Heather Peluso is a medical student in the Class of 2016 at Philadelphia College of Osteopathic Medicine.
Brain neoplastic changes can present with psychosis or be an aggravating factor in a patient with pre-existing behavioral symptoms. Changes in patients’ behavior or personality may be the first indicator of organic pathology within the brain parenchyma. \r\nPatients over the age of 50, patients with neurological symptoms, or atypical presentations of mental illness mandate neuroimaging with a CT or MRI to rule out organic pathology. \r\n\r\nCase Presentation\r\nA 19 year-old Caucasian male with no past psychiatric history presented with bizarre behavior and confusion over the past week. The patient reported that his friend had exposed him to a “pagan ritual” that destabilized him. He admitted to auditory hallucinations related to God and Lucifer and suicidal ideations. He had some loosening of associations, but provided a cogent history. In the next few days the patient had worsening confusion and continued to have religious delusions. He began confusing the identities of people around him and could not recall conversations held within the same hour. Brain MRI revealed a non-enhancing nodular cortical white matter focus in the right anterior temporal lobe, suggesting a low-grade glioma. \r\n\r\nConclusion\r\nClinicians should be cognizant of underlying brain lesions in patients initially presenting with atypical psychosis. Evaluation of a patient with an atypical presentation of psychosis should routinely include a neuroimaging study for the possibility of a gross lesion. Psychiatric patients with brain lesions may present without neurological findings. The reversibility of psychosis in some patients with brain tumors necessitates the proper diagnosis.\r\n
Dr. S.M. Yasir Arafat; MBBS, MBA, MPH & MD Resident in Psychiatry at Bangabandhu Sheikh Mujib Medical University, Bangladesh, since March 2014. He has 4 publications in international peer-reviewed journals and has experience of presenting papers in international conferences.
Mental illnesses are multifactorial disorders caused by the interaction of genetic and environmentalrnfactors. Multiple lines of evidence suggest that the roles of genetic and environmental factors depend on each other. The aim of the report is to share the presentation of different psychiatric illnesses in generations of a family. A 31 year old male, unmarried, studied up to class eight, unemployed, muslim, non smoker, with average intelligence, hailing from the Dhaka with lower-middle economic background was diagnosed as a case of Schizophrenia. He has very strong family history of mental illness more prominent in male and persistent in generations. Males were affected by schizophrenia, personality disorder and substance related disorder, whereas only one female was affected by depression with suicide. In the patient’s generation, two males were affected with schizophrenia, two male with personality disorder and two with substance related disorder without any presentation in female. In previous generation one male was affected with personality disorder (Father) and one female was suicide committer due to depression (Aunt). There was also presence of male psychotic patients in the grandmother’s family of the patient. Family, twin and adoption studies have shown that, for schizophrenia, autism, manic depressive illness, major depression, attention deficit hyperactivity disorder, panic disorder and other mental illnesses, the transmission of risk was heredity. Our case strongly made us curious to search for any common genetic link between different mental illnesses running in the family.rn