A Case Report of Non-Reactive Psychosis in a COVID-19 Patient

Background: COVID-19 causes reactive psychiatric symptoms like anxiety, depression, insomnia etc besides significant inflammatory response. A number of COVID-19 patients are found to present with complex neuropsychiatric syndromes, including the first onset of psychosis, that seem to be directly related to brain damage in the context of COVID-19. Most cases of psychotic disorder in COVID-19 patients are being found in individuals with no personal or family history of mental illness. Case Description: A 33-year-old man presented with acute restlessness, agitation, wandering, vandalizing things, suspiciousness, hallucinatory behaviour, decreased sleep for 3 days duration. There was no past history or family history of any psychiatric illness. There was a history of mild grade fever 7 days before the onset of the psychotic symptoms. The patient was uncooperative, irritable, and had hallucinatory behaviour. Rapid Antigen Test (RAT) was positive. The patient responded to injectable antipsychotic haloperidol which was later changed to Tab Olanzepine 5 mg. The patient developed no COVID symptoms and no psychotic symptoms were seen further. Conclusion: There is a possibility of a psychosis break as a COVID-19 clinical presentation, suggesting potential participation of inflammatory and autoimmunologic phenomena triggered as a response to the coronavirus infection.

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Clinical characteristics and sociodemographic features of psychotic major depression

Annals of General Psychiatry ◽

10.1186/s12991-021-00341-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Meng-qi Wang ◽

Ran-ran Wang ◽

Yu Hao ◽

Wei-feng Xiong ◽

Ling Han ◽

...

Keyword(s):

Family History ◽

Major Depression ◽

Clinical Characteristics ◽

Missing Values ◽

Psychotic Disorders ◽

Mental Health Center ◽

Psychiatric Diseases ◽

First Onset ◽

History Of ◽

Psychotic Major Depression

Abstract Background Psychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research. Methods This study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0–2/9, F33.0–2/9), and SZ (F20–20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method. Results PMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019–2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168–1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492–0.741), were more often divorced (OR 3.087, 95% CI 1.168–10.096), had a younger age of onset (OR 0.934, 95% CI 0.914–0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492–0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267–0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD. Conclusions PMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.

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Subjective cognitive complaints at age 70: associations with amyloid and mental health

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-325620 ◽

2021 ◽

pp. jnnp-2020-325620

Author(s):

Ivanna M. Pavisic ◽

Kirsty Lu ◽

Sarah E. Keuss ◽

Sarah-Naomi James ◽

Christopher A. Lane ◽

...

Keyword(s):

Family History ◽

Trait Anxiety ◽

Population Based ◽

Cross Sectional Study ◽

Subjective Cognitive Decline ◽

Cross Sectional ◽

Amyloid Pathology ◽

History Of ◽

Β Amyloid ◽

Anxiety Depression

ObjectiveTo investigate subjective cognitive decline (SCD) in relation to β-amyloid pathology and to test for associations with anxiety, depression, objective cognition and family history of dementia in the Insight 46 study.MethodsCognitively unimpaired ~70-year-old participants, all born in the same week in 1946 (n=460, 49% female, 18% amyloid-positive), underwent assessments including the SCD-Questionnaire (MyCog). MyCog scores were evaluated with respect to 18F-Florbetapir-PET amyloid status (positive/negative). Associations with anxiety, depression, objective cognition (measured by the Preclinical Alzheimer Cognitive Composite, PACC) and family history of dementia were also investigated. The informant’s perspective on SCD was evaluated in relation to MyCog score.ResultsAnxiety (mean (SD) trait anxiety score: 4.4 (3.9)) was associated with higher MyCog scores, especially in women. MyCog scores were higher in amyloid-positive compared with amyloid-negative individuals (adjusted means (95% CIs): 5.3 (4.4 to 6.1) vs 4.3 (3.9 to 4.7), p=0.044), after accounting for differences in anxiety. PACC (mean (SD) −0.05 (0.68)) and family history of dementia (prevalence: 23.9%) were not independently associated with MyCog scores. The informant’s perception of SCD was generally in accordance with that of the participant.ConclusionsThis cross-sectional study demonstrates that symptoms of SCD are associated with both β-amyloid pathology, and more consistently, trait anxiety in a population-based cohort of older adults, at an age when those who are destined to develop dementia are still likely to be some years away from symptoms. This highlights the necessity of considering anxiety symptoms when assessing Alzheimer’s disease pathology and SCD.

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Levels of anxiety, depression and denial in patients with myocardial infarction

European Psychiatry ◽

10.1016/s0924-9338(97)80204-0 ◽

1997 ◽

Vol 12 (3) ◽

pp. 149-151 ◽

Cited By ~ 4

Author(s):

D Sarantidis ◽

A Thomas ◽

K Iphantis ◽

N Katsaros ◽

J Tripodianakis ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Intensive Care Unit ◽

Family History ◽

Positive Family History ◽

Anxiety And Depression ◽

Previous Myocardial Infarction ◽

History Of ◽

Seeking Help ◽

Anxiety Depression

SummaryIn this study we investigated 1) the changes in anxiety, depression and denial from admission to discharge in patients admitted to the intensive care unit following an acute myocardial infarction and 2) the effect of smoking habits, time lapsed from the appearance of symptoms to seeking help behavior, presence of a person that motivated the patient to seek help, previous myocardial infarction (MI) and family history of MI, on these changes. The results indicated that 1) the levels of both anxiety and depression increased from admission to discharge, while denial decreased; 2) positive family history of MI was associated with lower difference of denial between admission and discharge.

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Clinical trends of scalp alopecia areata: a tertiary care hospital based observational study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20200607 ◽

2020 ◽

Vol 6 (2) ◽

pp. 193

Author(s):

Pallavi Singh ◽

Milind A. Patvekar ◽

Bhavika Shah ◽

Alisha Mittal ◽

Asmita Kapoor

Keyword(s):

Family History ◽

Observational Study ◽

Alopecia Areata ◽

Tertiary Care Hospital ◽

Past History ◽

Tertiary Care ◽

Disease Onset ◽

Epidemiological Data ◽

Care Hospital ◽

History Of

Background: Alopecia areata is one of the commonest types of non-scarring alopecia involving the scalp and/or body. As there is paucity of recent epidemiological data from our country, this study was conducted to determine the latest clinical and epidemiological trends of scalp alopecia areata.Methods: A hospital-based observational study consisting of 100 cases of clinically diagnosed scalp alopecia areata who reported to the Dermatology OPD, Dr. D.Y. Patil Medical College, Pune, was conducted for a period of six months. Socio-demographic and clinical information was collected and clinical examination was performed on all patients. The data was evaluated using appropriate statistical methods.Results: Out of the 100 cases enrolled, males (64%) outnumbered females (36%). The commonest presenting age group was 21-30 years (44%). Disease onset was sudden in 80% patients and 59% cases had a progressive disease course. Majority (75%) had a disease duration of less than 3 months. Majority cases were asymptomatic (80%) with no precipitating factors (90%). Past history and family history of alopecia areata were present in 13% and 9% cases, respectively. Personal and family history of associated diseases were present in 27% and 22% patients, respectively. Most patients had single (61%), patchy (83%) lesions with occiput (45%) being the commonest initial site. Nail changes were present in 22% cases, of which pitting (13%) was the commonest nail finding.Conclusions: This study reflects the clinical profile of scalp alopecia areata in a tertiary care hospital.

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Does a family history of RA influence the clinical presentation and treatment response in RA?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-207670 ◽

2015 ◽

Vol 75 (6) ◽

pp. 1120-1125 ◽

Cited By ~ 6

Author(s):

Thomas Frisell ◽

Saedis Saevarsdottir ◽

Johan Askling

Keyword(s):

Family History ◽

Disease Activity ◽

Treatment Response ◽

Clinical Presentation ◽

Degree Relative ◽

Eular Response ◽

Logistic Regression Models ◽

Drug Survival ◽

Early Ra ◽

History Of

ObjectivesTo assess whether family history of rheumatoid arthritis (RA), among the strongest risk factors for developing RA, also carries information on the clinical presentation and treatment response.MethodsThe prospective Swedish Rheumatology register was linked to family history of RA, defined as diagnosed RA in any first-degree relative, ascertained through the Swedish Multi-Generation and Patient registers. Clinical presentation was examined among patients with early RA 2000–2011 (symptom onset <12 months before inclusion, N=6869), and response to methotrexate (MTX) monotherapy in the subset starting this treatment (N=4630). Response to tumour necrosis factor inhibitors (TNFi) was examined among all patients with RA starting a TNFi as the first biological disease-modifying antirheumatic drug 2000–2011 (N=9249). Association of family history with clinical characteristics, drug survival, European League Against Rheumatism (EULAR) response and change in disease activity at 3 and 6 months was estimated using linear and generalised logistic regression models. Correlation in relatives’ response measures was also assessed.ResultsPatients with early RA with family history of RA were more often rheumatoid factor positive, but with no other clinically meaningful differences in their clinical presentation. Family history of RA did not predict response to MTX or TNFi, with the possible exception of no versus good EULAR response to TNFi at 6 months (OR=1.4, 95% CI 1.1 to 1.7). Having a relative who discontinued TNFi within a year increased the odds of doing the same (OR=3.7, 95% CI 1.8 to 7.5), although we found no significant familial correlations in change in disease activity measures.ConclusionsFamily history of RA did not modify the clinical presentation of RA or predict response to standard treatment with MTX or TNFi. Treatment response, particularly drug survival, may itself be familial.

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

Journal of Affective Disorders ◽

10.1016/j.jad.2006.05.022 ◽

2006 ◽

Vol 96 (1-2) ◽

pp. 127-131 ◽

Cited By ~ 10

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

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Postpartum Psychosis

Postpartum Mental Health Disorders: A Casebook ◽

10.1093/med/9780190849955.003.0006 ◽

2020 ◽

pp. 39-50

Author(s):

Nikole Benders-Hadi

Keyword(s):

Bipolar Disorder ◽

Family History ◽

Elevated Risk ◽

Psychotic Symptoms ◽

Postpartum Psychosis ◽

Poor Sleep ◽

Activity Levels ◽

History Of ◽

Infant Hospitalization ◽

Increased Activity

This chapter on postpartum psychosis notes that the risk of postpartum psychosis in the general population is very rare at less than 1%. In a mother with a known history of schizophrenia, this risk increases to 25%. Psychotic symptoms appearing postpartum may also be evidence of a bipolar disorder. The presence of elevated mood, increased activity levels and energy, poor sleep, and a family history of manic episodes all increase the likelihood that a bipolar disorder is present. Women with a personal or family history of a bipolar disorder are at an elevated risk of developing a mania or depression with psychotic symptoms postpartum. Postpartum psychosis due to any cause is a psychiatric emergency and treatment should be initiated early and aggressively to ensure the safety of mother and infant. Hospitalization and/or separation of the baby and mother may be necessary. The use of medication to treat schizophrenia or bipolar disorder during pregnancy may decrease the risk of a postpartum psychosis. With appropriate postpartum medication and support, the majority of women experiencing postpartum psychosis recover well and the risk of recurrent psychotic symptoms can be greatly reduced.

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Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden

BMC Medicine ◽

10.1186/s12916-020-1498-z ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Louise Lindberg ◽

Emilia Hagman ◽

Pernilla Danielsson ◽

Claude Marcus ◽

Martina Persson

Keyword(s):

Risk Factors ◽

Family History ◽

General Population ◽

Children And Adolescents ◽

Neuropsychiatric Disorders ◽

Obesity Treatment ◽

Sensitivity Analyses ◽

Anxiety And Depression ◽

History Of ◽

Anxiety Depression

Abstract Background Anxiety and depression are more common in children with obesity than in children of normal weight, but it is unclear whether this association is independent of other known risk factors. Interpretation of results from previous studies is hampered by methodological limitations, including self-reported assessment of anxiety, depression, and anthropometry. The aim of this study was to investigate whether obesity increases the risk of anxiety or depression independently of other risk factors in a large cohort of children and adolescents, using robust measures with regard to exposure and outcome. Methods Children aged 6–17 years in the Swedish Childhood Obesity Treatment Register (BORIS, 2005–2015) were included (n = 12,507) and compared with a matched group (sex, year of birth, and area of residence) from the general population (n = 60,063). The main outcome was a diagnosis of anxiety or depression identified through ICD codes or dispensed prescribed medication within 3 years after the end of obesity treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional models were adjusted for several known confounders. Results Obesity remained a significant risk factor for anxiety and depression in children and adolescents after adjusting for Nordic background, neuropsychiatric disorders, family history of anxiety/depression, and socioeconomic status. Girls in the obesity cohort had a 43% higher risk of anxiety and depression compared to girls in the general population (adjusted HR 1.43, 95% CI 1.31–1.57; p < 0.0001). The risk in boys with obesity was similar (adjusted HR 1.33, 95% CI 1.20–1.48; p < 0.0001). In sensitivity analyses, excluding subjects with neuropsychiatric disorders and a family history of anxiety/depression, the estimated risks in individuals with obesity were even higher compared with results from the main analyses (adjusted HR [95% CI]: girls = 1.56 [1.31–1.87], boys = 2.04 [1.64–2.54]). Conclusions Results from this study support the hypothesis that obesity per se is associated with risk of both anxiety and depression in children and adolescents.

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MON-252 Pituitary Tumor Apoplexy Presenting with Acute Psychosis

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1517 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Maria Mercedes Pineyro ◽

Patrica Agüero ◽

Florencia Irazusta ◽

Claudia Brun ◽

Paula Duarte ◽

...

Keyword(s):

Psychiatric Disorders ◽

Pituitary Tumor ◽

Psychiatric Treatment ◽

Psychiatric Symptoms ◽

Mental Illnesses ◽

Psychotic Symptoms ◽

Acute Psychosis ◽

Sellar Mass ◽

History Of ◽

Pituitary Tumor Apoplexy

Abstract Background: Pituitary tumors (PT) can present with neuropsychiatric symptoms. It has been associated with hormonal changes, as well as extension of the tumor to the diencephalon. Psychopathology has been reported in up to 83% in Cushing Disease (CD) and 35% in acromegaly (ACR). Psychiatric disorders (depression, anxiety and psychosis) have been reported up to 77% in CD and 63% in ACR. We present a rare case of a patient presenting with acute psychosis and a PT apoplexy. Case: A 27 year-old Caucasian female with a PMH of primary hypothyroidism presented with a 15-day history of delusions. She had delusional ideas on the subject of harm and prejudice, persecutory and mystical-religious. The mechanism was mainly intuitive and interpretive with false acknowledgments. She also had sleep disturbance, death ideation and subacute alteration of consciousness. There was no history of substance abuse or psychiatric disorders. She did not report headaches, visual disturbances, symptoms of hormone hypersecretion or hypopituitarism. She had regular menses on BCP. She had no family history of mental illnesses. Physical exam revealed reluctance, latency in responses and bradypsychia. She did not have acromegalic or cushingoid features. She was diagnosed with acute psychosis with atypical features so a brain CT was performed, which showed a sellar mass. Pituitary MRI revealed a sellar mass measuring 15x12x13 mm, with suprasellar extension, optic chiasm compression, hyperintense on T1- and hypointense on T2-weighted imaging compatible with subacute hemorrhage. She was treated with neuroleptics and benzodiazepines. Lab work revealed high prolactin (PRL) (114ng/dl), and normal 8 AM cortisol, FT4, LH, FSH and IGF-1 levels. Repeated PRL was 31,6 ng/dl after changing psychiatric treatment to aripiprazole. Her psychiatric symptoms improved. We postulate a diagnosis of PT apoplexy that presented with acute psychosis. In relation to the nature of the PT we postulate a non functioning pituitary adenoma (NFA) or a partial resolution of a prolactinoma after apoplexy. A follow up MRI is pending. Discussion: Infrequently, psychiatric symptoms may be the primary manifestation of brain tumors. Patients with PT have been reported to have altered quality of life, reduced coping strategies, increased prevalence of psychopathological alterations and maladaptive personality disorders. In addition, they can present with psychotic symptoms, mostly reported with hormone excess (GH and cortisol). Psychiatric symptoms such as anxiety and neurosis have been reported in NFA and prolactinomas. However, it is not clear a higher prevalence of psychiatric illnesses in these tumors. To our knowledge this is the first case of a pituitary tumor apoplexy presenting with acute psychosis. Conclusion: Psychiatric symptoms can be the first manifestation of PT, so atypical presentations should warrant further workup with brain imaging.

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Isolated cortical venous thrombosis after fetal demise

BMJ Case Reports ◽

10.1136/bcr-2018-228484 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228484

Author(s):

Mohammad Al-Jundi ◽

Ghassan Al-Shbool ◽

Mohamad Muhailan ◽

Moutasem Aljundi ◽

Christian J Woods

Keyword(s):

Family History ◽

Early Diagnosis ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Presentation ◽

Young Patients ◽

Fetal Demise ◽

History Of ◽

Venous Stroke ◽

Cortical Venous Thrombosis

Isolated cortical venous thrombosis (ICVT) occurring in the absence of dural venous thrombosis, constitutes about 2%–5% of all cerebral venous thrombosis. Its vague, non-specific presentation makes it a difficult and challenging diagnosis that needs an extensive workup especially in young patients. Outcome and prognosis depend mainly on early diagnosis and treatment. Here we discuss the clinical presentation, diagnosis and the treatment of a young woman diagnosed with ICVT with acute ischaemic venous stroke, in the setting of eclampsia and family history of coagulation disease.

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