2^nd International Conference on Psychiatry and Psychiatric Disorders May 02-04, 2016 Chicago, Illinois, USA

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

Dr. AJIT KUMAR ROY is a Neurologist in Kodigehalli, Bangalore and has an experience of 47 years in this field. Dr. AJIT KUMAR ROY practices at Manipal Hospital in Kodigehalli, Bangalore and Manipal Hospital - Old Airport Road in Old Airport Road, Bangalore. He completed MBBS from Prince of Wales Medical College, Patna in 1969, MD - Medicine from Armed Forces Medical College, Pune in 1977 and DM - Neurology from All India Institute of Medical Sciences, New Delhi in 1979.

Seizures are abnormal CNS function presumably caused by “Seizure” discharges from cerebral neurones. Pseudo seizures are episodic abnormal behaviour , which are determined motivationally.In many circumstances the distinction is subtle and may be difficult. Since prognosis treatment and disposal of such cases is different the initial medical investigation, usually by the family physician, plays a pivotal role. He or she must be well versed with the distinctive features of pseudo seizures. Salient features of pseudo seizures are described which may be useful in evaluation.\r\nPseudo seizures are of two types [1]. When the motivation for abnormal behaviour is conscious and purposeful they are called malingering and when the pseudo seizures are motivated subconsciously the condition is psychogenic caused by failure of ego-coping mechanisms.\r\nManifestation of pseudo seizures:\r\nThe most common manifestation of pseudo seizures is motor. There is motor posturing, tremulousness, violent bizarre shaking, jerking, kicking, grimacing, thrusting and rhythmic coordinated movement. Tonic posturing may closely mimic epileptic activity and may be bilateral. In all these movements careful observation would reveal that the patient observes the environment and interacts with it, however , responses to verbal stimuli may be impaired. The individual may have non-specific complaints and show semi purposeful activity. Hyperventilation or breath holding may be present, verbalisation suggesting distress may be reported. Discrete and meticulous note should be made of the setting, which is neutral in case of seizures, where as it is emotionally charged in pseudo seizures. Stereotypy is the hallmark of epileptic attacks whereas pseudo seizure vary with every attack. Seizures appear and disappear slowly and leave the patient dazed for sometime whereas after a pseudo seizure the individual is alert and absolutely normal. Pseudo seizures never occur in sleep and usually result in no injury or cause incontinence of urine and stool. Secondary gains are usually evident in pseudo seizures but may need detailed history taking for elicitation. In contrast to the bizarre presentation of pseudoseizures the clinical picture of seizures follows a distinctive pattern depending upon the type of seizure.\r\n•Laboratory studies that may help are routine metabolic profile. Drug and toxic profile may unravel unknown disorders. Psychiatric and neurologic examination are mandatory. CT scan of the head would help in detection of a structural lesion. Videotelemetry and simultaneous EEG monitoring would help in definitive way but is available only in afew centres in our country. In its absence, repeated and sleep EEG during an attack or soon after it, would rule out seizure disorder. Seizure disorders traversing the limbic structures in the brain cause a rise in serum prolactin and cortisol . This does not happen in case of motor manifestation of pseudo seizures. Levels of prolactin and cortisol estimated soon after a seizure would show a rise\r\n