Open Access Case Study

Acute Psychosis in an 18 Year Old Patient with Heart Failure and Suspected Renal Disease: A Case Report

Chikezie Uzoechi Eze, T. E. Ambakaderemo, Ebuenyi Ikenna Desmond

International Neuropsychiatric Disease Journal, Page 84-89
DOI: 10.9734/INDJ/2015/15570

Psychiatric disorders frequently coexist with medical illnesses. Most literature report on the occurrence of medical illnesses among patients with pre-existing psychiatric disorders.

In this article we report the development of psychosis in a teenager who was being managed for multiple medical conditions (heart failure, suspected renal disease and scrotal sepsis).

Illness factors and medication side effects are possible etiological factors for this.

This case further emphasizes the need for adequate consultation liaison services in the management of persons with multiple medical morbidities.


Open Access Case Study

Reversible Diffusion Restriction is Not Always Correlated with Clinical Recovery in Hypoglycemic Encephalopathy

Koçer Abdulkadir, Hasirci Buse, Okay Münevver, Varoğlu Asuman, Aralaşmak Ayşe

International Neuropsychiatric Disease Journal, Page 90-94
DOI: 10.9734/INDJ/2015/15058

An 84-year-old female patient presented to our emergency department with unconsciousness. She was diabetic and the blood level of glucose was 34 mg/dL. Diffusion-weighted images (DWI) revealed symmetrical hyperintensity in perirolandic regions and posterior aspects of corona radiata. Hypoglycemic encephalopathy was diagnosed. Serum glucose level returned to normal ranges rapidly and abnormal signal on DWI resolved after glucose infusion, but the patient continued to be in coma. The clinical-MRI discrepancy in hypoglycemic encephalopathy is a really crucial issue for clinicians and has not been well-studied. We argued that the disappearance of abnormal signals on DWI does not always indicate a clinical recovery.


Open Access Case Study

Differential Diagnosis and Treatment with Fluoxetine of Selective Mutism: A Case Presentation

Merve Cikili Uytun, Didem Behice Oztop, Salih Uytun

International Neuropsychiatric Disease Journal, Page 100-105
DOI: 10.9734/INDJ/2015/14957

Introductıon: Selective mutism (SM) is a pediatric psychiatric disorder that occurs when a child consistently fails to speak in specific situations in which speaking is expected, such as at school and social gatherings, but speaks appropriately in other settings. Selective mutism is often diagnosed when a child starts school anddoes not talk to teachers or peers, but talks to family members at home; the condition is frequently accompanied with anxiety and shyness.

Case Presentatıon: This case report provides information on the treatment of selective mutism in a 4-year-old Turkish male patient with preexisting behavioral inhibiton. In this case report our patient’s diagnosis is selective mutism predominated by behavioral inhibition.

Management and Outcome: Our patient was referred to the pediatric outpatient clinic with an initial diagnosis of autism due to autistic symptoms such as avoidance of strangers and lack of eye contact. The patient was diagnosed with selective mutism and play therapy was attempted with the child twice but he did not interact with us. Finally we decided to start fluoxetine suspension (5 mg/day). During follow-up, it was seen that there was a marked improvement in behavioral inhibition within one month. It was also seen that the social anxiety-like symptoms of selective mutism were almost resolved.

Conclusıon: Selective mutism is rare with a prevalence below 1% in the general population, but with a higher prevalence in populations at risk. It should be recognized in pediatric and psychiatric clinics. Its differential diagnosis is important for prognosis and treatment. Evidence for treatment strategies is very rare. Fluoxetine is recommended for selective mutism, and we found that it is useful for SM treatment.


Open Access Short Communication

The Role of Herpes Family Viruses in the Pathogenesis of Paranoid Schizophrenia: the Data of Multidimensional Correlations of Immunological, Morphological and Clinical Characteristics

Irina I. Mikhailova, Vera A. Orlova, Vitaly L. Minutko, Irina N. Malisheva, Tatjana P. Berezovskaya

International Neuropsychiatric Disease Journal, Page 74-83
DOI: 10.9734/INDJ/2015/14462

The majority of current researches of participation of herpes viruses in pathogenesis of schizophrenia are aimed at detection of increased specific antibodies level. Works studying polymodal system connections between antibodies to herpes viruses, other immunity parameters, structural brain changes and psychopathology symptoms in schizophrenia do not occur practically.

The aim was to  investigate the systemic relationships present between parameters of the immune system, including the level of serum antibodies to herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), cytomegalovirus (CMV), and Epstein-Barr virus (EBV), structural anomalies of brain and clinical symptoms of schizophrenia.         

Material and Methods: The study included data of investigation of 30 patients with episodic paranoid schizophrenia with progressing and stable defect and positive symptoms in remissions (EPSPSD) (main group) and 32 patients with episodic remittent paranoid schizophrenia (ERPS) (controls). We determined the leukocyte content, the lymphocyte subpopulations and the leukocyte phagocytosis in PHAGOTEST with fluorescein (FITC)-labeled opsonized bacteria and calculated the phagocytic index (PhI), the circulating immune complexes (CIC) level by spectrophotometry. The antibodies against herpes viruses were determined using the ELISA test. Total serum immunoglobulins, IgG, IgM, and IgA were determined by immunoturbidimetry. Clinical psychiatric examination, BPRS and MRI examination were used.

Results: MRI-signs of brain structures abnormalities, including hemodynamic disorders and developmental brain anomalies, were identified. Levels of IgG to studied herpes viruses were increased, levels of IgM to all studied herpes viruses differed from 0. The interactions of morphological, clinical and immunological parameters were defined.

Conclusion: These results demonstrate a definite link between herpes infection and the immune, clinical and morphological parameters of patients with the episodic paranoid schizophrenia with progressing and stable defect. The results confirm the infectious theory of the diseases.


Open Access Original Research Article

Nasal Septum Deviation is Not a Cause of Migraine or Tension Headache

Abdulkadir Koçer, Mehmet Eryılmaz, Hümeyra Dürüyen, Abdullah Belada, Hüseyin Yaman, Süber Dikici

International Neuropsychiatric Disease Journal, Page 95-99
DOI: 10.9734/INDJ/2015/15272

Objective and Aim: Nasal septum deviation (NSD) is an important otorhinolaryngologic cause of headache. We evaluated the frequency of common forms of headache in subjects with NSD.

Methods: All participants underwent examination, 4-mm rigid nasal endoscopy exam. One hundred and eighty six  patients (age ≥20 years) who had a diagnosis of NSD responded to a questionnaire used by neurologists to diagnose migraine and tension type headache. Migraine symptoms and pain severity were recorded using  a 0 to 10 visual analog scale (VAS). Subject’s pain severity of tension type headache was evaluated by VAS. To recruit controls, another  subjects without NSD were enrolled.

Results: A total of 97 subjects (52.2%) suffered from headache. In comparison, 63.7% of controls suffered from headache. In both groups, tension headache and migraine were the most common headache types. The groups were similar in terms of headache types (p > 0.05).

Conclusion: Nasal or sinus disease can not manifest solely as headache. It seems that the presence of nasal disorders are suggested to have been coincidental in relation to headache. A study involving NSD grading is needed for further clarification.