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Case report: Improvement of chronic mania after Steven-Johnson syndrome
- C. Pardo González, A. Tellez Gomez, C. Sanjuán Ortiz, J. Ribes Cuenca, D. M. Beltrán Cristancho, G. Ribes Jordán
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S694-S695
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Introduction
Stevens-Johnson Syndrome is a rare life-threatening condition characterized by severe mucocutaneous epidermal necrolysis and detachment of the epidermis. The condition centers around a delayed-type hypersensitivity reaction with a complex etiology stemming from a variety of causes.
ObjectivesTo present the case of a patient with a diagnosis of intellectual disability, bipolar disorder and epilepsy who, 14 days after starting treatment with Cariprazine, presented with pseudovesicular skin lesions suggestive of Steven-Johnson syndrome.
MethodsA non-systematic literature review on PubMed database on Steven-Johnson syndrome and other autoimmune processes in patients with bipolar disorder, and the impact on the affective symptoms of the former, was conducted. The clinical case report was prepared through the review of clinical records of the patient.
ResultsThe authors present the case of a 50-year-old woman, undergoing psychiatric follow-up for more than 30 years with a diagnosis of bipolar disorder. She has a moderate intellectual disability and generalized epilepsy diagnosed at the age of 13. Since the age of 20, the patient has presented clinical manifestations compatible with bipolar disorder.
On a dermatological level, the patient had medical records of hypersensitivity reaction to amoxicillin-clavulanic acid, intolerance to carbamazepine; and toxicoderma and hepatitis after treatment with Lamotrigine, compatible with DRESS syndrome.
At the time of the study, psychopharmacological treatment consisted in valproic acid, lithium and cariprazine (the latter being introduced 14 days earlier). Pseudovesicular and papular skin lesions were observed, with a dianiform appearance and central necrosis.
Prior to the debut of the dermatological condition, the patient showed a decompensation of her bipolar disorder, with escalating irritability, soliloquies, verbosity and hostility towards her parents, with episodes of psychomotor agitation.
After the appearance of the skin lesions, a striking clinical change was observed, with an almost complete remission of affective symptoms, temporally coincident with DRESS syndrome and cariprazine withdrawal.
ConclusionsIn recent years, research on autoimmune diseases and their relationship with mental disorders, such as bipolar disorder, schizophrenia and depression, has become increasingly abundant. The conclusions point to the fact that both disorders could be interrelated even at an etiopathogenic level. In this case report, we discuss a patient with a diagnosis of bipolar disorder with an important component of autoimmune response to different drugs, which seems to have influenced the clinical course of the mental illness.
Disclosure of InterestNone Declared
Depressive episode as initial symptoms of Perry syndrome
- A. Téllez Gómez, C. Pardo González, A. Sabater Ferragut, J. Ribes Cuenca
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S825
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Introduction
Perry syndrome is a rare neurological disorder, characterized by atypical parkinsonian symptoms, sleep disturbances, central hypoventilation, weight loss, and psychiatric symptoms, especially apathy or depression. This syndrome is due to a TDP-43 proteinopathy as a result of a mutation in the DCTN-1 gene.
ObjectivesTo present the case of a patient with a mutation in the DCTN1 gene, related to Perry syndrome, who debuted with several depressive episodes, with apathy and weight loss.
MethodsA non-systematic literature review was conducted on PubMed database on depressive episodes related to Perry´s syndrome. The clinical case report was prepared through the review of the clinical record of the patient.
ResultsThe authors present the case of a 49-year-old man, who contacted psychiatry for the first time 10 years earlier due to depressive symptoms, suffering multiple episodes. These episodes consisted of hypothymic mood, apathy, anhedonia and marked irritability, together with suicidal ideation, leading to several drug overdoses. He also presented disruptive behaviors, such as abusive drinking and aggressiveness. These episodes responded to antidepressants at medium doses, although maintaining several relapses. Given this, it was decided to introduce valproic acid as a mood stabilizer, with good tolerance.
In parallel, the patient’s mother, who had also suffered from depressive episodes, began with dementia symptoms, after which it was decided to request a genetic study. In this context, a mutation, similar in both patients, was observed in the DCTN1 gene, related to Perry syndrome.
In the case of the patient presented, no other associated alterations were found, neither in the neurological examination or in the rest of the tests performed (polysomnography without notable alterations, functional imaging tests without pathological findings).
ConclusionsNeurological diseases as Perry syndrome can show depressive symptoms and other behavioral changes at the beginning, developing the rest of the symptoms (parkinsonism, weight loss or central hypoventilation) several years after the onset of the symptoms. It must be taken into account in patients with a family history of mutations or atypical depressive symptoms. It should also be assessed in terms of genetic counseling.
Disclosure of InterestNone Declared
Manic episode secondary to single right cerebellar metastasis in context of ovarian tumor: report of clinical case
- A. Téllez Gómez, M.T. Rubio Granero
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S216
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Introduction
The cerebellum is often overlooked when evaluating neuropsychiatric disorders. Lately, evidence has increased for the existence of cerebellar connections -generally in relation to vermis and posterior lobe- with cortical areas related to pathophysiology of psychiatric disorders. The cerebellar affective cognitive syndrome, also known as Schmahmann syndrome, has even been described with an evaluation scale.
ObjectivesCase report of a patient suffering a manic episode in context of single right cerebellar metastasis derived from ovarian tumor.
MethodsA non-systematic literature review was conducted on PubMed database on cerebellum pathology related to psychiatrics disorders. The clinical case report was prepared through the review of the patient´s clinical record.
ResultsThe authors introduce the case of a 50-year-old woman, diagnosed with high-grade serous ovarian tumor, with single right cerebellar metastasis of 42mm, who was admitted to oncology due to behavioral alteration, with no prior psychiatric history. The patient showed hyperthymic mood, with speech scanned but fluid, manifesting intense well-being and ideation of mystical-religious and megalomaniac content. Haloperidol up to 7.5mg/8 hours and clonazepam 2 mg/8 hours were prescribed, switching haloperidol to olanzapine up to 25mg/day after several days, since the symptoms did not improve. Valproic acid 500 mg/24 hours was also added. Progressive improvement was seen, without worsening of motor symptoms or instability. The CCAS scale (Cerebellar Cognitive Affective/Schmahmann syndrome) was performed, with a positive result (10/10) being> 3 definitive CCAS.
ConclusionsThe relationship between cerebellum and neuropsychiatric disorders is still partly unknown, requiring more research to be able to carry out specific diagnoses and treatments for patients.
DisclosureNo significant relationships.
How Do Parents Influence Child Disruptive Behavior After Acquired Brain Injury? Evidence From a Mediation Model and Path Analysis
- Clara Chavez-Arana, Cathy Catroppa, Guillermina Yáñez-Téllez, Belén Prieto-Corona, Adriana Amaya-Hernández, Miguel A. de León, Antonio García, Roberto Gómez-Raygoza, Stephen J. C. Hearps, Vicki Anderson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 25 / Issue 3 / March 2019
- Published online by Cambridge University Press:
- 13 March 2019, pp. 237-248
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Objectives: Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact. Methods: Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis. Results: Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents’ executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were >0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25. Conclusions: A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237–248)