This study in veterans shows that the presence of mental illness and its comorbidities represents a significant risk factor for the diagnosis of liver disease, including HCV and alcohol-related cirrhosis.

With this understanding of the comorbidities of the coinfected population, integrated healthcare models involving mental health, internal medicine, substance abuse treatment and internal medicine are crucial to work with these medically and psychologically complex patients.

Objective: This retrospective study analyzed the testing rates of individuals enrolled in the Hepatitis C Clinical Case Registry for the Veterans Health Administration (VHA) in order to determine Human Immunodeficiency Virus (HIV) co-testing rates for veterans with hepatitis C (HCV). Design: A chart review of 247,006 veterans enrolled in the National HCV Clinical Case Registry was examined retrospectively. Regression analysis identified factors that increased the probability of being tested for HIV. Methods: Simple odds ratios and a complex regression were applied to this dataset to calculate testing incidence and prevalence of HIV. Results: Only approximately one third of veterans with HCV were tested for HIV and, of these, 13.2% were positive. Sixty eight percent of veterans with HCV were not co-tested for HIV and within this group there may be a significant number of unidentified cases of HIV. Veterans with severe mental illness, substance use disorders and marijuana abuse/dependence treatment were more likely to be tested for HIV. Antiviral therapy for HCV had no impact on likelihood of co-testing prior to treatment initiation. Conclusions: Most veterans with HCV are not co-tested for HIV despite common risk factors for HIV and HCV infection. Mandatory testing for HIV, at least among veterans with HCV, as well as identification and removal of barriers to HIV testing within the VHA would serve to facilitate disease management for veterans in the future.

No abstract

During late 19th and early 20th century neuropsychiatrists began to identify common behavioral and cognitive disturbances in epilepsy, but it is not until 1973 that Norman Gestchwind described the basics of what we know as Gestchwind syndrome. This syndrome includes the triada of hyper-religiosity, hypergraphia and hypo/hypersexuality and it was mainly associated with temporal lobe epilepsy. Moreover, it is well known the association between epilepsy and psychotic symptoms, the so-called schizophrenia-like syndrome, which can lead us to a false diagnosis of schizophrenia. We report a 44-year-old man who was brought to the hospital with delusional ideation of prosecution and reference in his work environment with important behavioral disruption, as well as delusional ideation of religious content. He had a diagnosis of schizophrenia since he was 18-years-old and personal history of generalized tonic-clonic convulsions in his twenties. During the admission, he recovered ad integrum very rapidly with low doses of risperidone, but referred recurrence of déjà vu episodes. After reviewing his patobiography and past medical history, we identified the presence of hypergraphia, hypersexuality and a profound religious feeling, fulfilling the criteria for Gestchwind syndrome, in the context of which was later diagnosed as chronic epileptic psychosis. It is very important a careful approach to the patobiography and personal history. Also, we should include classic differential diagnosis such as Gestchwind syndrome, as they can lead us finally to the correct diagnosis, which in this case meant not only a different treatment but also a better prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.