Dandy-Walker variant is a developmental malformation consisting of cerebellar hypoplasia and cystic dilatation of the fourth ventricle. Previous research has proposed a possible role for the cerebellum in cognition and in schizophrenia. In this paper we report a schizophrenia-like psychotic disorder in a 30 year-old woman with Dandy-Walker variant. The patient was treated with risperidone 6 mg/day, biperiden 4 mg/day and risperidone depot 50 mg injections fortnightly, and most of the symptoms were ameliorated within 2 months. The similar cognitive profile to populations with cerebellar pathology and rarity of the condition strongly suggests that there may be direct relationship between cerebellar pathology and appearence of psychotic symptoms.
PurposeThe aim of this study was to evaluate the prevalence of comorbid bipolar disorder (BD) among migraineurs and the impact of migraine–BD comorbidity on disease characteristics.Patients and methodsA total of 120 adult patients diagnosed with migraine at a single tertiary care center were included in this cross-sectional study. Data on sociodemographic and migraine-related characteristics, family history of psychiatric diseases, comorbid psychiatric diseases, and first-episode characteristics were recorded. Mood Disorders Diagnosis and Patient Registration Form (SCIP-TURK), Mood Disorder Questionnaire (MDQ), and Hypomania Checklist-32-Revised (HCL-32-R) were applied to all patients by experienced clinicians, and clinical diagnoses were confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Migraine Disability Assessment Scale (MIDAS) was used to evaluate the headache-related disability. Study parameters were compared between migraineurs with and without comorbid BD.ResultsThe diagnosis of comorbid BD was confirmed in 19.2% of migraineurs. A significantly higher percentage of patients with comorbid BD than those without comorbid BD had family history of BD (39.1% vs 6.2%, P<0.001), suicide attempt (30.4% vs 5.2%, P<0.001), and physical abuse (52.2% vs 26.8%, P=0.019). MIDAS scores were significantly higher (50.6 [43.2] vs 33.8 [42.7], P=0.0422) in migraineurs with comorbid BD than in those without comorbid BD. Multivariate logistic regression model revealed that a positive family history of type I BD (odds ratio [OR], 14.42; 95% confidence interval [CI], 2.94–70.73; P=0.001) and MIDAS scores >30 (OR, 3.69; 95% CI, 1.12–12.19; P=0.032) were associated with 14.42 times and 3.69 times increased likelihood of BD, respectively.ConclusionOur findings revealed comorbid BD in a remarkable percentage of migraineurs and a higher likelihood of having BD in case of a positive family history of type I BD and MIDAS scores >30. Comorbid BD was associated with a higher rate for a family history of BD, suicide attempt, and childhood physical abuse as well as aggravated migraine-related disability among migraineurs. Migraineurs with and without comorbid BD showed similar sociodemographic and migraine disease characteristics as well as similar high rates for comorbid anxiety and first-episode depression.
It is suggested that in case of blockage in an energy center, illness or imbalance may occur and it may be treated by touching by hand according to Reiki. In this case, the first episode of psychosis with intense occupation of reiki will be presented. A 57 year-old woman presented with the complaints of auditory hallucinations, decreased need for sleep, and skepticism. In psychiatric examination; poor self-care, irritable affect, decreased psychomotor activity, flight of associations, mystic delusions, and auditory illusions were noted. It was her first psychiatric administration and her complaints were exacerbated 10 days ago. According to her family, the patient, who has no intimate friendship, has been busy with reiki for 4 years. As the level of reiki goes up, the patient, who predicts the increase of the auditory hallucinations as a reward, has tried to heal the patients through the energy and has tried to eat the earth and to throw herself from 3 meters high. For a possible organic etiology, no pathological findings were found in the results of the blood tests and cranial MRI. Haloperidol 20 mg/day, biperidene 4 mg/day quetiapine 100 mg/day was recommended for the patient who was diagnosed as atypical psychosis. Within a week, her complaints were down. The beginning of the psychotic manifestations of our case, such as hearing the voices, may suggest that a mission like healing in this ritual leads the patient to a psychotic life. From another point of view, the fact that the patient's introverted prodromal period may suggest that there is a psychotic pattern with negative symptoms in the beginning, and perhaps the patient may turn to this area for self-medication. It may be appropriate to evaluate Reiki healing technique from the perspective of psychosis in addition to healing activity.
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