Introduction
We present the case of a 22-year-old patient who has been followed up in a daytime hospital for personality disorders since June 2022. Of note is the presence of multiple personalities ...(in total of more than 20 have been identified), each of which has distinct physical and psychological characteristics.
Objectives
The objective is to present a clinical case of dissociative identity disorder and to review the existence of scientific evidence supporting this diagnosis.
Methods
Literature review of scientific papers over the last years and classic textbooks on the issue. We included references in English and Spanish languages.
Results
Numerous studies support that dissociative disorders are the result of psychological traumas that generally begin in childhood. This is a difficult category to diagnose, since they present symptoms that also appear in other disorders such as those of the schizophrenic spectrum.
One or more dissociative parts of the subject’s personality avoid the traumatic memories while others become fixed to these traumatic experiences and manifest symptoms. In the case of our patient, there are dissociative episodes with subsequent amnesia and auditory, visual and olfactory hallucinations, as well as impulsive behaviors in the form of self-injury and a flattened affect, with significant emotional distancing.
Conclusions
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The prevalence of dissociative identity disorder is higher than traditionally thought.
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Some theories develop how trauma essentially produces a degree of dissociation of the psychobiological systems that constitute the subject’s personality.
Disclosure of Interest
None Declared
IntroductionWe present the case of a 78-year-old man with multiple somatic pathologies and associated depressive symptoms, under treatment with Citalopram 10mg, who was admitted due to cholangitis ...secondary to biliary prosthetic obstruction.Empirical antibiotic treatment with Meropenem and Linezolid was started, along with an increase in the dose of Citalopram to 20mg due to mood worsening. The patient begins with symptoms consisting of complex and polymorphic visual hallucinosis, without any affective or behavioral repercussions. He does not present another semiology of the psychotic sphere.ObjectivesTo highlight the importance of knowing the different interactions and adverse effects of drugs for good clinical management.MethodsWe collected the complete medical history of our patient and we carried out a review of the interactions and adverse effects described with the antibiotic drug Linezolid.ResultsAs the onset of hallucinations was temporarily correlated with the use of medications, drug-induced hallucinations were suspected, resolving completely after 2 days after withdrawal of Linezolid treatment.Linezolid is a nonselective inhibitor of MAO A and B, preventing the destruction of monoamine neurotransmitters like serotonin, dopamine, or norepinephrine. It has dopaminergic properties that may enhance the central nervous system effects of anticholinergics and co-prescription with serotonergic drugs increases the risk of serotonin syndrome.ConclusionsThis case highlights the importance of taking into account drug interactions and adverse effects to reduce the risk of drug induced symptoms and optimize their management.The increase in resistance to antibiotic treatment allows us to anticipate that the use of Linezolid will increase in the coming years, and it is important to know its mechanism of action given the interactions with psychotropic drugs that we use in our usual clinical practiceDisclosure of InterestNone Declared
Wernicke Encephalopathy: A case report Jiménez Cabañas, M.; Ruiz Guerrero, F.; Bermejo Pastor, A. ...
European psychiatry,
06/2022, Letnik:
65, Številka:
S1
Journal Article
Recenzirano
Odprti dostop
Introduction
We report a case of a 56-year old woman with a history of depressive disorder between 2012 and 2017 achieving full remission after treatment with antidepressants and anxiolytics. In the ...year 2021 was presented to the emergency department manifesting alteration of behavioral patterns, ataxia, mental confusion and horizontal nystagmus. A chronic alcohol abuse was also discovered while interviewing. She also exhibited low mood, anterograde amnesia and confabulations that improved rapidly after following treatment with thiamine.
Objectives
Reviewing clinical manifestations and treatment of Wernicke encephalopathy and the development of Korsakoff syndrome.
Methods
We systematically reviewed articles using PubMed.
Results
Wernicke encephalopathy is a well-known complication of thiamine deficiency, mostly associated with alcohol use disorder. Classically, the syndrome comprises changes in mental status, gait ataxia and ophthalmoplegia. However, the full triad has been described in only 10-17 % of cases, which in our the case is report. After the diagnosis was established and was treated with thiamine, a rapid improvement in the patient´s clinical status was observed. Cognitive impairment was later identified, taking into account the possibility of a Korsakoff syndrome characterized by irreversible brain damage and subsequent loss of anterograde memory. In our patient, this specific diagnosis was dismissed due to the clinical improvement after thiamine treatment.
Conclusions
It is relevant to emphasize the importance of a precise diagnosis and treatment of patients with Wernicke Encephalopathy to avoid the development of a Korsakoff syndrome.
Disclosure
No significant relationships.
Introduction
We present a 9-year-old girl with celiac disease who attends a Health Center referred by her pediatrician for rituals. Her mother describes rituals from early childhood that have been ...intensified by the death of her grandmother from pancreatic cancer. Since then, thoughts of gluten contamination and behaviors aimed at avoiding such contamination have increased. For example, not using the common household towel and not eating until all the guests have washed their hands. If the patient does not carry out these actions, she presents significant discomfort, crying and screaming until it is done. In addition, such behaviors take up a significant amount of time.
Objectives
To review the literature of Obsessive-Compulsive Disorder (OCD) in children.
Methods
Literature review of scientific articles searching in Pubmed. We considered articles in English and Spanish.
Results
Cognitive Behavioral Therapy and Sertraline up to 50mg were started. After several weeks the frequency of behaviors aimed at avoiding gluten contamination begins to decrease; as well as the anguish if these are not carried out.
Conclusions
OCD in childhood can present characteristics that differentiate it from OCD in adulthood, such as difficulty detecting obsessions and that children do not usually consider thoughts as unreal or excessive. Therefore, it is a real challenge, having to carry out an adequate differential diagnosis with other entities such as specific phobias, for adequate subsequent management.
Disclosure
No significant relationships.
Introduction
Up to 50% of patients with brain tumors experience psychiatric symptoms, and rates up to 80% have been reported in malignant neoplasms such as glioblastoma multiforme (GBM). Still, ...clinical presentation as mania-like syndromes is a rare phenomenon, mainly occurring when frontal structures are compromised.
We present the case of a 42-year-old woman who was admitted to our hospital due to manic symptoms coinciding with a recurrence of a bifrontal GBM, for which she underwent surgery 5 months prior.
Objectives
1) To describe the clinical particularities of this case, focusing on the differential diagnosis.
2) To review the association between manic symptoms and frontal dysfunction caused by brain tumors, with special interest on GBM.
Methods
A review of the patient’s clinical history and complementary tests performed was carried out. Likewise, we reviewed the available literature in relation to manic symptoms related to brain tumors.
Results
The patient’s GBM recurrence presented with late onset symptoms of mania, including euphoric mood, increased spending, ideas of grandiosity and hyper-religiosity. She had no previous psychiatric history but, interestingly, she had an extensive affective burden in her family, with 4 consummated suicides. However, she also presented other clinical signs, such as disorientation, perseveration, mild memory impairment and stereotyped motor behaviors, that pointed to relevant frontal lobe dysfunction, suggesting Moria as a possible contribution for the symptoms described.
Manic symptoms in the context of brain tumors appear in 7-15% of patients with psychiatric symptoms, usually associated with right frontal dysfunction (75% of cases). Bifrontal affectation, such as this patient, is only described in 6% of cases. Although fast growing, malignant tumors have been associated with higher rates of psychiatric symptoms, no correlation has been described between these and brain tumor histology.
Conclusions
- The presence of atypical manic symptoms, such as those presented in this case, should raise clinical concern for secondary mania.
- Moria shares similarities with mania, including mood elevation, tendency to hilarity or hyper-sexuality, that may hinder diagnosis of patients with frontal dysfunction.
- This case outlines the difficulties in making a differential diagnosis in patient with both manic and neurological signs, and highlights the implication of frontal structures in the development of manic symptoms.
Disclosure of Interest
None Declared
Introduction
We present the case of a 49-year-old woman who was diagnosed with multiple sclerosis at the age of 19 and suffers from an affective disorder that has been evolving for years. This ...condition, for which she has been followed by psychiatry and psychology for more than ten years, consists of alternating periods of hypomania lasting weeks and phases in which frank depressive symptomatology predominates, with no phases of euthymia in between and with a predominance of severe deterioration of her functionality at both poles.
Objectives
(1) We will review the term cyclothymia and explore the concept of “cyclothymic temperament” advocated by some authors, in order to be able to understand the dimension of the present case and reformulate its approach.
(2) The relationship between multiple sclerosis and bipolar spectrum disorders will be covered, reviewing the current knowledge in this regard and relating it to the patient’s symptomatology.
Methods
A review of the patient’s clinical history will be carried out, taking into account her life history, the complementary tests performed as well as the multiple therapeutic approaches tried over the last few years.
Likewise, a bibliographic review of the available scientific literature will be carried out in relation to the diagnosis of cyclothymia or bipolar disorder type II, the controversial term “cyclothymic temperament”, and the relationship that these diagnoses have with the diagnosis of Multiple Sclerosis.
Results
(1) Our patient could fit into what many authors define as a cyclothymic temperament, fulfilling, in certain episodes, the criteria that the manuals propose for bipolar disorder type II.
(2) 2.1
The prevalence of bipolar affective disorder in MS is approximately twice as high as in the general population (rates of 0.3-2.4%).
2.2
Patients with MS have higher scores in cyclothymic and hyperthymic temperament than the control group.
2.3
Certain drugs generally used in BD also seem to have a beneficial effect on MS.
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Conclusions
The reformulation of the concept of cyclothymia would allow us to recognize in our patient a basic temperament of long evolution that would be the substrate on which different factors have subsequently influenced, such as antidepressant drugs or multiple sclerosis. In addition, it is necessary to know the association between BD and MS, in order to be able to offer an adequate treatment, contemplating some pharmacological options such as Lithium or some Atypical Antipsychotics, given the beneficial effect both for the affective disorder and for the neurological process.
Disclosure of Interest
None Declared
Introduction
Withdrawal symptoms are common upon discontinuation of many psychotropic drugs. Catatonia, a neuropsychiatric condition characterized by a number of motor, behavioral, emotional, and ...autonomic abnormalities, has been described as a withdrawal syndrome in a growing number of case reports, but it is not well recognized. Treatment of catatonia usually includes benzodiazepines and electroconvulsive therapy. Standard consensus states that the use of neuroleptics should be avoided, as they are thought to worsen catatonia.
Objectives
With this case report, we attempt to contribute to the finding in literature that the withdrawal of clozapine may be associated with catatonia, and how reintroduction of clozapine could be indicated for its treatment.
Methods
A clinical case is presented of a 37-year-old female with a history of schizophrenia, presenting with altered mental status and new onset of catatonic signs and symptoms in the setting of a 7-day emetic syndrome. The possibility that vomiting prevented proper absorption of clozapine is postulated, causing the patient to present clinical features compatible with malignant catatonia.
Results
The patient required treatment with benzodiazepines, electroconvulsive therapy and clozapine re-initiation, leading to improvement of catatonic symptoms within a few days.
Conclusions
This case serves as a reminder to consider alternative diagnostic hypotheses in cases of catatonic syndrome unresponsive to standard treatments. When the clinical suspicion of drug withdrawal is high, restarting the discontinued medication, even an antipsychotic agent, may be indicated.
Disclosure
No significant relationships.
Introduction
We present the case of a 36-year-old male with depressive states, impulsive traits and fits of anger (including episodes of self and heteroagressiveness) since early childhood, in the ...context of traumatic family history and the beginning of an epileptic disease. These symptoms have been maintained over the years, in addition to other variable and recurrent symptoms, such as severe anxiety, somatizations or serious depressive symptoms.
Objectives
To highlight the possible influence of epilepsy in the course of mental illnesses, especially depression, as well as the increased difficulty in management.
Methods
We collected the complete medical history of a patient with an important history of mental health in addition to epileptic disease since childhood and we carried out a review of the comorbidity between these diseases and their treatment.
Results
The epileptic disease of our patient may have influenced the behavioural alterations and the depressive symptoms since childhood, as well as the personality traits with aggressiveness and impulsiveness. There is an added difficulty in treating this case given the possible interactions between antiepileptic and antidepressant medications.
Conclusions
This case highlights the importance of taking into account the influence of this comorbidity on the prognosis of patients. Knowing the interactions and side effects of drugs is essential for good clinical management.
Disclosure
No significant relationships.
Introduction
Wernicke Encephalopathy (WE) is the best characterized neurological complication of thiamine deficiency. Its clinical presentation can be diverse, including hallucinatory or delusional ...symptoms, and not necessarily associated with the classical triad of WE. This correlates with higher rates of under diagnosis. We present the case of a 72-year-old man with a history of alcoholism who was admitted to the hospital due to behavioural disturbances and subacute delusional ideas of harm.
Objectives
To review the epidemiology and clinical features of WE, as well as its clinical management.
Methods
Review of the literature on WE clinical presentation and management, focusing on psychopathological symptoms, applying the information to this specific case.
Results
Classical triad of WE is only to be found in 10-17% of patients. The most common clinical presentation is changes in mental state (82%), varying from subtle changes in memory, apathy, subtle disorientation or indifference to more severe presentations such as delirium, stupor or coma. Other frequent symptoms include oculomotor dysfunction and gait ataxia. High dose thiamine supplementation therapy has proven effective in preventing clinical progression and permanent neurological damage.
Conclusions
- WE is the most prevalent complication of thiamine deficiency, being associated to alcoholism in 50% of cases. - Changes in mental state is the most frequent form of clinical presentation, not necessarily associated with the classical triad of WE. - WE is a medical emergency that requires high dose thiamine supplementation therapy to prevent permanent neurological damage.
Disclosure
No significant relationships.
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