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.
Introduction: Atypical antipsychotic drugs are effective in the treatment of bipolar disorder. Studies have shown that atypical antipsychotic drugs are more superior to typical antipsychotic in term of neurocognitive function, negative symptoms and extrapyramidal side effects. Both aripiprazole and quetiapine are atypical antipsychotic drugs that are effective and commonly used in all phases of bipolar disorder treatment. Objective: The aim of this study is to examine and compare the clinical outcomes of aripiprazole and quetiapine in bipolar disorder patients. Method: This was a retrospective cohort study among patients from psychiatric unit, University Malaya Medical Center. Prescription records dated between January 1, 2013 and December 31, 2014 for psychiatric unit were extracted. The data of the subjects with prescription of the two atypical antipsychotic, namely aripiprazole and quetiapine was extracted. The outcome measures were the co-prescription of antihypertensive drugs, antidiabetic drugs and lipid lowering drugs. Results: A total of 58 subjects were recruited, 11 were on aripiprazole and 47 were on quetiapine. Statistical analysis has shown that both aripiprazole and quetiapine do not have any association with compliance to the medication and also follow up. Study also revealed that there is no association between the aripiprazole and quetiapine group with the metabolic side effects that were measured such as systolic or diastolic blood pressure, waist circumference, weight, glucose level and body mass index. Conclusion: This study has shown that both aripiprazole and quetiapine were similar in terms of metabolic side effect, compliance to medications and follow up.
Although comorbidity of obsessive compulsive disorder (OCD) with schizophrenia is well-established, the occurrence of psychotic symptoms especially hallucinations with OCD still requires further studies. We report a case of a child with OCD who experienced auditory hallucination with the recurrence of his OCD symptoms and the management involved. We discussed the possible differentials when auditory hallucinations occur in the context of OCD.
Neurosyphilis has been known to present with wide array of neuropsychiatric
signs and symptoms. However little is known of the severity of its
manifestations especially in our Malaysia setting. We are reporting a case of
a middle-aged ex-military Malay man who contracted neurosyphilis during
active service and since then had severe neuropsychiatric symptoms which
caused deterioration in his activities of daily living skills which warrants
constant supervision. We discuss the various presentations of neurosyphilis
and its sequelae despite completion of antibiotics treatment.
Chronic subdural hematoma manifests differently and may mimic the
presentation of psychiatric illnesses. Many a time, physicians are quick to
judge that new onset of psychiatric symptoms is due to the worsening of the
existing psychiatric illness. We reported a case of a lady with learning
disability presenting with neuropsychiatric symptoms who was found to have
an acute-on-chronic subdural hematoma. We discussed regarding the new
onset of neuropsychiatric features seen in patients with chronic subdural
hematoma and its management.
Although disturbance of consciousness in delirium patients have been well
established, but sudden drop of Glasgow Coma Scale (GCS) level to three is
frightening and mysterious. We are reporting a case of a delirious elderly
man with multiple medical illnesses presented with acute precipitous
decrement of GCS with pin point pupils bilaterally after given a course of
benzodiazepines and regained full consciousness spontaneously 32 hours
later. We discussed the use of deliriogenic medications in the context of
delirious elderly gentleman with multiple medical illnesses. We also looked
into the possible differentials of sudden drop of conscious level with bilateral
pin point pupils.