Undiagnosed normal pressure hydrocephalus as a cause of diagnostic difficulties in a patient with depression.

Normal pressure hydrocephalus is characterized by gait disturbance, urinary incontinence, cognitive impairment, and the finding of ventriculomegaly in imaging studies. It is one of the causes of potentially reversible dementia. The authors present the case of a patient with depression complicated by hydrocephalus. The combination of symptoms led to a delay in proper diagnosis and treatment.

[Psychotic disorders related with chronic use of mephedrone. Case report]. / Zaburzenia psychotyczne zwiazane z przewleklym przyjmowaniem mefedronu. Opis przypadku.

AIM: The aim of the study was to present the case of a patient with psychotic disorders, o most probably connected with persistent mephedrone use. METHOD: The analysis of the clinical case and medical documentation. RESULTS: The presented patient had used mephedrone regularly (few times a week) for four months. Because of delusions of reference, delusions of persecution, agitation and anxiety, she required psychiatric hospitalisation. During the first hospitalisation she denied using legal highs, she was diagnosed as having schizophrenia and treated with olanzapine. After discharge, she didn't stop to use legal highs and psychotic symptoms occurred once again. The patient needed another hospitalisation. Despite the fact that antipsychotic treatment wasn't administered, the symptoms resolved. Nevertheless, somnolence, apathy and social isolation were observed. CONCLUSIONS: Recently legal highs are very popular, especially among adolescents and young adults. That is the reason why physicians have become more anxious because there is little information about their contents. In most of them, synthetic or botanical substances are included. In clinical practice not only somatic but also psychiatric complications connected with legal high use are observed. It is difficult to verify why this patient developed psychotic symptoms after recurrent intoxication. It is possible that she has an individual predisposition to develop psychosis. In this case, we have no information about previous features of ultra high risk state in this patient.

[Delusion of sex change and body dysmorphic disorder in clinical picture of paranoid schizophrenia--case reports]. / Urojenia zmiany plci i dysmorfofobia w obrazie klinicznym schizofrenii paranoidalnej--opisy przypadków.

AIM: The aim of the paper was to present the basic data about delusions of sex change and body dysmorphic disorder and describe two cases of patients with these symptoms and paranoid schizophrenia. METHOD: Analysis of the course of illness and medical documentation. RESULTS: Coexisting of transsexualism and schizophrenia cause a lot of doubt. Moreover, delusions of sex change are probably more frequent than it is thought. It causes that in some cases the differential diagnosis of psychosis and gender identity disorders may be very difficult. Treatment of transsexuals is on one hand connected with expected effects but on the other hand with many serious, often irreversible health consequences. That is why the differential diagnosis of transsexualism and schizophrenia should be made carefully and thoughtfully. Body dysmorphic disorder can appear as nonpsychotic or psychotic disorder. The delusional variant can cause diagnostic and therapeutical problems as well as diagnostic mistakes. Sometimes people suffering from this disorder can be diagnosed as having schizophrenia. It usually takes place when psychotic symptoms, obsessions and compulsive activities connected with hiding of the imaginary look problem significantly distort everyday functioning. CONCLUSIONS: Rare, atypical psychopathological symptoms can coexist with schizophrenia. In this situation it is necessary to act carefully and precisely to make a proper diagnosis.

[Transsexualism or delusions of sex change? Avoiding misdiagnosis]. / Transseksualizm czy urojenia zmiany plci? Uniknac blednej diagnozy.

The aim of this paper was to present basic data about gender identity disorders and psychotic transsexual desires. From time to time in scientific literature there are descriptions of a diagnosis of psychotic disorders in persons previously diagnosed and treated as transsexuals, in whom the transsexual thinking disappears after using antipsychotic agents. Coexistence of transsexualism and schizophrenia causes a lot of doubt--it is observed in scientists opinions but also in the diagnostic criteria of DSM-IV and ICD-10. Moreover, delusions of sex change are probably more frequent than it is thought. It causes, that in some cases the differential diagnosis of psychosis and gender identity disorders may be very difficult. Transsexuals treatment is on one hand connected with expected effects but on the other hand with many serious, often irreversible health consequences (e.g. cardiovascular disease, risk of neoplasma development, infertility, consequences of surgical sex reassignment). That is why the differential diagnosis of transsexualism and schizophrenia should be made carefully and thoughtfully.

[Olfactory dysfunctions in patients with schizophrenia]. / Dysfunkcje wechowe u chorych na schizofrenie.

Olfactory dysfunctions in patients with schizophrenia are becoming the aim of an increased number of studies. Smell identification deficits are well known but also other olfactory processes are examined, eg. sensitivity, discrimination, familiarity and edibility. Smell identification deficits are present in patients with schizophrenia and also in their non-psychotic siblings. Moreover, this dysfunction was reported in a group of children and adolescents with psychosis. Patients have also neuroanatomical abnormalites in brains structures linked with olfaction, e.g. olfactory bulb. Probably, there is no relationship between pathology of olfactory mucosa and olfactory dysfunction. However, correlation between smoking, neuroleptic treatment and olfactory deficits was not found, but it is unclear what is the role of long-term pharmacotherapy. There is a relationship between negative symptoms, IQ and olfactory processing. Smell identification deficits are not specific for schizophrenia. This disorder is well described in Alzheimer's disease. It is possible that olfactory deficits in schizophrenia are induced by pathology in cortical or subcortical regions which cannot be detected in neuropsychological tests. Currently it is difficult to use olfactory deficits as endophenotypical markers of schizophrenia, and further studies are necessary.