Othello Syndrome After Cerebrovascular Infarction

Rocha, Sofia; Pinho, João; Ferreira, Carla; Machado, Álvaro

doi:10.1176/appi.neuropsych.12120408

Cited by 9 publications

(9 citation statements)

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“…For some patients, psychoses are transient and resolves either spontaneously or with the temporary use of antipsychotics and is due to the reduced impact of the lesion by resolution of edema and inflammation. Other patients develop persistent psychotic symptoms and require continual treatment . Here, antipsychotics are the mainstay of pharmacotherapy as there is no evidence that other forms of medication are effective in this condition .…”

Section: Treatmentmentioning

confidence: 99%

“…Nevertheless, the evidence which has accumulated from these detailed case descriptions shows that delusions mainly arise following right cerebral hemisphere damage. For example, of 16 published reports, which included 30 patients, 23 had unilateral right hemisphere lesions [8][9][10][11][12][13][14][15][16][17][18][19] compared to 7 with bilateral or left-sided hemisphere lesions or lesions elsewhere in the brain. [19][20][21][22] Collectively, these case reports also suggest that delusions can arise following right hemisphere damage as a new event without a premorbid history of psychosis and without altered consciousness, as in delirium, or intellectual impairment, as in dementia.…”

Section: P Os Ts Trok E Psychos Ismentioning

confidence: 99%

“…Psychosis can arise within the first few days following a stroke 13,15,16,20 or there may be a delayed onset of weeks or months. 13,16,18,22 For some patients, psychoses are transient and resolves either spontaneously or with the temporary use of antipsychotics 13,16,17,20,23 and is due to the reduced impact of the lesion by resolution of edema and inflammation. Other patients develop persistent psychotic symptoms and require continual treatment.…”

Section: Tre Atmentmentioning

confidence: 99%

“…Other patients develop persistent psychotic symptoms and require continual treatment. [16][17][18]27 Here, antipsychotics are the mainstay of pharmacotherapy as there is no evidence that other forms of medication are effective in this condition. 7 Thus, the management of poststroke psychosis is the same as that for the primary psychoses and likely reflects their common etiology.…”

Section: Tre Atmentmentioning

confidence: 99%

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Organic psychosis: The pathobiology and treatment of delusions

Joyce

2018

CNS Neurosci Ther

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Organic or secondary psychosis can be seen in diverse conditions such as toxic/metabolic disorders, neurodegenerative disease, and stroke. Poststroke psychosis is a rare phenomenon, but its study has significantly contributed to the understanding of delusion formation. The evidence from case studies of patients with focal strokes shows that delusions develop following unilateral damage of the right hemisphere. The majority of patients with right hemisphere stroke do not develop delusions however, and advanced neuroimaging analysis has elucidated why this symptom develops in only a small proportion. Lesions of the right lateral prefrontal cortex or lesions with connectivity to this area correlate with delusional beliefs in this subgroup. Studies of patients with primary psychosis, for example schizophrenia, or under the influence of the psychotogenic drug ketamine, also show abnormal function of this area in relation to the severity of their abnormal beliefs. The conclusion of these studies is that the right lateral prefrontal cortex is 1 hub in a neural network which includes the basal ganglia and limbic system and receives inputs from midbrain dopamine neurones. In patients with schizophrenia, or at risk of psychosis, dopamine is dysregulated and evidence suggests that faulty dopamine signaling is the precursor of delusion formation. It is therefore likely that the mechanism of delusion formation is the same in both primary and secondary psychosis. This is consistent with the mainstay of treatment of both conditions being antipsychotic medication. However, antipsychotic medication in people with cerebrovascular disease should be avoided if at all possible. This is because epidemiological studies have found that antipsychotic use is associated with an increased risk of stroke and will thus compound the possibility of a further cerebrovascular accident.

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Section: Treatmentmentioning

confidence: 99%

Section: P Os Ts Trok E Psychos Ismentioning

confidence: 99%

Section: Tre Atmentmentioning

confidence: 99%

Section: Tre Atmentmentioning

confidence: 99%

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Organic psychosis: The pathobiology and treatment of delusions

Joyce

2018

CNS Neurosci Ther

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“…3 With relation to jealous delusions, there is no specific location, but some areas do seem to be associated, including the frontal, posterior parietal, striatal, and thalamic regions. 4 Recent studies suggest that positive symptoms are related to a reduction in cognitive inhibition and left hemisphere overactivity after loss of right-sided influences. 3,5 Additionally, involvement of the right inferior frontal lobe and superior longitudinal fasciculus seems to be a risk factor for development of psychosis, possibly because it causes impaired anatomical connectivity, potentiating symptom-associated neural overactivity within the disconnected cortex.…”

Section: Case Descriptionmentioning

confidence: 99%

Post-stroke psychosis: how long should we treat?

Ferreira

Machado

Santos

et al. 2017

Trends Psychiatry Psychother.

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Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset. Keywords: Psychosis, stroke, antipsychotic treatment. ResumoObjetivo: Descrever o caso raro de um paciente que desenvolveu sintomas psicóticos após um acidente vascular cerebral (AVC) no nível do hemisfério direito que remitiram com tratamento antipsicótico, mas parece precisar de uma terapêutica de manutenção com antipsicótico em baixa dosagem. Descrição de caso: Um homem de 65 anos apresentou-se no serviço de urgência psiquiátrica por um quadro persistente de delírio de ciúmes, ilusões visuais e agitação com início cerca de 1 mês após AVC isquêmico no nível da artéria cerebral posterior direita. Esses sintomas só desapareceram com doses terapêuticas de antipsicótico (risperidona 3 mg/dia). Após 2 anos de seguimento, o paciente não mais apresentava atividade delirante, e o tratamento antipsicótico foi progressivamente descontinuado durante o ano seguinte. No entanto, 1 semana após a suspensão total, o paciente começou a ficar agitado e desconfiado, tendo-se reiniciado a risperidona 0,25 mg/dia, com rápida remissão clínica. O paciente está medicado com esta baixa dose de antipsicótico há um ano, permanecendo psicopatologicamente compensado e sem sintomas psicóticos. Comentários: A psicose é uma complicação relativamente rara após AVC. Segundo nosso conhecimento, não há casos descritos até ao momento de psicose após AVC que, aparentemente, requerem uma dose baixa contínua de antipsicótico. Nosso caso sugere que uma terapêutica de manutenção com antipsicótico em baixa dosagem pode ser necessária para determinados pacientes com psicose após AVC, especialmente para aqueles com fatores de risco e iní...

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