Simone Lazanio

Improvement of cognition in a patient with Cotard's delusions and frontotemporal atrophy receiving electroconvulsive therapy (ECT) for depression

A 69-year-old man presented with Cotards delusions, insomnia, profound depression, amnesia, difficulty concentrating, and cognitive deficit after two different surgical interventions. Brain imaging showed frontotemporal-subcortical atrophy and lateral ventricular enlargement. He responded poorly to a combination of sertraline, amisulpride and mirtazapine, with modest benefit on insomnia, and developed hypotension. After 18 days he was switched to olanzapine and venlafaxine, but his cognition worsened. He underwent bilateral electroconvulsive therapy (ECT). His mood improved, cognitive performance increased and anxiety symptoms remitted. This improvement persisted through the one-month post-discharge follow-up and depression eventually remitted.

Command hallucinations with self-stabbing associated with zolpidem overdose.

To the Editor: Since Viscott’s original description of 7 patients who developed hallucinations while taking chlordiazepoxide, there have been several reports of hallucinations with GABAA/ benzodiazepine agonists. Some reports concerned nonbenzodiazepine hypnotics, like zolpidem and zaleplon. Hallucinations range from visual to auditory, kinesthetic, and somesthetic and are often of unusual nature. Despite the low rate of these hallucinations (0.08%–3%), concerns may be raised over the use of nonbenzodiazepine hypnotics, due to the diffusion of hypnotic drug prescriptions. Hallucinations with zolpidem are usually visual, template-like (a background abstract design), and mostly hypnagogic or hypnopompic. It was suggested that hallucinations may be secondary to rapid withdrawal and reintroduction of zolpidem. We report the case of a man with untreated bipolar I disorder and a history of benzodiazepine abuse who developed auditory command hallucinations after zolpidem overdose and subsequently enacted his misperceptual experience.

Persistent interferon-β-1b-induced psychosis in a patient with multiple sclerosis

Interferon‐β is used in patients with multiple sclerosis to reduce autoimmunity; although other psychiatric side‐effects are common, in contrast to interferon‐alpha, psychosis has been reported only once. A patient with multiple sclerosis developed auditory hallucinations, paranoid delusions, and increased aggressiveness after 16 months of treatment with interferon‐β‐1b, 250 µg every other day. He responded after about one month to antipsychotic treatment, but tended to relapse upon dose reduction, and after 2 years still needs antipsychotics to control his symptoms. Because there was no change in his magnetic resonance imaging between pre‐ and post‐treatment with interferon, we concluded that psychosis was more related to interferon treatment than to the underlying disease.

Postpartum depression without delivering a child

Objective:  Depression in people related to delivering women is documented in their mates, but only anecdotal in other family members. We describe a case of depression in a woman who had previously experienced postpartum depression after the birth of her nephew.

Enucleation in Psychosis Associated with Aqueductal Stenosis

Reports of self-enucleation are frequent in medical literature, but cases of enucleation towards another are rare. We report the case of a man, 20 years of age, who suffered from psychosis with hydrocephalus and aqueductal stenosis that required a forensic psychiatric investigation to ascertain whether he was of unsound mind when he assaulted and enucleated the right eye of an officer and led to the surgical enucleation of the victims left eye. Based on his clinical interviews and hospitalization record, we conclude that at the time of the assault, he was suffering from a delusional disorder with religious and demonic content, visual and auditory hallucinations, illusion phenomena, delusional interpretations, imaginative elements, a feeling of terror, and command hallucinations that compelled him to perform the act of aggression.

Epilepsy and brain injury: A case report of a dramatic neuropsychiatric vicious circle

Abstract Primary objective: Early treatment of epilepsy is warranted to avoid possible severe consequences. This study aimed to assess the value of treatment in a patient who developed epilepsy after major brain surgery. Design: Case description. A 51 years-old man had a history of putative petit mal seizures since adolescence and left frontotemporal lobectomy after a major traffic accident at age 17. He subsequently developed quickly generalizing partial complex seizures, associated with severe behavioural alterations and personality changes; the condition was left untreated. A further seizure-related loss of consciousness led to another traffic accident at age 47. Methods and procedures: The patient was administered 200 mg/day topiramate, 600 mg/day quetiapine, 1000 mg/day valproate, 1200 mg/day gabapentin and 800 mg/day carbamazepine. Main outcomes and results: The instituted anti-epileptic treatment reduced seizure frequency and severity, but did not affect psychiatric symptomatology, which even worsened. An association between anti-epileptic drugs with mood stabilizing properties and an atypical anti-psychotic dramatically improved psychiatric symptoms, but did not prevent the patient from needing long-term healthcare. Conclusions: Long-term untreated epilepsy may expose to accident proneness and further psychiatric deterioration. Early diagnosis and treatment of epilepsy may help in avoiding a potentially lethal vicious circle.