doses and responses between PWS with deletion and those with disomy. Non-parametric tests were used with random permutations for p-value and bootstrap 95% confidence interval computations. First, we found that disomy was associated with a more severe clinical phenotype than deletion. Second, we observed that topiramate was less effective and less tolerated in disomy, compared to deletion. These results suggest that a pharmacogenomic-based approach may be relevant for the treatment of compulsions in PWS, thus highlighting the importance of personalized medicine for such complex heterogeneous disorders.

Rare case of Fahr's syndrome with dissociative amnesia

Background: Fahr's syndrome (FS) is a movement and psychiatric disorder characterized by symmetrical and bilateral calcification of the basal ganglia. Dissociative amnesia is a rare psychiatric disorder that occurs after stressful events and is classified as a dissociative disorder. In addition, dissociation is the process by which the mind conceals stressful events from consciousness. Several neuropsychiatric manifestations in FS have been reported. However, due to their rarity, FS and dissociative amnesia can be misdiagnosed. Case: A 43-year-old female presented with Parkinsonian symptoms and an inability to recall important personal information. FS and dissociative amnesia were diagnosed after a thorough medical, psychiatric, and diagnostic investigation. Subsequently, correction of calcium and phosphate levels by α-hydroxy-vitamin-73 D3 and psychotherapy were administered for two-months until there were no neuropsychiatric symptoms reported. Conclusion: This research highlights a rare case of FS with dissociative amnesia which pathophysiology is not completely understood due to limited research.

Delusional infestation: What nurses should know.

Patients with delusional infestation, a rare psychiatric disorder, have a false and fixed belief that insects or other organisms are crawling in or on their skin. This article describes signs and symptoms, available treatments, and appropriate nursing interventions for patients with primary delusional infestation.

Autopsy Report of Sudden Death with Findings of Polyembolokailomania – A Rare Psychiatric Disorder

Internationalization has prompted expanded migration prompting incidents of deaths outside the deceased’s own nation are on the ascent. The basic assumption being, that the danger during the excursion is more noteworthy than that present in the normal conditions of the traveler. Many legal formalities comes to play following demise of a foreign national. The officials of that country, following the death of a foreign national on foreign soil, conduct a primary investigation. Worldwide, cardiovascular disease is the most frequent cause of sudden death contributing for about 45-50% cases and acute myocardial infarction (AMI) being leading entity. We present a case of foreign national, who died while travelling on an intercontinental flight. This case describes the autopsy findings emphasizing the cardiac rupture, along with accidental finding of rare psychiatric disorder polyembolokialomania.

A Rare Case of an Elderly Woman with Delusional Parasitosis (Ekbom’s Syndrome)

Introduction: Delusional parasitosis is a form of relatively rare psychiatric disorder in which the sufferer holds firms false believe of their skin being infested by parasite. On 1938 scientist Ekbom published a case report detailing 8 patients suffering from this delusional perception and hence this condition is also known as Ekbom’s syndrome.
 Case Presentation: We present a 67 years old normotensive non diabetic female patient who was brought to the outpatient Department by her son with complain that, insects are crawling under her skin. She has been suffering from this condition for three years and it was causing tremendous psychosocial and physical adverse consequences. She has never been on treatment by any specialist before but has received treatment from traditional village healers with little improvement.
 Conclusion: Ekbom’s syndrome is a rare yet important delusional disorder. This is a hard to treat condition that Doctors should be aware of.

Psychiatric Disorders in Mӧbius Sequence: Intermittent Presentation of Auto-Aggressive Outbursts

Anecdotal evidence suggests the possible association of psychiatric disorders with Mӧbius sequence, although the evidence is not conclusive. Intermittent presentation of auto-aggressive outbursts, in particular, could be related to Mӧbius sequence, different from the common psychotic symptoms. The present report describes the clinical case of a young man with Mӧbius syndrome who exhibited a complex representation of severe mental retardation and concomitant psychiatric disorders. Extremely rare psychiatric disorders represented the main feature in this clinical case, besides the other well-known signs and symptoms of the Mӧbius syndrome. Psychiatric disorders could, therefore, prove to be an interesting field of study for an extensive exploration of the Mӧbius syndrome.

Childhood-Onset Schizophrenia: Insights from Induced Pluripotent Stem Cells.

Childhood-onset schizophrenia (COS) is a rare psychiatric disorder characterized by earlier onset, more severe course, and poorer outcome relative to adult-onset schizophrenia (AOS). Even though, clinical, neuroimaging, and genetic studies support that COS is continuous to AOS. Early neurodevelopmental deviations in COS are thought to be significantly mediated through poorly understood genetic risk factors that may also predispose to long-term outcome. In this review, we discuss findings from induced pluripotent stem cells (iPSCs) that allow the generation of disease-relevant cell types from early brain development. Because iPSCs capture each donor’s genotype, case/control studies can uncover molecular and cellular underpinnings of COS. Indeed, recent studies identified alterations in neural progenitor and neuronal cell function, comprising dendrites, synapses, electrical activity, glutamate signaling, and miRNA expression. Interestingly, transcriptional signatures of iPSC-derived cells from patients with COS showed concordance with postmortem brain samples from SCZ, indicating that changes in vitro may recapitulate changes from the diseased brain. Considering this progress, we discuss also current caveats from the field of iPSC-based disease modeling and how to proceed from basic studies to improved diagnosis and treatment of COS.

Cotard and Capgras delusions in a patient with bipolar disorder: “I’ll prove, I’m dead!”

ABSTRACTCotard is a syndrome that is characterized by ideas of damnation or rejection, anxious melancholia, insensitivity to pain, and nihilistic delusions concerning one’s own body or existence. It is most often encountered in middle age or older women who are severely depressed. Capgras syndrome is a rare psychiatric disorder with colourful symptoms. The patient believes that the identities of close relatives or friends are not real but are replaced by others. Co-existences of psychiatric and organic diseases with Cotard’s syndrome and Capgras syndrome are reported in different studies. There is still requirement of more research to establish a position in diagnostic classification systems for these syndromes which are thought to have a multifactorial etiology. In this report, we described a patient with bipolar disorder type-2 who displayed comorbid Cotard and Capgras delusions which were most evident at the onset of menstrual periods.

Delusional infestation. Ekbom´s syndrome in a 47-year-old woman. Case report

Introduction: Delusional infestation is a rare psychiatric disorder defined as a condition in which the patient has the unshakable belief and perception of being infested with parasites. Its treatment is difficult, and frequently includes antipsychotic medications (such as olanzapine or aripiprazole). Non-pharmacological treatment, particularly psychotherapy, can be used for less severe cases. Dermatologists and psychiatrists must take a multi-disciplinary approach (preferably in a psycodermatology dedicated clinic) since this type of patients sometimes refuse treatment.Case description: A 53-year-old female businesswoman describes a clinical history of five years of visual hallucinations, depressive symptoms, and generalized pruritus, along with the use of toxic substances to “clean” her skin and cloths. She reports similar symptoms in some relatives but they were not evaluated. Blood tests and analyses of the “specimen” brought by the patient were performed, yielding negative results. The patient had never been assessed by any specialist, and showed disoriented during the consultation. Follow-up was not possible due to the reluctance of the patient to follow the indications and seek psychiatric treatment. Moreover, the patient did not respond to further communication attempts.Discussion: Delusional infestation is an uncommon disease that endangers the patients and the people around them. Its treatment is difficult and long, and not conducting proper follow-up is a great risk. Its prevalence and incidence is variable and generally unknown. It can affect the patient, their next of kin, pets or the environment, and the “pathogen” can be a living organism or an inanimate object. Conclusion: This case is important as it shows the hardships of treatment, adequate follow-up and care, as well as the need to improve how these patients are approached. Additionally, both classical and uncommon signs and symptoms could be observed as the patient stated that her relatives were affected (possible delusional infestation by proxy).

Diagnosis and treatment management procedure in a case with delusional parasitosis

Delusional parasitosis is a rare psychiatric disorder frequently accompanied by dermatological problems. Despite the medical evidence, these patients have a constant belief that parasites are present in their bodies. The most common form is mono-hypochondriac psychosis, which there is no psychiatric disorder. These patients usually have a feeling of itching, biting, and crawling on their skin. Typically, patients can cause ulceration, erosions of the skin with tools such as nails, skin peelers, tweezers, etc., which will harm them to remove the pathogens they have in the past. In this case report, we aimed to report the diagnosis and treatment of a patient diagnosed with delusional parasitosis as a result of evaluations made for the first time to the psychiatric outpatient clinic.

Taphophobia and 'life preserving coffins' in the nineteenth century.

In 1891 the Italian psychiatrist Enrico Morselli (1852-1929) described taphophobia, defining it as an extreme condition of claustrophobia due to the fear of being buried alive. This rare psychopathological phenomenon reflects an ancient fear, and its origin is not known. Taphophobia is closely linked to the problem of apparent death and premature burial. In the nineteenth century, scientists and authors paid particular attention to the issue of apparent death, and special devices (safety coffins) were invented to ensure that premature burial was avoided. Nowadays taphophobia is quite a rare psychiatric disorder; different forms of social anxiety disorders are much more widespread. Its modern equivalent could be the fear of organs harvested from a patient who is still alive.

Atypical Frotteurism Associated with Voyeurism and Obsession in a Six-Year-Old Boy

Introduction: Frotteuristic sexual interest is a rare psychiatric disorder characterized by at least six months of recurrent and intense sexual arousal from touching or rubbing against a non-consenting person, usually in a crowd. Case Presentation: A six-year-old boy was referred to the psychiatrist while accompanied by his mother and grandmother with the complaint of excessively rubbing his genitalia many times a day against his female family members’ bodies, primarily their buttocks. Conclusions: Experts are advised to focus on diverse sexual history dimensions, especially uncontrollable masturbation behaviors, that can predict sexual interests. Although frotteurism is a rare psychiatric disorder, and although this case is atypical given the early childhood presentation of abnormal sexual behavior carried out secretly and not in a crowd, it is clear that frotteurism is the appropriate diagnosis after ruling out other more common disorders.

Sudden onset of Cotard’s syndrome as a clinical sign of brain tumor

We report the clinical case where the sudden onset of a Cotard syndrome in a 69 year old lady lead to the discovery of a multifocal glioblastoma in the right temporo-parietal lobe. Cotard’s syndrome is a rare psychiatric disorder in which the afflicted patient believes he or she is dead. These nihilistic thoughts are the expression of a rare syndrome first described by Jules Cotard in late XIX century. The Cotard’s syndrome has been studied and it seems that its psychopathology can be ascribed to the temporoparietal cortex. Although the Cotard’s syndrome is not part of the DSM-V it is common in psychiatric literature and is included in ICD-10-CM within code F22. It has been described associated with organic lesions and atrophy of the non-dominant temporo-parietal cortex, in pathologies like bipolar disorder, schizophrenia1, subdural hemorrhage2, multiple sclerosis, brain atrophy3 and cerebral infarction4 among others5-7. We observed the case of a female patient, 69 years old, with no relevant past medical history, that was admitted to the John Radcliffe Hospital in Oxford (UK) with an episode of numbness in the left hand and an episode of dizziness whilst at home, duration of symptoms was of 15 minutes and then resolved entirely. She had no history of head trauma. Neurological exam was unremarkable and the stroke team felt a CT scan was not required, however she failed occupational therapy assessment and was not sent home. During the night she developed the delusion of being dead. When being interviewed, in the next day early in the afternoon, she stated: – “I think I’m dead (...) it started during the night, like it was some kind of a dream, but this remain until now” (...) – “Do you rationally think you are dead?” – “I do. It may not make much sense since I realize I have blood pressure when they measure it but I rationally think I am dead.”

A case report of folie a deux: Mother and daughter

Shared paranoid disorders, a relatively rare psychiatric disorder in which paranoid delusions are transferred from one individual to one or more other susceptible person(s) in close association. Folie a deux is characterized by a complex dependent relationship between the involved individuals, yet a challenging diagnosis. In the paradigm of changing nosology, where the term shared/induced psychotic disorder is going obsolete, it is important to recognize such cases due to the potential for recovery in the submissive partner. Here, we present a case report and discussion of folie a deux involving inducer mother and induced daughter. In the clinical case presented, folie a deux was easily diagnosed, but its treatment proved to be a bigger challenge.

Folie a deux

Shared psychotic disorderis a rare psychiatric disorder. It is defined when a primary psychotic person imposes his/her delusional beliefs to the other person usually in a close relationship. Occurrence of this disorder among family members and close friends has been described. However, its exact incidence and prevalence is not known. Since such case has not been reported in Nepal to best of our knowledge, we present a case of shared delusional disorder along with brief review of literature. This case report describes a case of common shared persecutory delusion in husband and wife.

Recognition and management of factitious disorder

Factitious disorder is a rare psychiatric disorder characterised by feigned medical symptoms. This article discusses the warning signs and describes a management approach that maximises engagement with the patient while minimising harm.

Induced Psychosis or Psychotic Relapse? An Unexpected Effect of Anti-Parkinson Treatment

Induced or shared psychosis is one of the rare psychiatric disorders in which an inductor, suffering from a psychotic disorder induces a psychotic condition - with similar symptoms - in a person with strong emotional attachment (the recipient). Diagnosis is based on strict criteria, therefore it is essential to have thorough knowledge of the inductor?s and the recipient?s medical history. In our case, we examined an elderly couple ? both 83 years old ? with newly formed, thematically identical acoustic hallucinations and delusions. During patient interviews it turned out that the husband suffers from Parkinsonia disease and the wife was treated in the 1960s with the diagnosis of schizophrenia. Though, based on the medical history the diagnosis of shared psychotic disorder became questionable, we thought it is worth to further examine the interaction of the two patients? psychopathology.