ABSTRACT
Adult-onset Still's disease (AOSD) is an uncommon inflammatory condition characterised by a triad of fevers, arthralgias and a salmon-coloured rash. It is also strongly associated with high ferritin levels, whose role in its pathogenesis is not entirely clear. Central nervous system (CNS) manifestations are exceedingly rare in this disease, accounting for only a handful of reported cases. Herein, we describe a case of a 63-year-old woman who developed new-onset psychiatric symptoms in the months preceding her diagnosis. 2 months after her diagnosis, she experienced an exacerbation of psychiatric symptoms followed by new-onset seizures in conjunction with an acute lung infection. In addition, we discuss two other previously reported cases of AOSD patients with psychiatric symptoms as their initial presentation.
Subject(s)
Aggression , Mania/immunology , Paranoid Behavior/immunology , Seizures/immunology , Still's Disease, Adult-Onset/diagnosis , Anticonvulsants/administration & dosage , Arthralgia/immunology , Diagnosis, Differential , Electroencephalography , Female , Fever/immunology , Glucocorticoids/therapeutic use , Humans , Levetiracetam/administration & dosage , Lorazepam/administration & dosage , Mania/diagnosis , Mania/drug therapy , Methotrexate/therapeutic use , Middle Aged , Paranoid Behavior/diagnosis , Paranoid Behavior/drug therapy , Seizures/drug therapy , Still's Disease, Adult-Onset/complications , Still's Disease, Adult-Onset/drug therapy , Still's Disease, Adult-Onset/immunology , Treatment OutcomeSubject(s)
Coronavirus Infections/psychology , Hallucinations/psychology , Paranoid Behavior/psychology , Pneumonia, Viral/psychology , Psychotic Disorders/psychology , Adult , Antipsychotic Agents/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/immunology , Cytokine Release Syndrome/immunology , Female , Hallucinations/drug therapy , Hallucinations/immunology , Humans , Male , Pandemics , Panic Disorder/psychology , Paranoid Behavior/drug therapy , Paranoid Behavior/etiology , Paranoid Behavior/immunology , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , Psychotic Disorders/immunology , SARS-CoV-2Subject(s)
Diaphragm/physiopathology , Paranoid Behavior/drug therapy , Pimozide/adverse effects , Substance Withdrawal Syndrome/etiology , Tardive Dyskinesia/chemically induced , Tremor/chemically induced , Aged , Antipsychotic Agents , Female , Humans , Substance Withdrawal Syndrome/physiopathology , Tardive Dyskinesia/physiopathology , Tremor/physiopathologyABSTRACT
Intra-articular administration of corticosteroids is a commonly used treatment for osteoarthritis as well as other inflammatory disorders of the joints. It is well known that delirium and psychosis can arise following the administration of oral corticosteroids but there are few documented cases of the development of acute hyperactive delirium with psychosis following intra-articular administration. We describe a case of an 82-year-old female patient with moderate dementia who developed a delirium with psychosis which responded well to a first-generation antipsychotic.
Subject(s)
Anti-Inflammatory Agents/adverse effects , Delirium/chemically induced , Methylprednisolone/analogs & derivatives , Psychoses, Substance-Induced/etiology , Aged, 80 and over , Anti-Inflammatory Agents/administration & dosage , Antipsychotic Agents/therapeutic use , Delirium/drug therapy , Female , Humans , Injections, Intra-Articular , Methylprednisolone/administration & dosage , Methylprednisolone/adverse effects , Methylprednisolone Acetate , Paranoid Behavior/chemically induced , Paranoid Behavior/drug therapy , Psychoses, Substance-Induced/drug therapyABSTRACT
BACKGROUND: Previous studies suggested that alterations in serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. Imbalance in serum cortisol and DHEA-S levels may be related to responsivity to antipsychotic treatment. AIM: To compare serum cortisol and DHEA-S levels between patients with schizophrenia and healthy controls and to evaluate their association with psychopathology in schizophrenic patients with different response to antipsychotic treatment. MATERIAL AND METHODS: This clinical prospective study included 60 patients with schizophrenia and 40 healthy age and sex matched controls. All patients experienced an acute exacerbation of the illness (PANSS: P1 and P3 ≥ 4). Clinical evaluation of patients was performed using the Positive and Negative Symptom Scale. A questionnaire for socio-demographic and clinical data collection was used. For the purposes of the study, the examined group was divided in two subgroups: responders and nonresponders. Serum cortisol and DHEA-S levels were measuredat baseline in all participants and after 3 and 6 weeks of the antipsychotic treatment in patients with schizophrenia. RESULTS: Patients with schizophrenia had significantly higher serum cortisol and DHEA-S levels comparedwith control group. Responders had significantly higher serum cortisol and DHEA-S levels compared with nonresponders. Responders group had significant correlation between serum cortisol and PANSS positive scale score as well as between hostility and serum DHEA-S. CONCLUSION: Elevated serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. Serum cortisol and DHEA-S are associated with psychopathology in schizophrenic patients with different response to antipsychotic therapy.
Subject(s)
Antipsychotic Agents/therapeutic use , Dehydroepiandrosterone Sulfate/blood , Hydrocortisone/blood , Schizophrenia/blood , Schizophrenia/drug therapy , Schizophrenic Psychology , Case-Control Studies , Delusions/drug therapy , Delusions/psychology , Hallucinations/drug therapy , Hallucinations/psychology , Hostility , Humans , Paranoid Behavior/drug therapy , Paranoid Behavior/psychology , Prognosis , Prospective Studies , Treatment OutcomeSubject(s)
Humans , Male , Adult , Prisons/methods , Prisons/organization & administration , Prisons , Substance-Related Disorders/complications , Marijuana Abuse/complications , Marijuana Abuse/diagnosis , Borderline Personality Disorder/complications , Borderline Personality Disorder/diagnosis , Abdominal Wall/surgery , Abdominal Wall , Paranoid Behavior/drug therapy , Paranoid Behavior/epidemiology , Paranoid Behavior/prevention & control , Paranoid Disorders/complications , Abdominal Injuries/complications , Abdominal Injuries/surgery , Abdominal InjuriesABSTRACT
Neurosyphilis can present with psychiatric symptoms. The late form can occur in old age with psychosis, paranoid delusions, affective disorders or cognitive impairment. Here we present a case of neurosyphilis in an elderly woman who, over six months, progressively manifested personality changes and paranoid delusions which were initially suspected as Alzheimer's disease. Psychotic symptoms showed a good response to antibiotic treatment. We conclude that neurosyphilis is a relevant differential diagnosis in patients developing severe psychiatric symptoms in old age. As a causal antibiotic treatment is possible this infectious disease should be considered seriously in gerontopsychiatric patients.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Delusions/etiology , Neurosyphilis/diagnosis , Neurosyphilis/drug therapy , Paranoid Behavior/etiology , Aged , Aging/psychology , Delusions/drug therapy , Female , Humans , Neurosyphilis/complications , Neurosyphilis/psychology , Paranoid Behavior/drug therapy , Treatment OutcomeSubject(s)
Aggression/drug effects , Antineoplastic Agents/adverse effects , Bipolar Disorder/chemically induced , Leuprolide/adverse effects , Paranoid Behavior/chemically induced , Aged , Aggression/psychology , Antineoplastic Agents/administration & dosage , Benzodiazepines/therapeutic use , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Humans , Injections, Subcutaneous , Leuprolide/administration & dosage , Male , Olanzapine , Paranoid Behavior/drug therapy , Paranoid Behavior/psychology , Selective Serotonin Reuptake Inhibitors/therapeutic use , Treatment OutcomeABSTRACT
The aim of this study was to determine if the severity of paranoid/belligerence was a major determinant of neuroleptic dosage in newly admitted patients with acute or exacerbated schizophrenia. Two clinical psychiatrists, who had no clinical responsibility for drug treatment and were blind to neuroleptic dosage regimens, jointly interviewed 155 patients who were cooperative enough to be carefully interviewed with the Structured Clinical Interview for the DSM-III-R, Positive and Negative Syndrome Scale (PANSS) Edition. The large majority of the patients were receiving moderate dosages of neuroleptics (mean peak dosage: 500 mg/day of chlorpromazine equivalents). There was a positive correlation between the score on the PANSS paranoid/belligerence cluster and the daily dosage of neuroleptic treatment. Splitting the sample by gender, the correlations remained highly significant. In a multivariate analysis controlling for the effects of other clinical variables, paranoid/belligerence and gender emerged as significant predictors of neuroleptic dosage. Clinicians prescribed lower doses of neuroleptics for female patients and higher doses for patients with higher ratings on the PANSS paranoid/belligerence cluster. These findings suggest that clinicians' strategy of increasing neuroleptic dosage at the manifestation of hostility is not limited to assaultive or uncooperative schizophrenic patients who are on very high dosages of neuroleptics.
Subject(s)
Antipsychotic Agents/administration & dosage , Chlorpromazine/administration & dosage , Paranoid Behavior/drug therapy , Schizophrenia/drug therapy , Schizophrenic Psychology , Adolescent , Adult , Aged , Female , Hostility , Humans , Male , Middle Aged , Multivariate AnalysisABSTRACT
Progressive dementia developed during a 15-month period in a 56-year-old woman with serologically and clinically documented primary Sjögren's syndrome. Findings from magnetic resonance imaging and angiography were normal, but a brain biopsy disclosed perivascular lymphocytic inflammation in leptomeningeal and parenchymal vessels. Treatment with high-dose corticosteroids produced rapid and nearly complete resolution of the dementia.
Subject(s)
Dementia/etiology , Meningoencephalitis/etiology , Prednisone/therapeutic use , Sjogren's Syndrome/complications , Alzheimer Disease/diagnosis , Dementia/diagnosis , Dementia/drug therapy , Diagnostic Errors , Female , Hallucinations/drug therapy , Hallucinations/etiology , Humans , Meningoencephalitis/drug therapy , Middle Aged , Paranoid Behavior/drug therapy , Paranoid Behavior/etiology , Psychological Tests , Sjogren's Syndrome/drug therapySubject(s)
Cerebrovascular Circulation , Mental Disorders/physiopathology , Mental Processes/physiology , Adult , Affective Symptoms/physiopathology , Affective Symptoms/therapy , Aged , Alcoholism/physiopathology , Cerebrovascular Circulation/drug effects , Computers , Dementia/physiopathology , Female , Haloperidol/therapeutic use , Humans , Male , Middle Aged , Paranoid Behavior/drug therapy , Paranoid Behavior/physiopathology , Substance-Related Disorders/physiopathology , Xenon RadioisotopesABSTRACT
Paranoid symptoms were found in 40% of patients admitted to a university general hospital psychiatric unit during a ten-month period. Fifty-eight percent of this group had frank paranoid delusions, while the rest had ideas of reference or generalized suspiciousness. Only one half of those who had paranoid delusions had paranoid schizophrenia. A significant number had affective disorders or organic brain disorder. Ideas of reference and suspiciousness were found in many patients who were not psychotic. The therapeutic implications of these findings are reported in three patients who were inadequately treated for affective disorders because the presence of paranoid symptomatology had led to an incorrect diagnosis of schizophrenia.