A psychotic experience during adolescence: reasoning about differential diagnosis. case report

ABSTRACT CONTEXT: The aim of the present clinical review was to illustrate the diagnostic difficulty associated with psychotic experiences during adolescence, in the light of the multiplicity of circumstances interplaying during this period. It was also intended to illustrate the observation that not all hallucinations occur in the context of a declared psychotic disorder. Case Report: The patient was a 16-year-old adolescent girl who came to the Emergency Department of Coimbra Pediatric Hospital. On admission, she displayed mood and sensory perception disorders, with a bizarre gait abnormality. A diagnosis of conversion disorder was finally suggested, in accordance with the International Classification of Diseases, 10th edition. CONCLUSIONS: Conversive hallucinations are rare in the psychiatric literature. This diagnostic hypothesis only gained consistency over a long period of follow-up within a child and adolescent psychiatry outpatient service, which was fundamental for appropriate diagnostic clarification. The authors discuss psychotic experiences that can arise from a neurotic setting and share the reasoning that was constructed in relation to the differential diagnosis. The psychogenesis and phenomenology of this young patient's conversive hallucinations and the therapeutic strategies adopted over the course of the follow-up are also discussed.

Charles Bonnet syndrome: characteristics of its visual hallucinations and differential diagnosis / Síndrome de Charles Bonnet: características das alucinações visuais e diagnóstico diferencial

Objective: To present an eight-case serie of patients with Charles Bonnet syndrome (CBS). Method: All patients were initially evaluated by an ophthalmologist and then submitted to a neurologic evaluation with exclusion of alternative psychiatric and neurologic diagnoses. Results: Five patients were male (62.5%) and the mean age was 52.3+16.0 years. Two patients suffered from severe myopia and glaucoma, three had retinitis pigmentosa, one had anterior ischemic optic neuropathy, one had age-related macular degeneration and one had toxoplasmic retinochoroiditis. Mean visual acuity in the right eye was 1,12 logMAR and in the left eye 0.57 logMAR. A mean delay of 41.7 months occurred until diagnosis. All hallucinations were complexes and mostly ocurred on a weekly-basis (62.5%) and lasted for seconds (87.5%). Conclusions: Physicians who care for low vision patients should be aware of CBS and appropriately diagnose its hallucinations after exclusion of psychiatric and neurologic diseases. .

Objetivo: Apresentar uma série de oito casos da síndrome de Charles Bonnet (SCB). Método: Todos os pacientes foram avaliados por um oftalmologista e por um neurologista, tendo sido excluídos diagnósticos alternativos neurológicos e psiquiátricos. Resultados: Cinco pacientes eram homens (62,5%) e a média de idade foi de 52,3±16,0 anos. Do total de pacientes: dois tinham miopia grave e glaucoma, três retinose pigmentar, um neuropatia óptica isquêmica anterior, um degeneração macular relacionada à idade e um retinocoroidite toxoplásmica. A acuidade visual média no olho direito foi de 1,12 logMAR e no olho esquerdo foi de 0.57 logMAR. Houve um atraso de 41,7 meses, em média, para o diagnóstico. Todas as alucinações eram complexas, ocorriam, em sua maioria, semanalmente (62,5%) e duravam segundos (87,5%). Conclusão: Médicos que lidam com pacientes com baixa visão devem saber distinguir as características peculiares da SCB, após exclusão de doenças neurológicas e psiquiátricas. .

Auditory hallucinations in tinnitus patients: Emotional relationships and depression

Introduction: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. Aims: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. Method: Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. Results: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. Conclusions: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective...

Eye-related visual hallucinations: Consider ‘Charles Bonnet syndrome’.

The Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.

Síndrome de Charles Bonnet: Manejo con haloperidol en paciente nonagenaria. Caso clínico / Charle Bonnet syndrome: Report of one case managed with haloperidol

Charles Bonnet syndrome is an underrecognized condition characterized by complex visual hallucinations, ocular problems causing visual deterioration and preserved cognitive status. Its prevalence is 5/1000 in ambulatory ophthalmologic patients. Generally occurs in elderly people in whom it may be confused with delirium or dementia. The first management step is to improve vision, if possible. Hallucinations may be managed pharmacologically. We report a 94 year-old woman with the characteristic clinical picture of the syndrome that improved with haloperidol.

Fundamentos y controversias en la diferenciación entre alucinaciones en población clínica y normal / Foundations and controversies in the differentiation of hallucinations in clinical and non-clinical populations

En la actualidad las alucinaciones son un síntoma primordial en Psicopatología. De hecho, cierto tipo de ellas, pueden ser suficientes para el diagnóstico de trastornos graves como la esquizofrenia. Igualmente, pueden estar presentes en diversas entidades como la demencia, depresión, trastornos de personalidad, etc. Sin embargo, a pesar de su relevancia, también presentan una serie de dificultades que tienen que ver tanto con su significado como con la etiología de las mismas. Asimismo, en los últimos años han cobrado gran relevancia los estudios que analizan la continuidad de este tipo de experiencias entre la población sin un diagnóstico psicopatológico y la población clínica. De este modo, el objetivo del presente trabajo va encaminado a determinar cuáles son las principales aportaciones que se han hecho en los últimos años en este terreno y también cuales son los principales problemas y conclusiones que se pueden sacar hasta el momento. Así, cuestiones fundamentales como ¿es escuchar voces patognomónico de un trastorno mental?, ¿tener un síntoma "psicótico" es la antesala a desarrollar un desorden clínico?, ¿las alucinaciones no auditivas siguen el mismo mecanismo que las auditivas?, ¿estamos hablando del mismo fenómeno alucinatorio en pacientes que en no pacientes, es decir, son comparables?, son aspectos centrales en la literatura actual que requieren una revisión.

Nowadays, hallucinations are an essential symptom in Psychopathology. In fact, some kind of them may be sufficient to a serious disorder diagnosis, such as schizophrenia, and may be present in several diseases such as dementia, depression or personality disorders. However, hallucinations present some difficulties related to their meaning and etiology. In recent years, studies analyzing the frequency of hallucinations in populations with no psychopathological diagnosis and in clinical ones have become important. For this reason, the present study aims at determining the principal contributions to this field in the last years, and the main problems and conclusions to date. Among relevant questions in this field requiring a revision, there can be found the following: is hearing voices patognomonic of a mental disorder? is having a psychotic symptom the previous step to a clinical disorder?; do non-auditory hallucination have the same mechanism than the auditory ones?; can the same hallucinatory phenomenon be found in diagnosed and in non-diagnosed people?.

Síndrome de Charles Bonnet: presentación de tres casos y revisión de la literatura / Charles Bonnet syndrome: Report of three cases

Charles Bonnet syndrome is characterized by the presence of visual hallucinations associated with loss of vision. We report three patients aged 74, 84 and 80 years (two women) with a severe loss of vision due to ocular diseases and silent visual hallucinations, that they recognized as unreal. Two patients felt that the hallucinations were ominous. Years later, two suffered a probable Alzheimer's disease (AD). One of them had a mild cognitive impairment when the syndrome appeared, that evolved into an AD with psychosis. This syndrome is not uncommon in older patients with loss of vision and it is probably underdiagnosed. Its pathogenesis is probably a cortical deafferentation. The content of the visual hallucinations (faces, landscaped, and so on) coincides with the activation of different areas of the visual association cortices).

Síndrome de Charles Bonnet: presentación de dos casos / Charles Bonnet syndrome: two cases

En este artículo se presentan dos casos de pacientes con el síndrome de Charles-Bonnet, entidad que tiende a ser subdiagnosticada en el ámbito de la salud, dada su rareza y desconocimiento por parte del personal médico. A partir de estos casos se presentan las características clínicas del síndrome y se brindan pautas para tener en cuenta en la fisiopatología, evaluación clínica, factores de riesgo, diagnóstico diferencial y tratamiento.

In this paper two cases of patients with Charles Bonnet syndrome are presented. This entity tends to be subdiagnosed in the scope of the health, giving to its peculiarity and ignorance on the part of the medical personnel. From these cases the clinical characteristics of the syndrome shows and guidelines offer to consider the physiopathology, clinical evaluation, risk factors, differential diagnosis and treatment.

gentleman with acute onset hallucinations and delusions

Acute psychotic disorders with a remitting course have a long history. The diagnosis of "Brief Psychotic disorder" is based on DSM IV criteria. Relatively low doses of antipsychotic drugs lead to significant symptom amelioration. Generally, brief psychotic disorder has a good prognosis and runs its course in less than a month. A good prognosis is usually associated with sudden onset, short duration of symptoms, and good premorbid adjustment

Determination of scopolamine in the poisoning case by GC/MS / 法医学杂志

OBJECTIVE@#To separate and determine scopolamine from the food in a poisoning case by GC/MS.@*METHODS@#The scopolamine was determined by GC/MS/El used CP5860(CP-sil8CB) column (30 mx 0.25 mmx 0.33 microm) with liquid- liquid extraction.@*RESULTS@#The deny scopolamine was found in the case sample, and the chromatographic separation of the peaks is fine.@*CONCLUSION@#The method is accurate and reliable.

Hallucinations in Parkinson's disease--a study of forty three patients.

OBJECTIVE: To see the prevalence of hallucinations in patients with Parkinson's disease and to compare the various parameters between hallucinators and non-hallucinators. METHODS: Forty-three patients of Parkinson's disease were included. Detailed motor assessment was done with UPDRS scales. Assessment was done for the presence of depression and sleep disturbances. The patients were enquired for the presence of depression and sleep disturbance. The patients were enquired for the presence of hallucinations. Hallucination types and associated emotional experience were probed into. Comparative analysis was subsequently done between hallucinators and non-hallucinators. RESULTS: The mean age of the patients was 61.47 years while mean duration of symptoms of PD was 4.30 years. The mean UPDRS II and III scores were 15.18 and 38, respectively. Fifteen patients (34.9%) had experienced hallucinations. The hallucinations described were visual as well as auditory in nature. Majority of these patients (12 out of 15, 80%) had not volunteered about their hallucinations on their own. On analysis of various parameters between the hallucinators and non-hallucinators, it was observed that hallucinators were older and had a higher mean duration of symptoms of PD. The patients with hallucinations had a higher severity of motor symptoms and signs. Hallucinators more commonly had depression and sleep disturbances. Mean dosage of L-dopa equivalent dose was higher in patients with hallucinations as compared to those without hallucinations. On statistical analysis, however, only two parameters were found to be different in a statistically significant manner. These were the duration of illness and the Hoen and Yahr scale (p < 0.05). Also, hallucinations occurred independent of dopaminergic drugs. CONCLUSION: Hallucinations are common source of distress but are often neglected. One should always probe actively into the presence of hallucinations.

Delírios e alucinações no idoso: demência com corpos de Lewy / Delusions and hallucinations in the elderly: dementia with Lewy bodies

Manifestações psicóticas, tais como delírios e alucinações, säo comuns na velhice, podendo chegar a 6 por cento do total de idosos na comunidade, seja no decurso de estados paranóides tardios ou como sintomas de comportamento nas demências. Entretanto, a definiçäo desses sintomas näo tem seguido a devida diferenciaçäo descrita pela psicopatologia clássica, permitindo assim que confabulações, idéias prevalentes e pseudoðalucinações näo sejam reconhecidas. Esse fato traz como conseqüência dificuldades para o entendimento da história natural desses sintomas durante o curso da doença e problemas na conduta clínica a ser prescrita. Respostas a tratamentos medicamentosos säo esperados para sintomas psicóticos primários, quando em verdade podeðse estar diante de manifestações psicologicamente compreensíveis ou explicáveis por transtornos de consciência e/ou memória. A demência com corpos de Lewy tem dentre os sintomas axiais para o diagnóstico clínico a presença de delírios estruturados e alucinações visuais complexas. No entanto, estas cursam de modo flutuante e o paciente tem alguma crítica, cabendo entäo discussäo quanto à estrutura primária desse vivência. Esta revisäo tem como objetivo apresentar as principais características das alucinações e delírios no idoso, em especial na demência com corpos de Lewy e discutir a psicopatologia e suas implicações para o diagnóstico e tratamento desses sintomas

Drogas ilicitas e esquizofrenia em adolescentes / Use of illicit drugs and schizophrenia in adolescents

Este trabalho trata da investigacao dos registros medicos de todos os adolescentes hospitalizados no Departamento de Psiquiatria infantil e de adolescentes com o diagnostico de esquizofrenia ou psicose esquizoafetiva (DSM-IV) associado ao uso e abuso de drogas ilicitas...

Charles Bonnet syndrome: Review of literature and a report of three cases

The cases of three elderly women with Charles Bonnet Syndrome are reported. Review of the literature includes description of syndrome, its aetiology, management and association with ocular pathology

Ilusiones, alucinaciones: estudio homeopático / Illusions, hallucinations: homeopathic study

Este trabajo nació a partir de las clases programadas para el Curso Anual de Homeopatía "De la teoría a la práctica" a cargo de la Dra. Micaela Moize, en su cátedra de los días martes. La intención de los autores fue realizar un estudio minucioso de la rúbrica ILUSIONES de los Repertorios de Barthel, de Schroyens y del Nuevo Repertorio de Kent de Eizayaga, para hacer una organización más fácil en la búsqueda en dichos síntomas. Primeramente, presentamos una suscinta definición de Sensopercepción, Ilusiones y Alucinaciones; luego agrupamos los síntomas de acuerdo a sus características, haciendo una breve descripción de cada grupo con sus ejemplos. Las sub-rúbricas que ofrecieron dudas en cuanto a su ubicación, fueron estudiadas en la Materia Médica. Finalmente, este artículo es la introducción al trabajo donde hemos reagrupado la rúbrica ILUSIONES con todas sus modalidades siguiendo nuestro esquema referencial

Diferencial psicopatológico das síndromes delirantes/alucinatórias orgânicas e esquizofrenia: uma revisäo crítica / Psychopathological differentiation of organic delusion and hallucinatory syndromes and its overlap with schizophrenia

O autor realizou um levantamento bibliográfico das principais publicaçöes sobre síndromes esquizofreniformes orgânicas e sua superposiçäo aparente com a esquizofrenia. Tomando como ponto de partida essa dificuldade que a literatura tem mostrado de distinçäo das duas síndromes, empreendeu uma investigaçäo psicopatológica onde procurou-se uma aproximaçäo entre o saber clássico e os modelos mais recentes, derivados da neuropsicologia de Luria e do trabalho de pesquisadores ingleses e americanos. Demonstra-se que a síntese de diversas áreas de conhecimento podem aperfeiçoar os instrumentos diagnósticos e de pesquisa nessa área

Síndrome de Charles Bonnet / Charles Bonnet Syndrome

O presente trabalho apresenta uma síndrome onde encontram-se associadas perda e alucinaçöes visuais. Tal síndrome ocorre mais frequentemete em indivíduos idosos e com estado mental preservado. Os autores revisam 17 casos discutindo os mecanismos aluninogênicos envolvidos e características diagnósticos sugestivas. Ressaltam a necessidade de considerá-la como parte do diagnóstico diferencial com doenças psiquiátricas e orgânicas manifestadas por alucinaçöes visuais

Alucinações auditivas musicais no idoso: relato de caso / Musical auditory hallucinations in elderly: case report

Os autores relatam um caso de alucinações auditivas musicais em paciente idosa. Fazem análise e discussão de várias hipóteses diagnósticas. Hipoacusia e depressão são apontadas como fatores de risco