IntroductionMental comorbidities, such as phobia, obsessive compulsive symptoms and anxiety disorders, are common in Williams syndrome. However, psychotic symptoms are rare in these patients. We report a case of psychosis in a patient with Williams syndrome.Case presentationA 23-year-old Caucasian woman with Williams syndrome arrived at the emergency room with persecutory delusions, auditory and verbal hallucinations, soliloquies and psychomotor agitation. These symptoms were consistently present for 2 months. No evidence of other medical illnesses or psychoactive substances was found. There was no evidence of prior psychiatric symptoms or family history of psychiatric or neurological disorders. She was treated with antipsychotics and her symptoms were resolved.ConclusionWe describe a rare case of a patient with Williams syndrome who experienced a nonorganic psychotic episode. Literature on this topic is scarce and, therefore, this case report intends to add further data about this comorbidity.
IntroductionHikikomori, a form of severe social isolation, once characterized as a Japanese cultural-bond behavior with social and economic consequences, it is now being described in other countries. Its presentation mimics some clinical features of various classified mental diseases, such as prodromal phase of schizophrenia, personality disorders, Internet dependence, social phobia or depression, without fulfilling their defining criteria.Objectives/methodThis work aimed to do a brief review of this subject, describing one case that is probably the first ever reported in Portugal, comparing it with similar cases around the world.ResultsThe patient was a 22-year-old male, taken to psychiatry evaluation after 4 years of social withdrawal, avoiding or blocking any contact even with family members, which resulted in work and school impairment. He spent most of his days locked at his room, investing his time in particular interests and Internet use, only leaving to eat or do his basic hygiene. At that time, he presented no affective or psychotic symptoms and perceived his behavior as egosintonic. After six appointments with psychotherapeutic approach, he was able to get a job and improved his communication with the others, especially with family.Discussion/conclusionThis case fits most of the reports found on literature, in its presentation and clinical management. Hikikomori is not considered yet a disorder and further documentation of these cases is still needed to define its place in psychiatric nosology.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionMixed features refers to the presence of high and low symptoms occurring at the same time, or as part of a single episode, in people experiencing an episode of mania or depression. In most forms of bipolar disorder, moods alternate between elevated and depressed over time. A person with mixed features experiences symptoms of both mood “poles” – mania and depression – simultaneously or in rapid sequence.Aims and objectivesTo review the nosological status of bipolar mixed states and its treatment.MethodsOnline search/review of the literature has been carried out, using Medline/Pubmed, concerning “mixed states”, “affective disorder”, “bipolar disorder”.ResultsThe presence of depressive symptomatology during acute mania has been termed mixed mania, dysphoric mania, depressive mania or mixed bipolar disorder. Highly prevalent, mixed mania occurs in at least 30% of bipolar patients. Correct diagnosis is a major challenge. The presence of mixed features is associated with a worse clinical course and higher rates of comorbidities. There is ongoing debate about the role of antidepressants in the evolution of such states.ConclusionsClinical vigilance and careful evaluation are required to ensure mixed states are not missed in the clinical context. Atypical antipsychotics are emerging as the medications of choice in the pharmacological management of mixed states.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Bipolar disorder is characterized by persistent and/or recurrent mood changes between depressive and manic poles. Rapid cycling is a frequent, although underrecognized, condition in bipolar disorder, and it is known to worsen the prognosis of the disease. With regard to the treatment of bipolar depression, there is a shortage of evidence-supported treatment choices, and the literature on the subject includes few references to cases of manic switch induced by lamotrigine.The authors describe a case of a rapid cycling bipolar patient who presented manic symptoms after initiating treatment with lamotrigine.
IntroductionParaphilias are rarely diagnosed in the clinical setting, although the estimated highest possible lifetime prevalence is approximately 12% for males and 4% for females. There are various presentations, including transvestism and fetishism. In this regard we present a case report of a 41 year old patient with a clinical picture compatible with Transvestism and Fetishism, whose clinical diagnosis was clinched years later.ObjectivesThe objective of this paper is to describe a case report whose diagnosis is compatible with transvestism and fetishism.AimsUnderstanding the clinical features of this pathology, regarding a diagnostic and therapeutic improvement.MethodsCase report and bibliographic research on Pubmed e MedscapeResults and ConclusionsTravestism and Fetishism is often under-diagnosed and occurs almost exclusively in heterosexual men and can cause significant distress. Therefore, it is crucial to clinch an early diagnosis in order to start an appropriate treatment.
IntroductionThe corticobasal degeneration (CBD) is a rare and severe neurodegenerative condition associated with a heterogeneous clinical syndrome of behavioral, motor, sensory and cognitive symptoms. Epilepsy is often associated with ictal, post-ictal and inter-ictal behavior changes, and it‘s a rare manifestation in DCB.Objectives/AimsLiterature review on topic Corticobasal Degeneration, with presentation of a clinical case.MethodsResearch conducted in Pubmed with the words:’corticobasal degeneration’,’neuropsychiatric symptoms’. The clinical information was collected from patient and family.ResultsThe authors report a case of a 55 years-old women with a history of anorexia nervosa, an affective disorder with features of Major Depression of 7 years of evolution and Epilepsy. Was admitted toInpatient Psychiatry Unit by rapidly progressive neurodegenerative clinical status of 6 months period, with temporo-spatial disorientation, incoherent speech, personality regression identifying substantial changes in behavioral pattern (apathy, depressed mood, anxiety), committing almost completely their autonomy. Neurological examination reported mnesic deficits, difficulty in memory recall, lack of ability to calculate and abstraction, ideational and ideomotor apraxia,’alien limb’ phenomenon, parkinsonism with global bradykinesia, gait in small steps and left hemibody stiffness. Emphasize the complementary diagnostic exams, the electroencephalographic study with bilateral paroxystic activity of central predominance and brain-MRI revealing leukoencephalopathy, Globus pallidus mineralization and cortico-subcortical atrophy.ConclusionsThe differential diagnosis of prion encephalopathy and limbic encephalitis were excluded, having performed therapeutic trial with methylprednisolone without improvements. It is discussed in this clinical case of DCB, the long pre-symptomatic period of pathological behavior and epilepsy, relative to rapidly progressive neurological deterioration.
IntroductionLithium is a mood stabilizer used in the treatment of bipolar disorder. Lithium has recently been associated to permanent neurological damage namely persistent cerebelar dysfunction as well as peripheral and central neuropathies.ObjectivesTo present a clinical case of a probable Syndrome of Irreversible Lithium-effectuated Neurotoxicity (SILENT) and a review of the literature concerning this rare syndrome.AimsIncrease awareness and knowledge of SILENT.MethodsPsychiatric and psychological evaluation of a probable clinical case of SILENT and review of the literature using the key words “lithium neurotoxicity” and “Syndrome of Irreversible Lithium-effectuated Neurotoxicity”.ResultsA 54-year-old female patient was admitted in our hospital due to involuntary lithium intoxication, with acute renal and cardiovascular failure, neurological, metabolic and electrolytic dysfunction in an acute confusional state and in need of dialysis. The patient clinical picture rapidly improved although, when she achieved normal lithium seric levels, it was observed a worsening of the preexisting confusional state followed by two consecutive generalized tonic-clonic convulsions and a partial convulsion. A short time after, it was recognized the development of a persistent catatonic state. It was detected urinary incontinence and repetitive, monosyllabic, incoherent, short phrased speech featuring echolalia, together with emotional lability and incongruous affect. The patient slightly improved with the introduction of anti-Parkinson's pharmacotherapy.ConclusionsThis clinical case raises several differential diagnoses due to its psychiatric and neurologic characteristics. We conclude that the most probable diagnosis is SILENT.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionParkinson's disease is the most common neurodegenerative movement disorder in the elderly population. The disease is clinically characterized by major motor symptoms that include bradykinesia, rigidity, tremor and postural instability. In addition to the motor symptoms, Parkinson‘s disease is characterized by emotional and cognitive deficits, which reduce quality of life independently from motor manifestations.Objectives/AimsTo discuss the clinical manifestations of depression in Parkinson's disease according to the most recent scientific literature.MethodsOnline search/review of the literature has been carried out, using Medline/Pubmed, concerning, “Parkinson's disease” and “depression”.ResultsDepression is the most frequent psychiatric disorder in Parkinson's disease. In up to 30% of the cases, the depressive symptoms precede the development of motor symptoms. Independently of the age of appearance, duration and severity of the motor symptoms, depression is generally an integral part of the disease. Depression in Parkinson's disease is generally mild or moderate, with premature loss of self-esteem and volition. Although the high rates of suicidal ideation, suicide is rare. There is also a high prevalence of panic attacks and anxiety.ConclusionsIt is difficult to correctly identify depression in Parkinson's disease as some symptoms assigned to Parkinson's disease itself can in fact be the clinical manifestation of a depressive disorder. On the other hand, depressive symptoms may not be recognized as such, but considered manifestations of Parkinson's disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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