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Early-onset schizophrenia: an adolescent case report
- C. Alcalde-Diosdado Crespi, E. K. Alvarado Altuve, S. Cruz Bailén, I. Caparrós del Moral
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1049
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Introduction
This is the case of a girl, aged 13, starting on 2021 with a first psychotic episode. Before this episode, her psychiatric history was an adjustment disorder because of scholar bullying, fully recovered before the onset of the current symptoms.
ObjectivesTo describe an interesting case of early-onset psychosis.
MethodsWe have used the interviews with the patient and her profile in Diraya (the medical database software in Andalucía).
ResultsThe first symptoms started 6 months before the first hospitalization, and consisted in mild behavioural disorders, with disobedience and rudenesses, which represented a significant change compared with the previous personality of the patient. 3 weeks before the first admission she abruptly started to experience disconnection, unmotivated laughs, decreaded academic performance and incoherent speech. Also, she showed motor symptoms, consisting in oral and right-hand stereotypies. Then, she was hospitalized in a Pediatric unit, in order to rule out organicity. The nuclear magnetic resonance showed an image suggestive of venous development anomaly, with no acute injuries. Her cerebral spinal fluid was widely studied, and all the results were negative, including: the technique of PCR for many virus and bacteria that can cause meningitis or encephalitis; a bacterial culture; a biochemical study; antineuronal antibodies; and a limbic encephalitis antibodies study. Besides, the blood count, the biochemistry, the gasometry and serology were also negative. No drugs were detected in the urinalysis. Once the organicity was ruled out, she was treated with Olanzapine and Diazepam, and destinated to my child and adolescent psychiatry unit. During the first hospitalization we observed that she looked very often to the mirror, showed soliloquies and took leaps. During the interviews she was desinhibited. She initiated a delusional speech, focused in sexual topics. She said that she’s had a baby in the future with his father, and talked a lot about things she had already made in the future. During this admission, we changed the treatment to Quetiapine and Valproate.
The second hospitalization was was done due to a lack of efficacy with the previous treatment and the presence of autolytic thoughts. We switched from Quetiapine to Aripiprazole. After a few days, she showed again a desinhibited behaviour, and kept the delusional speech, that now was more complex, refering that she had more than 20 babies, with many different men. After this we tried Lurasidone and suspended Aripiprazole, she showed a clinical improvement, at the cost of many side effects, though. So we finally changed to Clozapine, in combination with Gabapentin. Since she got clinical levels of clozapine, the delusions have been encapsulated.
ConclusionsThe differential diagnosis is set with an early-onset schizophrenia and a schizoaffective disorder. Obviously, the evolution of the sypmptoms in the following months and years will have the last word.
Disclosure of InterestNone Declared
Influence of COVID-19 in the development of delusional ideas disorder. A case report
- E. Alvarado Altuve, M. Almodovar Rivera, C. Alcalde-Diosdado Crespi
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S543-S544
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- Article
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- You have access Access
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Introduction
Hypochondria is characterized by the presence, for 6 months or more, of a generalized and non-delusional concern with fear of having (or the idea that one has) a serious illness, based on the wrong interpretation of the symptoms. In somatic-type delusional disorder, the delusional idea is fixed, indisputable, and occurs intensely because the patient is fully convinced of the physical nature of the disorder.
ObjectivesTo describe a clinical case and make a differential diagnosis of hypochondriac disorder vs somatic-type delusional disorder.
MethodsCase report: 61-year-old woman, after suffering from COVID-19, develops a hypochondriacal disorder vs. somatic delusional disorder, presenting anxiety-depressive symptoms and digestive somatic complaints, with a loss of 15 kg of weight. She made frequent visits to doctors and multiple complementary tests discarding organicity. She required involuntary hospital admission for 48 days, and pharmacological treatment with Venlafaxine 150 mg, Olanzapine 5mg, Mirtazapine 30mg and Alprazolam 1mg. The patient presented slow evolution during admission, with ups and downs and stagnation, meriting enteral nutrition due to refusal to ingest, given abdominal kinesthetic hallucinations and digestive evaluation (EDS) with a result of antral gastritis and negative H. pylori. In subsequent follow-ups after partial remission of symptoms, obsessive personality traits are glimpsed, although with better personal functioning.
ResultsThe diagnosis at discharge was inconclusive, however the data points to a somatic-type delusional disorder.
ConclusionsThe influence of COVID-19 as a triggering factor, social isolation and premorbid personality traits, influence the development of a Somatic Delusional Disorder vs Hypochondriac Disorder, regarding this case.
DisclosureNo significant relationships.
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