P-450 - Inaugural psychiatric presentation of sporadic Creutzfeldt-Jacob disease: case report

Abstract

The case of a 72-year-old male patient with initial depressive symptoms and visual hallucinations, added to a progressive motor and cognitive neurological impairment, is presented. The patient died of pneumonia 7 weeks after the onset of the symptoms; the necropsy confirmed the diagnosis of Creutzfeldt-Jacob disease (CJD) suggested previously by complementary diagnostic tests (brain magnetic resonance imaging, electroencephalogram, 14-3-3 protein determination in the cerebrospinal fluid and study of the prionic protein gene). Discussion: CJD is a rare dementia characterized by a rapidly progressive course. Psychiatric symptoms, including depression and personality change, occur early in the clinical course in about a third of patients, being estimated in some studies that 10% of patients are first admitted to psychiatric wards. Psychiatric symptoms associated with CJD have often lead to erroneous initial diagnoses of functional psychosis, depressive pseudodementia, or hysteria. Analysis of the psychiatric symptoms does not suggest specific features that rapidly allow the differentiation from more common psychiatric disorders, although the occurrence of associated persistent sensory symptoms may raise the possibility of this diagnosis. Later, the characteristic rapidly progressive neurological impairment is decisive in the affirmation of the diagnosis of CJD.