scholarly journals Acute mania with psychotic symptom in post COVID-19 patient

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S50-S51
Author(s):  
Sridevi Shanmugam ◽  
Praveen Kumar ◽  
Blaga Carr
Keyword(s):  
Mental Health ◽  
Psychiatric Illness ◽  
Neuropsychiatric Symptoms ◽  
Previous History ◽  
Acute Mania ◽  
Medical Attention ◽  
Psychotic Symptoms ◽  
High Dose ◽  
Neuropsychiatric Complications ◽  
History Of

AimsCOVID-19 is an on-going pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent evidence suggests that SARS-CoV-2 may be associated with various neuropsychiatric symptoms, including mania. We present a case of a middle aged man presenting with acute mania with psychotic symptoms 20 days post COVID infection in the absence of prior psychiatric illness. This report highlights the need for rigorous neuropsychiatric assessment in patient with symptoms of SARS-CoV-2 infection.MethodA 52-year-old man of West African origin with past history of hypertension and no previous history of mental health illness presented with acute manic symptoms on background of two weeks of high fever, diarrhoea, mild headache, dry cough and anosmia. He was tested positive for SARS-CoV-2 infection on COVID PCR test. He was under self-isolation along with his family members who exhibited mild symptoms of SARS-CoV-2, none of them required hospital admission. He was initially fearful to seek medical attention but was brought in by family after exhibiting behaviour changes, obsession with toilet cleaning, reckless spending and getting aggressive approximately two weeks after the onset of acute upper respiratory symptoms. He presented elated in mood with pressure of speech and grandiose ideas. Investigations like neuroimaging and bloods were unremarkable. Initial psychiatric assessment found symptoms consistent with acute mania and he was detained under the Mental Health Act. During admission, he was sexually disinhibited and agitated on the ward requiring IM antipsychotics. He was treated with high dose of Olanzapine and Sodium valproate and his symptoms subsided within two weeks.ResultThis case emphasises the manifestation of neuropsychiatric illness post COVID-19 without a background of psychiatric illness, hypoxemia and cerebral infarction.Based on the CORONERVE Programme and latest retrospective Lancet cohort studies, the period between 14 and 90 days after diagnosis, 5.8% COVID-19 survivors had their first recorded diagnosis of psychiatric illness.It is also important to consider other organic disease given the simultaneous diagnosis of COVID-19. Although it is not yet possible to confirm here due to the lack of a validated CSF-PCR assay, previous reports have implicated SARS-CoV-2 in the development of viral encephalitis, and this remains an important differential.ConclusionClinicians should be alert to the possibility of patients with COVID-19 developing neuropsychiatric complications post SARS-CoV-2 infection, mandating the need for vigilant initial neuropsychiatric assessment and possibly follow-up care in 3 months.

scholarly journals Psychiatric Symptomatology in Early-Onset Binswanger’s Disease: Two Case Reports

1995 ◽  
Vol 8 (1) ◽  
pp. 43-46 ◽  
Author(s):  
R. M. Lawrence ◽  
J. C. Hillam
Keyword(s):  
Early Identification ◽  
Psychiatric Illness ◽  
Case Reports ◽  
Accurate Diagnosis ◽  
Psychotic Symptoms ◽  
Psychiatric Symptomatology ◽  
Neurological Signs ◽  
Binswanger’S Disease ◽  
History Of ◽  
Binswanger's Disease

We describe two cases of Binswanger's disease of pre-senile onset which presented with affective and psychotic symptoms well before the appearance of cognitive deterioration and neurological signs, initially evading an accurate diagnosis. Psychiatrists should be aware of white matter disease and its role in the pathogenesis of psychiatric illness. Particular attention should be given to a history of hypertension as a risk factor in the early identification of these cases.

Psychotic symptoms in pediatric bipolar disorder and family history of psychiatric illness

2006 ◽  
Vol 96 (1-2) ◽  
pp. 127-131 ◽  
Author(s):  
Richard Rende ◽  
Boris Birmaher ◽  
David Axelson ◽  
Michael Strober ◽  
Mary Kay Gill ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Psychiatric Illness ◽  
Psychotic Symptoms ◽  
Pediatric Bipolar Disorder ◽  
History Of

Prevention of Steroid-Induced Neuropsychiatric Complications With Neuroleptic Drugs: A Review

2021 ◽  
pp. 104990912110347
Author(s):  
Ivy Akid ◽  
Suzanne Nesbit ◽  
Julie Nanavati ◽  
Oscar Joseph Bienvenu ◽  
Thomas J. Smith
Keyword(s):  
Low Dose ◽  
Randomized Clinical Trials ◽  
Neuropsychiatric Symptoms ◽  
Review Literature ◽  
Treatment And Prevention ◽  
Neuropsychiatric Complications ◽  
History Of ◽  
Trial Evidence ◽  
History Of Depression ◽  
Positive Effect

Corticosteroids are used for a multitude of indications in palliative patients. In this narrative review, we aim to review literature on the treatment and prevention of neuropsychiatric complications of steroids. For prevention, only lamotrigine had a positive effect in a small number of studies. For treatment, olanzapine appears to be nearly universally effective at low doses, but randomized trial evidence is lacking. Further randomized clinical trials are necessary to elucidate data-driven guidelines for prevention and treatment of corticosteroid-induced neuropsychiatric symptoms. Until further data are available, it is reasonable to consider low dose olanzapine for any patient taking 40 mg of prednisone or its equivalent, especially those with a history of depression or neuropsychiatric symptoms.

Previous induced abortion and ante-natal depression in primiparae: preliminary report of a survey of mental health in pregnancy

1978 ◽  
Vol 8 (4) ◽  
pp. 711-715 ◽  
Author(s):  
R. Kumar ◽  
Kay Robson
Keyword(s):  
Mental Health ◽  
Preliminary Report ◽  
Previous History ◽  
First Trimester ◽  
Induced Abortion ◽  
Depression And Anxiety ◽  
History Of ◽  
Expectant Mothers ◽  
Clinically Significant ◽  
In Pregnancy

SynopsisOne hundred and nineteen primiparae, who were routinely attending ante-natal clinics, were interviewed repeatedly between the 12th and 36th weeks of their pregnancies. The incidence of depression was highest in the first trimester and, overall, about a fifth of the sample was found to be suffering from clinically significant neurotic disturbances. In a proportion of these expectant mothers there was an association between depression and anxiety early in pregnancy and a previous history of induced abortion; this phenomenon may reflect a reactivation of mourning which was previously suppressed.

scholarly journals COVID-19-associated brief psychotic disorder

2020 ◽  
Vol 13 (8) ◽  
pp. e236940 ◽  
Author(s):  
Colin M Smith ◽  
Jonathan R Komisar ◽  
Ahmad Mourad ◽  
Brian R Kincaid
Keyword(s):  
Mental Illness ◽  
Family History ◽  
Psychotic Disorder ◽  
Neuropsychiatric Symptoms ◽  
Healthy Woman ◽  
Psychotic Symptoms ◽  
First Case ◽  
Brief Psychotic Disorder ◽  
History Of ◽  
New Onset

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.

Genomic Characterization Of Histiocytic Lesions Following Pediatric T-Cell Acute Lymphoblastic Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4940-4940
Author(s):  
Richard McMasters ◽  
Brian K. Turpin ◽  
Michael J. Absalon ◽  
Christine L. Phillips ◽  
Karen Burns ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Previous History ◽  
Genomic Analysis ◽  
High Dose ◽  
Pet Ct ◽  
History Of ◽  
Genomic Characterization ◽  
Notch1 Mutations

Abstract Introduction The development of histiocytic lesions after acute lymphoblastic leukemia (ALL) is rare, occurring in 6 of 971 patients enrolled on BFM treatment regimens for T-ALL (Trebo 2005).  Few cases of histiocytosis arising after a history of T-ALL have been characterized at the molecular level for genomic alterations. One case of fatal Langerhans cell histiocytosis (LCH) following treatment of T-ALL revealed activating mutations in NOTCH1; in contrast, no NOTCH1 mutations were identified in 24 other cases of LCH or Rosai-Dorfman disease without a previous history of T-ALL (Rodig 2008). In patients without prior leukemia, BRAF V600 mutations have been identified in a significant proportion of patients with LCH or Erdheim-Chester Disease but not in other histiocytoses (Haroche 2012). Methodology and Principal Findings Next generation focused exomic sequencing of 236 genes and 47 Introns was conducted on samples of histiocytic lesions from two patients with a previous history of T-ALL. Case 1 A 2 year-old male presented with marked adenopathy, mediastinal mass and white blood cell count 67,000 cells/uL with 30% blasts. The blasts expressed CD45, CD2, CD3 (surface/cyto), CD5, CD7, CD38, CD45 (bright), TCR gamma-delta, but were negative for CD4, CD8, and TdT.  Karyotype was 46,XY,t(8;14)(q24;q11.2),der(12)t(12;20)(q11;q13.3),der(20)t(12;20)(q21;q13.3) with rearrangement of MYC (8q24) confirmed by FISH. He was treated for T-ALL per Children’s Oncology Group (COG) protocol AALL0434 and had 5% residual bone marrow blasts at day 29 of induction. MRD-negative remission was ultimately achieved with high-dose cytarabine and methotrexate followed by consolidation with nelarabine.  He underwent matched unrelated cord blood transplant following conditioning with cyclophosphamide and total body irradiation with cranial boost, and engrafted at day +14. Surveillance bone marrow at day +110 revealed systemic juvenile xanthogranuloma (JXG) without T-ALL. PET/CT revealed FDG-uptake in the diffusely enlarged spleen and throughout the skeleton. Due to progressive cytopenias, therapy was initiated with vinblastine and prednisone as per LCHIII. However, refractory cytopenias exacerbated by splenic sequestration developed following induction, and he was then treated with thalidomide and splenectomy. The spleen weighed 404 grams (expected 40 grams) and was diffusely infiltrated with JXG. The cytopenias dramatically improved and he continued thalidomide for 2 months until PET scan demonstrated progression. Genomic analysis of the JXG lesion revealed NRAS G13D mutation, and FISH demonstrated MYC rearrangement identical to the initial T-ALL sample. Case 2 A 12-year-old male presented with WBC 142,700 cells/uL and CNS leukemia. Flow cytometry showed T-ALL with CD2, surface CD3, CD4, CD5, CD7, CD8, CD24 (subset), CD71, HLA-DR (subset) and TdT (partial). There was a clonal TCR gamma gene rearrangement and a biallelic CDKN2A (p16) deletion by FISH. He was enrolled on COG AALL0434 and had a rapid response with remission in both CNS and marrow at induction day 29.  Following completion of high-dose methotrexate interim maintenance he developed hepatosplenomegaly, pancytopenia and elevated serum bilirubin, ferritin, and triglycerides.  Bone marrow aspirate showed rare hemophagocytosis but no evidence of T-ALL.  He was treated with dexamethasone and etoposide with no response. Follow-up bone marrow revealed brisk hemophagocytosis and a diffuse histiocytic neoplasm. Karyotype was 48,XY,+7,+11[2] /49,idem,+18[3] /46,XY[14]. PET/CT showed hepatosplenomegaly with FDG uptake in anterior mediastinum, hepatic nodules, spleen, and bone marrow. He was treated with Campath and then with intensive chemotherapy with fludarabine, cytarabine, and liposomal daunorubicin with no response and ultimately succumbed to disease. Genomic analysis of the clonal histiocytic infiltrate revealed KRAS G12C, BRAF G469V, NOTCH1 Q2440, and CCND2 G268R mutations, and FISH positive for biallelic CDKN2A (p16) deletion similar to original T-ALL. Conclusions Our extensive genomic characterization suggests a unique molecular pathogenesis for histiocytic disorders arising after T-cell ALL and identified RAS signaling pathway and NOTCH1 mutations. Furthermore, these findings strongly indicate a potential derivation or trans differentiation from the malignant leukemic stem cell clone. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Adolescent Catatonia Successfully Treated with Lorazepam and Aripiprazole

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Aaron J. Roberto ◽  
Subhash Pinnaka ◽  
Abhishek Mohan ◽  
Hiejin Yoon ◽  
Kyle A. B. Lapidus
Keyword(s):  
Case Report ◽  
Children And Adolescents ◽  
Emotional Distress ◽  
Successful Treatment ◽  
Previous History ◽  
Treatment Modalities ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Significant Impairment ◽  
History Of

Catatonia is especially concerning in children and adolescents. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. In this case report, we discuss a patient with no previous history of neuroleptic medication or psychotic symptoms, presenting with first-episode catatonia in the presence of disorganized, psychotic thoughts. We then review the catatonia syndrome, citing examples in the literature supporting its underdiagnosis in children and adolescents, and discuss successful treatment modalities. It is important to diagnose and treat catatonia as efficiently as possible, to limit functional and emotional distress to the patient.

Termination of Pregnancy and Psychiatric Morbidity

1995 ◽  
Vol 167 (2) ◽  
pp. 243-248 ◽  
Author(s):  
Anne C. Gilchrist ◽  
Philip C. Hannaford ◽  
Peter Frank ◽  
Clifford R. Kay
Keyword(s):  
Social Factors ◽  
Psychiatric Illness ◽  
Unplanned Pregnancy ◽  
Psychiatric Morbidity ◽  
Previous History ◽  
Termination Of Pregnancy ◽  
Factors Associated ◽  
Confounding Variables ◽  
History Of ◽  
Self Harm

BackgroundWe investigated whether reported psychiatric morbidity was increased after termination of pregnancy compared with other outcomes of an unplanned pregnancy.MethodThis was a prospective cohort study of 13 261 women with an unplanned pregnancy. Psychiatric morbidity reported by GPs after the conclusion of the pregnancy was compared in four groups: women who had a termination of pregnancy (6410), women who did not request a termination (6151), women who were refused a termination (379), and women who changed their minds before the termination was performed (321).ResultsRates of total reported psychiatric disorder were no higher after termination of pregnancy than after childbirth. Women with a previous history of psychiatric illness were most at risk of disorder after the end of their pregnancy, whatever its outcome. Women without a previous history of psychosis had an apparently lower risk of psychosis after termination than postpartum (relative risk RR = 0.4, 95% confidence interval CI = 0.3–0.7), but rates of psychosis leading to hospital admission were similar. In women with no previous history of psychiatric illness, deliberate self-harm (DSH) was more common in those who had a termination (RR 1.7, 95%CI 1.1–2.6), or who were refused a termination (RR 2.9, 95%CI 1.3–6.3).ConclusionsThe findings on DSH are probably explicable by confounding variables, such as adverse social factors, associated both with the request for termination and with subsequent self-harm. No overall increase in reported psychiatric morbidity was found.

scholarly journals Predictors of cerebrovascular event reoccurrence in patients with depression: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031927 ◽  
Author(s):  
Wa Cai ◽  
Christoph Mueller ◽  
Hitesh Shetty ◽  
Gayan Perera ◽  
Robert Stewart
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Cox Regression ◽  
Previous History ◽  
Research Centre ◽  
Cerebrovascular Event ◽  
Case Register ◽  
Physical Health Problems ◽  
History Of

ObjectivesTo identify predictors of recurrent cerebrovascular morbidity in a cohort of patients with depression and a cerebrovascular disease (CBVD) history.MethodsWe used the Maudsley Biomedical Research Centre Case Register to identify patients aged 50 years or older with a diagnosis of depressive disorder between 2008 and 2017 and a previous history of hospitalised CBVD. Using depression diagnosis as the index date we followed patients until first hospitalised CBVD recurrence or death due to CBVD. Sociodemographic data, symptom and functioning scores of Health of the Nation Outcome Scales, medications and comorbidities were extracted and modelled in multivariate survival analyses to identify predictors of CBVD reoccurrence.ResultsOf 1292 patients with depression and CBVD (mean age 75.6 years; 56.6% female), 264 (20.4%) experienced fatal/non-fatal CBVD recurrence during a median follow-up duration of 1.66 years. In multivariate Cox regression models, a higher risk of CBVD recurrence was predicted by older age (HR, 1.02; 95% CI, 1.01 to 1.04) (p=0.002), physical health problems (moderate to severe HR, 2.47; 95% CI, 1.45 to 4.19) (p=0.001), anticoagulant (HR, 1.40; 95% CI, 1.01 to 1.93) (p=0.041) and antipsychotic medication (HR, 0.66; 95% CI 0.44 to 0.99) (p=0.047). Neither depression severity, mental health symptoms, functional status, nor antidepressant prescribing were significantly associated with CBVD recurrence.ConclusionsApproximately one in five patients with depression and CBVD experienced a CBVD recurrence over a median follow-up time of 20 months. Risk of CBVD recurrence was largely dependent on age and physical health rather than on severity of depressive symptoms, co-morbid mental health or functional problems, or psychotropic prescribing.

scholarly journals Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Katerina Kaikoushi ◽  
Maria Karanikola ◽  
Nicos Middleton ◽  
Evanthia Bella ◽  
Andreas Chatzittofis
Keyword(s):  
Psychiatric Treatment ◽  
Male Gender ◽  
Psychotic Symptoms ◽  
High Dose ◽  
Psychiatric History ◽  
Cross Sectional ◽  
Prescription Patterns ◽  
Syndrome Scale ◽  
History Of ◽  
Compulsory Care

Background Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care although there is lack of evidence to support this practice and related risks for patients. Aims We aimed to investigate prescription patterns in patients with psychosis under compulsory psychiatric treatment in Cyprus and to identify predictors for pharmaceutic treatment patterns. Method This was a nationwide, descriptive correlational study with cross-sectional comparisons, including 482 patients with compulsory admission to hospital. Sociodemographic and clinical data were collected. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Prescribed medication patterns, including use of medication pro re nata (PRN, when required), were recorded. Results Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants. Polypharmacy without a PRN schema was reported in 5.6% (n = 27) of the participants. We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included. In the logistic regression analyses, predictors for prescription of high-dose antipsychotics were male gender, positive psychiatric history, receiving state benefits and a negative history of substance use. Male gender was the only predictor for polypharmacy without a PRN schema whereas male gender, negative family psychiatric history, receiving state benefits and the total score on the positive symptoms PANSS subscale were predictors for polypharmacy with a PRN schema included. Conclusions A high frequency of polypharmacy and use of medication PRN beyond clinical guidelines has been reported for the first time in psychiatric compulsory care in Cyprus; revision in antipsychotic prescription is needed.

Sign in / Sign up

Export Citation Format

Share Document