Bilateral Basal Ganglia Calcifications Manifesting as Psychosis With Manic Features: A Case Report on Fahr's Syndrome.

Fahr's syndrome is a rare neurodegenerative disorder characterized by symmetric bilateral calcifications in the basal ganglia. While this is largely a hereditary disease with autosomal dominant inheritance, a small percentage is sporadic in nature with no metabolic or other underlying causes identified. Fahr's syndrome has both neurological and psychiatric manifestations that include movement abnormalities, seizures, psychosis, and depression. Approximately 40% of patients with basal ganglia calcification present with psychiatric symptoms including mania, apathy, or psychosis. We present a case of a 50-year-old woman with no previous medical or psychiatric history who presented with an altered mental status that progressed to psychosis over three years. On one admission, the patient was found to have elevated liver enzymes and a positive antinuclear antibody panel but was without electrolyte abnormalities or movement disturbances. The patient was subsequently diagnosed with unspecified psychosis in the emergency department, which was later revised to Fahr's syndrome confirmed by neuroimaging. This report discusses her presentation, clinical symptoms, and management of Fahr's syndrome. Above all, it underscores the importance of complete workup and adequate follow-up of middle-aged and elderly patients with cognitive and behavioral disturbances, as Fahr's syndrome can be elusive in the early stages.

Traumatic Brain Injury Induced Secondary Psychosis in a Young African American Male.

Traumatic brain injury (TBI) is an intricate process in which the chemical balance and physical structure of the brain are altered. This medical condition's effects range from altered mental status to an irreversible comatose state, and in severe cases even death. TBI affects millions of individuals worldwide on an annual basis. In the United States, approximately 2.87 million TBI-related emergency department (ED) visits were reported in 2014, and nearly 43% of these cases will experience long-term disabilities. These disabilities have both short- and long-term consequences on health, ranging from physical, emotional, and psychosocial changes in an individual. The goal of this case report is to highlight the morbidity of patients with TBI, with a key focus on TBI-induced secondary psychosis. While many patients recover from their symptoms of TBI within weeks to months, a subdivision of patients with TBI has permanent damage that will significantly affect the quality of their daily lives. TBI-induced secondary psychosis is the new onset of psychosis that can comprise visual, auditory, and tactile hallucinations, delusions, and disorganized thoughts. In this case report, the patient is a 22-year-old African American male who suffered a TBI at the age of 16. Prior to the patient's TBI sustained in 2016, the patient did not have a hospital record of past psychiatric illness. In addition, the patient's family history did not show evidence of schizophrenia, bipolar, or depression in close or distant relatives. The patient presented to the ED for a psychiatric evaluation due to psychotic behavior. In this case report, we will discuss the pathogenesis, clinical presentation, and other secondary causes of TBI-induced secondary psychosis.

Psychotherapeutic and adjunctive pharmacologic approaches to treating posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a potentially disabling illness that affects millions of people worldwide and can be very difficult to treat, especially the sleep disturbances often associated with this disorder. Successful treatment focuses on psychotherapy, and medications may be useful adjuncts. This article gives examples of successful therapeutic approaches and adjunctive medication use in PTSD.