THE COMPLEXITY OF DUAL PATHOLOGY: REGARDING A CASE REPORT OF SEIZURES

Introduction Wernicke’s encephalopathy (WE) is a potentially reversible neuropsychiatric emergency caused by thiamine deficiency, whose classical triad consists of acute onset of confusion, gait ataxia, and oculomotor dysfunction. The diagnosis is missed in 75-80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, which is characterized by memory impairment associated with confabulation. Early recognition of nutritional deficiency or any portion of the triad is critical and should prompt treatment, since WE is readily reversible if treated with adequate doses of parenteral thiamine. Objectives Starting from a case report of suspected WE, we pretend to discuss the differential diagnosis of seizures in dual pathology. Methods Non-systematic review of the literature was performed in PubMed database using the keywords “Wernicke’s Encephalopathy”, “Seizures”, “Alcohol” and “Benzodiazepines”. The articles were selected according to their relevance. A patient´s clinical record was reviewed and presented. Results We present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus. Anamnesis was hampered by the language barrier and absence of past medical history and patient’s alcoholic habits remained unclear. After suspicion of WE it was introduced thiamine and diazepam, with significant improvement. After discontinuation of diazepam, the patient presented with several episodes of tonic-clonic seizures. He was medicated for seizures with clinical stabilization. At time of discharge the diagnostic discussion prevailed. Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption. Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking. Seizures may also occur during alcohol withdrawal, for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures. Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments. Conclusions This case illustrates the complexity of neuropsychiatric diagnoses in dual pathology. It requires a longitudinal assessment for a better understanding of clinical conditions and establishment of the best therapeutic approach. Disclosure of Interest None Declared

Introduction: Darier's disease, also known as Darier-White disease or keratosis follicularis, is a rare autosomal dominant genodermatosis.Clinical experience has long suggested an association between neuropsychiatric abnormalities and Darier's disease.Moreover, associations with mental retardation, schizophrenia, mood disorders and suicide have been reported.Objectives: We studied the association between Darier's disease and schizophrenia.Methods: We illustrate a case of schizophrenia and Darier's disease comorbidity with a small review of the literature that summarizes the characteristics of such an association.Results: Mrs SD, 48 years old, with a prior history of schizophrenia, moderate intellectual disability and several hospitalizations in psychiatry.She was hospitalized in our department of psychiatry "A" of the Hedi Chaker university hospital after she was brought by the police for odd and disorganized behavior, environmental violence and refusal of treatment.On somatic examination, the presence of crusty maculopapular skin lesions, non-pruritic, yellowish brown in color and a few millimeters in diameter, located on the back of both hands and feet, face and neck was noted.The patient reported that her brother has similar skin lesions.A dermatological consultation was sought for assessment of her skin condition and a skin biopsy confirmed the diagnosis of Darier's disease.Conclusions: Schizophrenia and intellectual disabilities are frequently associated with Darier's disease.Physicians should be aware of this association in order to allow a rapid diagnosis and early management of psychiatric disorders associated with this genodermatosis.Objectives: Starting from a case report of suspected WE, we pretend to discuss the differential diagnosis of seizures in dual pathology.Methods: Non-systematic review of the literature was performed in PubMed database using the keywords "Wernicke's Encephalopathy", "Seizures", "Alcohol" and "Benzodiazepines".The articles were selected according to their relevance.A patientś clinical record was reviewed and presented.

Disclosure of
Results: We present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus.Anamnesis was hampered by the language barrier and absence of past medical history and patient's alcoholic habits remained unclear.After suspicion of WE it was introduced thiamine and diazepam, with significant improvement.After discontinuation of diazepam, the patient presented with several episodes of tonicclonic seizures.Objectives: The aim of this case report is to describe the clinical picture of a 26-year-old boy with ADHD and the consequences deriving from the missed diagnosis of the disorder during childhood.
Methods: We report a case of undiagnosed and untreated ADHD and the ensuing consequences.Results: G.V. is a boy who came to our attention complaining about a vague depressive symptomatology.After psychopathological examination we detected mood instability, with the alternance of phases characterized by deep despair and melancholy and phases of agitation with internal tension and generalized anxiety.He reported a tendency to act on an impulsive basis and an occasional abuse of cocaine together with a daily abuse of high doses of Alprazolam.
During the past years the boy had been visited by several psychiatrists who made various diagnoses (borderline or avoidant personality disorder, cyclothymic disorder) and prescribed various drugs but none of these were able to stabilize the psychopathological condition.The clinical history revealed the presence of a pervasive picture of inattention and hyperactivity since childhood which had heavily conditioned the patient's functioning over time.
The inattentive pattern has persisted unchanged over the years, while the hyperactive one has improved leaving room for a stable sense of internal tension and generalized anxiety on which mood fluctuations are cyclically inscribed.A diagnosis of ADHD, combined presentation type, was made by using the DIVA-5.The patient was first prescribed lithium, which was subsequently replaced with valproic acid.After mood stabilization and the reduction of anxious symptoms prolonged-release methylphenidate was added to therapy, obtaining resolution of the clinical picture.
80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, which is characterized by memory impairment associated with confabulation.Early recognition of nutritional deficiency or any portion of the triad is critical and should prompt treatment, since WE is readily reversible if treated with adequate doses of parenteral thiamine.
He was medicated for seizures with clinical stabilization.At time of discharge the diagnostic discussion prevailed.Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption.Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking.Seizures may also occur during alcohol withdrawal, for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures.Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments.Conclusions: This case illustrates the complexity of neuropsychiatric diagnoses in dual pathology.It requires a longitudinal assessment for a better understanding of clinical conditions and establishment of the best therapeutic approach.He recognized these visions as unreal and felt distressed by them.No cognitive impairment was observed on several neuropsychological tests.He was reassured of the false nature of the visual experiences after explanations that he had no mental illness and that the problem could disappear.He was taught how to keep the images away by closing his eyes for sometimes and repeated blinking.After six weeks of psychological intervention, the visual experiences had disappeared without using any drug Conclusions: In the management of CBS drug treatments remain partially satisfactory.Nonpharmacological interventions focus on the reduction of the visual pathway deprivation.This therapeutic alternative seems to provide positive benefits.