Alcohol-induced psychotic disorder (AIPD) is a rare complication of alcohol
abuse which is characterized by an acute onset of auditory or visual
hallucinations that occur either during or after a period of heavy alcohol
consumption. Other symptoms include delusions, thought disorder,
psychomotor disturbances, and abnormal affect. To establish the diagnosis,
one must rule out other disorders such as alcohol withdrawal delirium or
other psychotic disorders. Although it is well recognised, relatively little is
known about the condition. Moreover, the pathogenesis and treatment of
AIPD are still unclear despite high co-morbidity with other psychiatric
disorders, high re-hospitalization as well as mortality rates and suicidal
behaviour. Therefore, the prognosis appears less favourable. We present a
case of young man with AIPD with suicidal attempt secondary to auditory
hallucination.
Objectives: This paper aims to discuss the issue related to the application of temporary insanity plea through a case report of a man who was earlier certified as mentally sound following a murder and suicide attempt. Methods: We report a man who committed murder and attempted suicide 7 years ago, had a psychiatric certification of not having mental illness and recently requested for a second psychiatric assessment. The factors taken into consideration in arriving at the final diagnosis are discussed. Results:The man was found to have brief psychotic disorder precipitated by psychological blow and sleep deprivation with underlying undiagnosed borderline mental retardation.Conclusion: In assessing patient with
temporary insanity plea, various areas in the history need to be explored deeply with thorough investigations to be done in order to arrive at a fair conclusion for the patient’s and victim’s sake.
Objective: To study the demographic data of patients and the pattern of crime in the study group, to look at the outcome of assessment by psychiatrist on fitness to plea and insanity at time of offense and to assess association between the nature of crime with presence of psychopathology during the crime. Method: This is a retrospective study. All available case notes for 342 forensic admissions from January 2007 until March 2010 were reviewed. All related information on 135 patients that committed violent crime was taken for analysis. Result: Majority of patients were male, Malay, single, education up to secondary school and unemployed. Only 38% of patients had encountered psychiatric services, 20% had previous imprisonment and 49% had history of substance usage. In cases involving victims (87%), 64% the victims were known to the patient, 53% had hallucination or delusion or both at the time of crime and 90% was found to have some diagnosis of mental illness after psychiatrist assessment. Only 81% of formal forensic reports were available in the case note and it showed 94% were fit to plea and 82% were at sound mind at the time of offense. Conclusion: Substance abuse had high prevalence among the patient. Almost 2/3 never had any encounter with psychiatric services before the admission. Even with the high percentage of patient diagnosed with mental illness, they were still found to be fit to plea in court and are at sound mind at the time of offense
Objective: The objective of the study is to compare insight in Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis. Also to ascertain if impaired insight is associated with poorer psychosocial function. Method: 90 consecutively'admitted patients who were diagnosed with Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis were administered the scale to assess unawareness to mental illness to measure insight, the global assessment of function to measure psychosocial function and the brief psychiatric rating scale to measure psychosis.
Results: Schizophrenia was found to be associated wit h the poorest insight compared to the affective disorders. Major depression with psychosis was found to be associated with better insight than bipolar affective disorder. Results being significant in both cases. Also it was noted that there was a negative correlation between insight and psychosocial function.
Conclusion: We can conclude that Schizophrenics have the poorest insight followed by bipolar affective disorder with psychosis and then major depressive disorder with psychosis. We also infer that Schizophrenics have the poorest psychosocial function followed by bipolar affective disorder with psychosis and then major depressive disorder patients with psychosis. Also impaired insight is associated with impaired function.
The functional behavior of the thyroid is fundamental in most diseases and represents the basis for diagnosis and therapy. The status can be euthyroidism, hypothyroidism or hyperthyroidism. The psychiatric manifestation varies in different thyroid status. Those with hypothyroidism were described to have depression, psychosis and cognitive dysfunction. Meanwhile, those with hyperthyroidism were found to have psychosis, aggression, anxiety as well as cognitive impairment.
Dissociation, including multiple personality disorder, has long been a controversial topic. Patients with suggestive symptoms are often misdiagnosed as malingering or even having
schizophrenia. The former as a result of the overlooking of a clinician on the fact that suggestibility itself plays a key role in the emergence and perpetuation of this illness and the latter due to the lack of knowledge of the whole dissociative disorder spectrum, often resembling that of a psychotic disorder. Another contributing factor to the small number of patients with this diagnosis is due to the reluctance of a psychiatrist to do so because of his/her lack of experience and also fear of humiliation of being accused of seeking fame from diagnosing this somewhat glamorous phenomenon. In Malaysia, various culture bound syndromes often present with similar symptoms too. This article will attempt to understand this dissociation on the local context using case studies as a reference point.
Objective: This case report highlights psychosis post craniopharyngioma surgery.
Methods: We report a case of a young Malay lady who presented with psychotic symptoms after she underwent craniotomy for craniopharyngioma.
Results: Presence of prominent hallucinations and delusions after removal of the tumour and the symptoms lasted more than a month. The psychosis subsided with antipsychotic.
Conclusion: Psychosis post craniopharyngioma surgery is still possible whether possibly due to the residual tumour or as a result of treatment sequealae.
Wolfram syndrome (WFS) is a rare neurodegerative disorder which is characterized by presentation of diabetes insipidus, juvenile diabetes mellitus, optic atrophy and deafness. We describe a case of WFS with presentation of psychosis. A 17-year-old female presented with psychiatric manifestations, namely inappropriate behaviour and second person auditory hallucination since the age of 16 years. The patient was diagnosed with type 1 diabetes mellitus at the age of 10 years old and subsequently progressive hearing and visual loss a year later. Her ophthalmic evaluation revealed total blindness due to optic atrophy. However she did not have renal dysfunction and diabetes insipidus which are also features of the syndrome. There is scarce literature to describe on psychiatric presentation in WFS. In the past, the psychiatric manifestation which was reported most of times was mood and suicidal behaviour. Hardly any article reported about psychosis (hallucination). We believe, her psychiatric manifestations were related to sensory deprivation due to blindness and deafness caused by the progression of WFS.
Introduction: Auditory hallucination (AH) is often unexplored in depth in clinical practice. This study sought
to ascertain the relationship between AH, depressive symptoms and quality of life (QOL) and its association
with socio-demographic and clinical variables.
Methods: This was a cross sectional study done in a
psychiatry unit involving 60 schizophrenic patients between 18 to 60 years old. Psychotic Symptom Rating
Scale – Auditory Hallucination subscale (PSYRATS-AH), Calgary Depression Scale for Schizophrenia (CDSS)
and World Health Organization Quality of Life-Brief scale (WHOQOL-BREF) were used as instruments.
Results: Alcohol intake was found to be significantly associated with the severity of AH. A significant
moderate positive correlation was found between AH total score and CDSS (r=0.53, p
The dopamine hypothesis of schizophrenia is based on the fact that hyperdopaminergic
state is involved in causing psychosis and antipsychotic drugs block the
dopamine receptor. COMT regulates the homeostatic levels of neurotransmitter
dopamine in the synapses and plays a role in the neurocognitive function. The
dysregulation of dopamine in the prefrontal cortex influences the cognitive function and
the severity of the psychotic symptoms in schizophrenia. During epigenetic event,
methylated COMT gene may cause reduction in its expression and contribute to the
clinical presentation of schizophrenia. Therefore, the aim of this study was to assess the
feasibility of using COMT DNA methylation for the prediction of specific psychotic
presentation of schizophrenia. (Copied from article).
Objective: Lacunar infarct is a small infarct in the distal distribution of deep
penetrating vessels. A silent stroke is not associated with outward symptoms.
The objective of this report is to highlight a case of a silent young stroke
presenting with peduncular hallucinosis.
Methods: This gentleman was
thoroughly investigated and was found to have a lacunar infarct of the Pons
and Occipital Lobe. A further referral to Neurology thereafter; for an in
depth investigation into the cause of this silent young stroke.
Results:
Treatment with low dose antipsychotic resolved the complaints; while the
episode being transient.
Conclusion: Organic psychosis is responsive to
antidopaminergic agents, via action on the Ponto-Geniculo-Occipital
pathways.
Schizencephaly is an uncommon congenital malformation of the central
nervous system which affects the development of the cerebral cortex. It is
defined as the gray matter lined filled cleft with cerebrospinal fluid that
extends from the pial surface to the ventricle. There exists a paucity in
scientific literature regarding the association between schizencephaly and
psychosis. We report a case of a 36-year-old male, presented with worsening
crisis of aggression, disorganized behavior and auditory hallucinations over
20 years. CT brain scan revealed unilateral left open lip schizencephaly, a
finding during his recent admission to the psychiatry ward.
The psychiatric morbidity following hysterectomy has received increasing attention. One of the sequelae of hysterectomy has been a brief, acute psychosis with excellent outcome, the etiology and pathomechanism of which is still unclear. Two Chinese patients born of Southeast Asian origin who manifested brief, acute psychosis following hysterectomy are presented. Therapy comprised drug treatment with low dose antipsychotics and benzodiazepines coupled with hypnosis and marital therapy to explore and treat the underlying pathology. Both psychotic states resolved. Follow-up at 12 months revealed stable mental condition in one subject; however, the second patient was lost to follow up. The impact of the womb's removal is explored in the context of the ethnicity of the patients and their sociocultural background.
Epilepsy surgery has been performed by a few centres in Malaysia, including Hospital Universiti Sains Malaysia (HUSM). To date, a total of 15 patients have undergone epilepsy surgery in HUSM. The epilepsy surgery included anterior temporal lobectomy (ATL) with amygdalohippocampectomy (AH) and Vagal nerve stimulation (VNS). The surgical outcomes of the patients were assessed using the International League Against Epilepsy (ILAE) outcome scale. The ILAE scores for patients who underwent ATL with AH were comparatively better than those who underwent VNS. One of the patient who underwent ATL with AH and frontal lesionectomy was found to have psychosis during follow up. Epilepsy surgery has proven to be an important treatment for medically resistant epilepsy. Thus it is important to raise public awareness regarding epilepsy and its treatment.
We report a case of a 19-year-old immunocompetent Malay woman who presented with a worsening psychotic disorder of 1-year duration. She initially presented with social isolation with subsequent mutism and stupor. Physical examination revealed a stuporous, emaciated, dehydrated woman with Glasgow Coma Scale of 11/15 (E4V2M5). She had a blank stare, mutism and akinesia. Motor examination revealed upper motor neuron findings. Neck stiffness was present, however, Kernig's and Brudzinski's signs were negative. There were no other findings on other systems. Brain imaging and EEG were normal. Cerebrospinal fluid investigations revealed positive cerebrospinal fluid Mycobacterium tuberculosis PCR (MTB PCR). The patient was treated with empirical antituberculosis drugs and steroids. On follow-up visit 1 month later, her psychotic symptoms had fully resolved. She was able to ambulate and care for herself; she was unable to recall the symptoms she had experienced before and during admission.
In a cross-sectional study of 24 Oriental children with systemic lupus erythematosus (SLE) with a mean age of 11.25 years, 75% were found to have clinical and neurophysiological evidence of cerebral lupus. Seizures were the most common manifestation affecting 11 (61%) of the cases, followed by psychosis in five (27.7%), encephalopathy in five (27.7%), headaches in five (27.7%), personality changes in four (22.2%), stroke in three (16.6%), movement disorders in three (16.6%) and myelitis in one child (5.5%). Four children had cerebral lupus as the presenting manifestation of SLE. Twenty-one children had an electroencephalogram (EEG) of which 11 were normal. Abnormalities detected in the rest included focal sharps, slowing of background and electrodecremental changes. There was a poor correlation of EEG with the clinical presentation. Sixteen children with cerebral lupus had a computed tomogram (CT) of which three were normal. The commonest abnormality was cerebral atrophy with or without infarcts. Only four of the cases had lupus anticoagulant but compliment was reduced in 13. Sixteen of the cases also had renal involvement. Treatment was generally with steroids with only two patients receiving cyclophosphamide for cerebral relapse. Eight children (44%) made a full recovery. Learning disability was the most frequent sequelae affecting one-third of children seen at a 1-year follow up. Four (22%) had epilepsy, two (11%) had motor deficits and one child had optic atrophy. One child died of cerebral haemorrhage during a hypertensive crisis.
A total of 23 patients with psychoses associated with thyrotoxicosis were admitted to the psychiatric unit of a University Hospital over a 13-year period, of which 20 patients were included in this retrospective study. It was found that a parallel relationship between thyrotoxicosis and psychosis appears to exist in six patients, while in the remaining 14 patients, the course of the two disease processes were largely independent of each other. Paranoid delusions and auditory hallucinations were the most prominent psychiatric symptoms. Depression was commonly seen even in patients who were not having an affective illness. In four patients, a mixed schizo-affective psychosis was seen, suggesting that the diagnostic distinction between the affective and schizophrenic reactions are often blurred in psychosis associated with thyrotoxicosis.
This study examines twenty-four cases of amok, believed the largest number of cases ever collected. They were observed in Sarawak, East Malaysia. They occurred in all indigenous groups in Sarawak, excluding the Chinese, such as Malay, Sea Dayak, Land Dayak, Kayan, Punan and Melanau at frequencies more or less following the proportion of these groups in the total population. No differences were found according to religion, the Malay being Muslim and the other groups either predominantly Christian like the Iban or animistic. Only slight diminution in the frequency was observed from 1954 to 1968. The education level of the amok runners was much lower than that of the average population. The weapons used were those immediately at hand be it parang (short sword), ax, sticks, knives, guns, bare hands or a lorry. The classical four stages were largely present: (a) brooding and withdrawal, (b) homicidal paroxysm, (c) continuation of homicidal behaviour until killed, restrained or falling into stupor of exhaustion, (d) complete or partial amnesia. While in 14 no motive could be ascertained, insult, jealousy and paranoid ideation was present in the others. Both family history of mental illness and personal psychiatric history were predominant. All cases fell into accepted diagnostic categories from organic and endogenous psychosis to neurosis and behaviour disorder.