Typical Psychosis Research Articles

Psychosis symptoms associated with Niemann-Pick disease type C.

Niemann-Pick disease type C (NP-C) is a severe neurovisceral lipid storage disease that results in the accumulation of unesterified cholesterol in lysosomes or endosomes. The clinical presentations of NP-C are variable which include visceral symptoms, neurologic symptoms and psychiatric symptoms. Psychosis is the most common psychiatric manifestation of NP-C and is indistinguishable from a typical psychosis presentation of schizophrenia. The common psychotic presentations in NP-C include visual hallucinations, delusions, auditory hallucinations and thought disorders. Psychosis symptoms are more common in adult or adolescent-onset forms compared with pediatric-onset forms. The underlying pathophysiology of psychosis in NP-C is most probably due to dysconnectivity particularly between frontotemporal connectivity and subcortical structures. NP-C sometimes is mistaken for schizophrenia which causes delay in treatment due to lack of awareness and literature review. This review aims to summarize the relevant case reports on psychosis symptoms in NP-C and discuss the genetics and pathophysiology underlying the condition.

Delusional hyperthyroidism-A case report

IntroductionDisorders of endocrine function are among the most common etiology of psychiatric illness.The link between psychosis and hyperthyroidism is still poorly understood. We report an unusual presentation of hyperthyroidism as a psychotic state. Careful history, physical examination, and laboratory investigation, including thyroid function tests, should be part of the assessment of patients with any unexplained acute psychosis to detect this potentially curable disease. In this way, this article analyzes the psychiatric, physical and laboratory findings associated with hyperthyroidism and treatment.ObjectivesTo report a case of psychosis in a patient with endocrine disease.MethodsClinical records. Research on PubMed and Medscape using the Mesh Terms “hyperthyroidism”, “psychosis” and “thyroid and psychiatric manifestations”.ResultsWe present the case of a male patient, previously followed on our ambulatory psychiatric service for drug-induced psychosis. He was hospitalized due to psychotic symptoms, without substance abuse. Inpatient evaluation diagnosed hyperthyroidism. The patient did not present any somatic changes, except for psychosis. The patient was effectively treated with antipsychotics. He was referred to further evaluation and started antithyroid therapy.ConclusionsThyroid disease should be considered in the differential diagnosis of a broad spectrum of psychiatric symptoms. Psychosis is a rare complication of hyperthyroidism, ranging between 1–20%. The typical psychosis is reported to simulate manic-depressive psychosis. This association reinforces the need of a careful clinical evaluation in patients presenting with psychosis. Such psychiatric symptoms remit successfully with concomitant administration of antipsychotics and normalization of thyroid levels.Disclosure of interestThe authors have not supplied their declaration of competing interest.

121. Differences Between Auto-Antibody Titres in Cerebrospinal Fluids and Sera of Patients With Anti-N-methyl-D Receptor Encephalitis

Abstract Anti--methyl-D-aspartate receptor (NMDAR) encephalitis is one of autoimmune limbic encephalitis which receives the most attention in the psychiatric field. Patients with anti-NMDAR encephalitis typically exhibit psychiatric symptoms such as hallucination, delusion, aggression, manic episodes, and abnormal behaviors. With the given psychiatric symptoms, those patients are often diagnosed as atypical psychosis or schizophrenia and medicated with antipsychotic drugs. The definite diagnosis of anti-NMDAR encephalitis still remains to be established, however. The subjects were the patients whose cerebrospinal fluids (CSF) were verified to contain anti-NMDAR1 receptor (GRIN1) auto-antibodies and thus were diagnosed as anti-NMDAR encephalitis. These subjects exhibited chronic or subacute symptoms which were classified into typical psychosis (21 patients) and atypical psychosis (20 patients). We measured the immunoreactivity for NMDAR1 in the cell-based immunoassay in all CSF samples as well as in some of their serum samples (37 patients). This study was approved by the authorization of the Kanazawa Medical College Ethics Committee and Niigata University Medical Ethics Committee. All the patients provided written informed consent to allow the use of CSF and blood samples for this investigation. Although all the CSF samples were positive for the auto-antibodies, the positive frequency of their blood samples was lower in the subjects with atypical psychosis (23.5%; 4 patients) than in those with typical psychosis (65.0%; 13 patients) ( < .05). In addition, the auto-antibody titres were significantly lower in both CSF ( < .05) and serum ( < .01) of the subjects with atypical psychosis. These results suggest that the patients with anti-NMDAR encephalitis, but not with typical psychotic symptoms, often exhibit lower or undetectable blood concentrations of anti-NMDAR1 auto-antibodies. Thus, the definite diagnosis of anti-NMDAR encephalitis requires CSF examination.

Atypical psychosis in emergency: A case review

The authors describe the presentation of a case of a typical psychosis in the emergency services, and describe the unusual clinical features of manifestation of psychotic disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

P02-223 Postraumatic psychosis. Clinical features

Aims:Traumatic brain injury (TBI) cause a wide range of after-effects, including psychiatric disorders. Psychosis although uncommon is a very serious consequences with important functional, therapeutical and legal implications.Methods:Our work is based on a systemic review of the articles published related to TBI and psychosis.Results and conclusions:Delirious psychosis are twice more common than schizophrenia-like psychosis (28% to 14%).Delusions and hallucinations are predominant over passive phenomena or negative symptoms.Evolution and chronicity of postraumatic psychosis depends on the severity of the TBI and on the psychiatric and neurological previous conditions.Treatment is the same as used for typical psychosis, even though side effects are more frequent.

Psychosis related to methadone withdrawal.

We present two cases of typical psychosis related to methadone withdrawal. The two cases, appearing in the adult age, are not related to previous personal or familiar psychiatric illness and do not show the classical symptoms of methadone withdrawal. The appearance of this type of case is an experience repeated in different groups of researchers. In the line of previous investigators, we propose an alteration of neuromodulation in central opiate-dopamine system.

Nutrition and Psychoses

Nutrition can be involved in the pathogenesis of psychotic disorders in a complex way. Nutrition deficiency syndromes in the matured adult brain are well studied, and have contribution considerably to the understanding of the biochemical bases of psychiatric illness. The importance of nutritional substances like the vitamins and trace elements in the development of psychotic disorders is stressed particularly by orthomolecular psychiatry. From the nutritional-metabolic point of view, a considerable number of hypotheses have arisen and discusses the findings concerning the metabolic and nutritional basis of schizo-affective psychoses. It can be concluded that a subtype of the schizo-affective disorders is caused by a disturbed serineglycine metabolism, which may result in the endogenous synthesis of hallucinogenic substances. This group of schizo-affective disorders can be distinguished from others by the presence of vivid perceptual anomalies. Dietary factors, such as catabolism, or an excess of serine and/or glycine contribute to the outbreak of this typical psychosis in susceptible persons, whereas a high carbohydrate, low protein, and low fat diet appears to be beneficial to these patients.