http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 23 May 2013 18:04:11 +0000 http://www.hindawi.com/crim/psychiatry/2013/486064/ Geschwind syndrome has been described in patients with temporal lobe epilepsy and is characterized by sexual behavioural disorders, hyperreligiosity, hypergraphia, and viscosity. Presented here is a case of a 53-year-old man with clinical findings consistent with Geschwind syndrome in the setting of a known diagnosis of schizoaffective disorder, with no identifiable comorbid illness of temporal lobe epilepsy or frontotemporal dementia. Brain MRI showed bilateral temporal lobe atrophy greater than would be expected for age and more prominent on the left side than the right. It is likely that these structural abnormalities may be related to this patient’s clinical presentation of Geschwind syndrome. To our knowledge, this is the first reporting of a case of Geschwind syndrome in the setting of schizoaffective disorder. These symptoms of Geschwind syndrome were present irrespective of mental state status. The report highlights the importance in correct identification of underlying cause and differentiation between Geschwind syndrome and schizoaffective disorder in order to avoid mistreatment and consequent iatrogenic adverse events. Kara O'Connell, Joanne Keaveney, and Raymond Paul Copyright © 2013 Kara O'Connell et al. All rights reserved. Thu, 16 May 2013 13:32:22 +0000 http://www.hindawi.com/crim/psychiatry/2013/136194/ Acute dystonic reactions are becoming much less prevalent in clinical practice due to the use of newer antipsychotics. Drug-drug interactions, patient characteristics, and environmental and genetic factors all contribute to the rate of occurrence of acute dystonia with second generation agents. In this case, we report a glossopharyngeal dystonia secondary to a lurasidone-fluoxetine CYP-3A4 interaction to highlight the importance of maintaining an index of suspicion for laryngeal dystonia, a potentially fatal dystonia. Sean Paul, Brian K. Cooke, and Mathew Nguyen Copyright © 2013 Sean Paul et al. All rights reserved. Thu, 16 May 2013 11:02:57 +0000 http://www.hindawi.com/crim/psychiatry/2013/913248/ Delusional parasitosis is characterized by the false idea that own body is infested by invisible mites, insects, or other parasites. This case report describes a 24-year-old woman with delusional parasitosis who was treated with ziprasidone monotherapy (120 mg/day) with a complete remission of delusion and followed for one year without symptom recurrences. These findings, although preliminary, indicate that further investigation of ziprasidone monotherapy for the treatment of delusional parasitosis is warranted in further trials. Domenico De Berardis, Nicola Serroni, Stefano Marini, Gabriella Rapini, Alessandro Valchera, Michele Fornaro, Monica Mazza, Felice Iasevoli, Giovanni Martinotti, and Massimo Di Giannantonio Copyright © 2013 Domenico De Berardis et al. All rights reserved. Thu, 16 May 2013 07:59:36 +0000 http://www.hindawi.com/crim/psychiatry/2013/926395/ Several neurological side effects induced by tacrolimus are described in the scientific literature, ranging from mild neurological symptoms to delirium and psychosis. We report the case of a 46-year-old man with no prior psychiatric history who suddenly manifested manic-like psychosis associated with elevated trough tacrolimus blood concentrations 17 years after kidney transplant. The use of antipsychotics may improve the severity of symptoms; but in order to obtain a complete remission, the reduction in the dose of tacrolimus, or its replacement with alternative immunosuppressant therapies, is recommended. Giuseppe Bersani, Pietropaolo Marino, Giuseppe Valeriani, Valentina Cuoco, Claudia Zitelli, Claudia Melcore, and Francesco Saverio Bersani Copyright © 2013 Giuseppe Bersani et al. All rights reserved. Sun, 12 May 2013 17:44:47 +0000 http://www.hindawi.com/crim/psychiatry/2013/124719/ Challenges encountered in the diagnosis and treatment of frontotemporal dementia (FTD) are further confounded when presented with comorbid psychiatric disorder. Here we report a case of progressive FTD in a patient with a long history of bipolar affective disorder (BAD) 1, depressed type. We also report beneficial effects of electroconvulsive therapy and its potential application in similar comorbid disorders. Sean Paul, Jennifer Goetz, Jeffrey Bennett, and Tessy Korah Copyright © 2013 Sean Paul et al. All rights reserved. Mon, 04 Mar 2013 11:52:47 +0000 http://www.hindawi.com/crim/psychiatry/2013/617251/ We report a unique case of an adverse interaction between the oxazolidinone antibiotic linezolid, the tricyclic antidepressant amitriptyline and the opioid analgesic fentanyl in a 68-year-old woman with advanced ischemic peripheral arterial disease and sepsis, under empirical antibiotic treatment. We also summarize the current relevant literature as identified via PubMed, EMBASE, and PsycINFO as well as reference sections of selected articles. Lampros Samartzis, Paraskevi Savvari, Sofoklis Kontogiannis, and Stavros Dimopoulos Copyright © 2013 Lampros Samartzis et al. All rights reserved. Thu, 28 Feb 2013 09:19:15 +0000 http://www.hindawi.com/crim/psychiatry/2013/718950/ Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings. Maria Skokou and Philippos Gourzis Copyright © 2013 Maria Skokou and Philippos Gourzis. All rights reserved. Wed, 06 Feb 2013 11:35:20 +0000 http://www.hindawi.com/crim/psychiatry/2013/197323/ This paper described the application and feasibility of exposure therapy treatment (ET) for posttraumatic stress disorder (PTSD) in a multitraumatized tortured refugee with chronic PTSD and depression, in need of an interpreter. The patient received 26 one-hour sessions of ET involving exposure to his trauma-related memories. Symptoms of PTSD, depression, and anxiety were assessed at pre- and posttreatment and 3-, 6-, and 12-month followup with the Harvard Trauma Questionnaire (HTQ-R), PTSD Symptom Scale-Self Report (PSS-SR), Major depression inventory (MDI), and Beck Anxiety Inventory (BAI). Treatment led to a significant improvement across all measures of posttraumatic stress disorder, anxiety, and depression, and the improvement was maintained at the 12-month follow-up. The results from this case study provide further preliminary evidence that ET may be effective in treating multi-traumatized torture survivors who are refugees and in need of an interpreter, despite the additional stressors and symptoms complexity experienced by tortured refugees. Bo Søndergaard Jensen Copyright © 2013 Bo Søndergaard Jensen. All rights reserved. Wed, 30 Jan 2013 10:45:19 +0000 http://www.hindawi.com/crim/psychiatry/2013/367594/ Nowadays, the misuse of benzodiazepines (BZDs) is a cause for a serious concern among pharmacologically inexperienced patients, whether treated or untreated, that could lead to significant complications, including tolerance, dependence, and addiction. We present a case report in which an Italian patient affected by anxiety disorder and treated with BZDs presented a severe case of dependence on BZDs. We treated him according to an agonist substitution approach, switching from the abused BZD to a slow-onset, long-acting, high potency agonist (clonazepam), and looking at the methadone treatment model as paradigm. We decided to use clonazepam for its pharmacokinetic properties. The advantage of choosing a slow-onset, long-lasting BZD for the treatment of our patient was that it led us to a remarkable improvement in the clinical situation, including the cessation of craving, absence of withdrawal symptoms, reduced anxiety, improvements in social functioning, and a better cognition level. Angelo Giovanni Icro Maremmani, Luca Rovai, Fabio Rugani, Silvia Bacciardi, Matteo Pacini, Liliana Dell'Osso, and Icro Maremmani Copyright © 2013 Angelo Giovanni Icro Maremmani et al. All rights reserved. Wed, 30 Jan 2013 08:02:52 +0000 http://www.hindawi.com/crim/psychiatry/2013/381261/ The aim of this paper is to report the first case of atomoxetine leading to false-positive urine drug screen. An otherwise healthy 27-year-old female with a history of attention deficit hyperactivity disorder (ADHD) treated with atomoxetine had an acute onset tonic-clonic seizure. On arrival to the hospital, a urine toxicological drug screen with immunochemical cloned enzyme donor immunoassay (CEDIA) was performed. Results were positive for amphetamines; however, the presence of these substances could not be confirmed with urine gas chromatography-mass spectrometry (GC-MS). She denied any illicit drug use, herbal medications, or supplements, and her other prescription medications have not been previously known to cause a false-positive result for amphetamines. While stimulant treatments for ADHD could certainly result in a positive result on urine screen for amphetamines, there have been no reports of false-positive results for amphetamines secondary to patients using atomoxetine. We implicate atomoxetine, and/or its metabolites, as a compound or compounds which may interfere with urine drug immunoassays leading to false-positive results for amphetamines CEDIA assays. Joshua L. Fenderson, Amy N. Stratton, Jennifer S. Domingo, Gerald O. Matthews, and Christopher D. Tan Copyright © 2013 Joshua L. Fenderson et al. All rights reserved. Mon, 17 Dec 2012 13:15:31 +0000 http://www.hindawi.com/crim/psychiatry/2012/394603/ Obsessive compulsive disorder (OCD) is one of the most frequently occurring psychiatric conditions in older adults. While exposure and response prevention (ERP) is considered the most effective psychological treatment for children and adults with OCD, research investigating its effectiveness for older adults is scarce. This clinical case study investigates the effectiveness of ERP in an 80-year-old man with a 65-year history of OCD. The client received 14 individual, 50-minute ERP treatment sessions. Clinician-based Y-BOCS scores reduced by 65% from 20 (moderate) at pretreatment to 7 (subclinical) at 7-month posttreatment followup. OCI-R total scores reduced by 45% from 38 at baseline to 21 at 7-month follow-up. Despite his long history of the disorder, ERP was effective and well tolerated. The application of ERP for older adults with OCD, including age-specific modifications that may be required for this treatment approach, is discussed. Mairwen K. Jones, Bethany M. Wootton, and Lisa D. Vaccaro Copyright © 2012 Mairwen K. Jones et al. All rights reserved. Thu, 13 Dec 2012 18:10:54 +0000 http://www.hindawi.com/crim/psychiatry/2012/368039/ The efficacy of behavior therapy based mainly on real-life exposure situations as well as applied tension was examined for a combined case of blood-injury-injection (BII) phobia and social anxiety disorder. Treatment involved 28 behavior therapy sessions, while applied tension technique was also described and practiced. The specific contribution of social skills techniques, fantasy, and real-life situations exposure was examined in a single case design. The subject was a 39-year-old male with anxiety symptoms when confronting an audience, as well as symptoms of the autonomic nervous system (bradycardia and syncope), which were better explained by BII. All self-report measures regarding fear, social phobia, and anxiety were reduced after behavior therapy and remained maintained at followup, while BII decreased further after applied tension techniques. The contribution of behavior therapy to the overall outcome of the case is considered significant for many reasons that are discussed in the pape. Fotini Ferenidou, Theodoros Chalimourdas, Velissarios Antonakis, Nikolaos Vaidakis, and Georgios Papadimitriou Copyright © 2012 Fotini Ferenidou et al. All rights reserved. Thu, 13 Dec 2012 11:04:34 +0000 http://www.hindawi.com/crim/psychiatry/2012/347421/ Background. During the past few years, there have been a number of case reports concerning rhabdomyolysis following quetiapine poisoning; however, there has been none concerning the medication in its extended-release form. Methods. We present the case report of a 48-year-old man presenting a major depressive disorder and borderline personality disorder, who after voluntary intoxication with 12000 mg of quetiapine extended-release developed signs of acute rhabdomyolysis. Results. The rhabdomyolysis was confirmed by the laboratory and the clinical findings, with elevated levels of creatinine, creatine phosphokinase, and CRP. Discussion. We would like to pinpoint the importance of this complication and our concern of prescribing it for psychiatric patients with chronic somatic comorbidities. Antonios Liolios and Othman Sentissi Copyright © 2012 Antonios Liolios and Othman Sentissi. All rights reserved. Tue, 11 Dec 2012 19:13:20 +0000 http://www.hindawi.com/crim/psychiatry/2012/798512/ In the neurodevelopment of adolescent anorexia nervosa (AN), dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is proposed to be a central component. Furthermore, a therapeutic milieu focusing on affect regulation can contribute much to treatment, given the emotional processing difficulties associated with this disorder. Studies of HPA axis function following such specialist treatments for adolescent AN, however, are rare. This study describes the diurnal pattern of HPA axis activation, including the cortisol awakening response (CAR), in a 16-year-old female diagnosed with AN both during illness and at clinical recovery following milieu therapy with a focus on affect regulation. Specialised single-case study statistics were used to assess whether the patient's data were significantly different from the healthy “norm” at illness and recovery. During illness, her measure of affective problems was outside of the normal range and cortisol and DHEA secretory profiles were significantly elevated across the diurnal period. However, at recovery both her affective state and HPA axis function became comparable to healthy controls. This case study suggests that salivary markers of HPA axis function can be feasibly incorporated into the clinical regime within a specialist adolescent AN residential service and could be used by clinicians to monitor prognosis and interventions. Andrea Oskis, Catherine Loveday, Frank Hucklebridge, David Wood, and Angela Clow Copyright © 2012 Andrea Oskis et al. All rights reserved. Wed, 28 Nov 2012 12:21:13 +0000 http://www.hindawi.com/crim/psychiatry/2012/730151/ Patients with dural arteriovenous fistulas (DAVFs) in the transverse-sigmoid sinus suffer from several symptoms: bruit, headache, visual impairment, and so on. But depression is rare in patients with DAVF. The authors reported a rare case presenting the improvement of depression after the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmann's syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmann's syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans. Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Chihoko Sakamoto, and Kenjiro Fujiwara Copyright © 2012 Minoru Nakagawa et al. All rights reserved. Tue, 20 Nov 2012 12:35:10 +0000 http://www.hindawi.com/crim/psychiatry/2012/215214/ The serotonin syndrome, which is characterized by psychiatric, autonomic nervous and neurological symptoms, is considered to be caused by excessive stimulation of the 5-HT1A and 5-HT2 receptors in the gray matter and spinal cord of the central nervous system, after the start of dosing or increase of the dose of a serotoninergic drug. There have been hardly any reports of induction of serotonin syndrome by electroconvulsive therapy (ECT) in combination with antidepressant. We present the case of a female patient with major depressive disorder (MDD) who developed transient serotonin syndrome soon after the first session of ECT in combination with paroxetine. Paroxetine was discontinued, and her psychiatric, autonomic nervous and neurological symptoms were gradually relieved and disappeared within 2 days. We performed the second ECT session 5 days after the initial session and performed 12 sessions of ECT without any changes in the procedure of ECT and anesthesia, but no symptoms of SS were observed. Finally, her MDD remitted. ECT might cause transiently increased blood-brain barrier (BBB) permeability and enhance the transmissivity of the antidepressant in BBB. Therefore, it is necessary to pay attention to rare side effect of serotonin syndrome by ECT in combination with antidepressant. Nagahisa Okamoto, Kota Sakamoto, and Maki Yamada Copyright © 2012 Nagahisa Okamoto et al. All rights reserved. Wed, 14 Nov 2012 15:42:46 +0000 http://www.hindawi.com/crim/psychiatry/2012/585303/ Electroconvulsive therapy (ECT) is commonly used in the management of medication nonresponsive depressive disorder, with proven efficacy in psychiatric practice since many decades. A rare complication of intracranial bleed following this therapeutic procedure has been reported in sporadic case reports in the English literature. We report a case of such a complication in a 42-year-old male, a known case of nonorganic medication nonresponsive depressive disorder for the last two years who required ECT application. Presenting symptoms included altered mental state, urinary incontinence, and repeated episodes of vomiting; following ECT procedure with magnetic resonance imaging (MRI) of the brain suggestive of bilateral acute subdural hematoma. Despite the view that it may be used in neurological conditions without raised intracranial tension, it will be worthwhile to be vigilant during post-ECT recovery for any emergent complications. Ranganath R. Kulkarni and Sateesh Melkundi Copyright © 2012 Ranganath R. Kulkarni and Sateesh Melkundi. All rights reserved. Mon, 12 Nov 2012 16:17:40 +0000 http://www.hindawi.com/crim/psychiatry/2012/720354/ Background. Delirious mania (DM) as a clinical entity is well described, yet is often unrecognized in clinical practice. While most often misdiagnosed as acute psychotic episodes of organic delirium, these patients meet the criteria for mania with attendant delirium and pose therapeutic challenges. In addition to the case presentation, this paper also discusses the available literature on DM. Case Presentation. A 29-year-old man with DM was treated with a combination of electroconvulsive therapy (ECT), divalproex 2000 mg/day, loxapine 100 mg/day, and lorazepam 4 mg/day. He demonstrated clinically significant improvement by day 10, which persisted through the twelve-month follow-up period. Conclusions. DM is a severe psychiatric syndrome which should be accurately diagnosed. Patients with DM should be treated aggressively, especially with ECT. Lack of recognition of DM can lead to serious morbidity or fatal outcomes. Though the concept of DM is well established, recent psychiatric literature does not make a mention of this life threatening yet treatable condition. We propose that there is a dire need to keep this concept alive. Rajshekhar Bipeta and Majeed A. Khan Copyright © 2012 Rajshekhar Bipeta and Majeed A. Khan. All rights reserved. Mon, 05 Nov 2012 15:45:32 +0000 http://www.hindawi.com/crim/psychiatry/2012/427698/ Mild cognitive impairment is a clinical condition more frequent in patients with Parkinson's disease than in general population. The nonamnestic presentations, usually characterized by executive dysfunction, are most prevalent. We present a case report of a Parkinson’s disease patient diagnosed with nonamnestic mild cognitive impairment that showed complete remission of cognitive symptoms after one year. We discuss the possible causes for the remission, focusing on the treatment of medical conditions such as a major depressive episode and vitamin B12 deficiency, in addition to the change of pharmacological treatment. In a third assessment, cognitive performance remained normal. The case report highlights the importance of controlling clinical comorbidities on the assessment and followup of mild cognitive impairment, especially on Parkinson’s disease. Jonas Jardim de Paula, Marco Túlio Gualberto Cintra, Débora Marques Miranda, Maria Aparecida Camargos Bicalho, Edgar Nunes Moares, and Leandro Fernandes Malloy-Diniz Copyright © 2012 Jonas Jardim de Paula et al. All rights reserved. Thu, 11 Oct 2012 15:05:14 +0000 http://www.hindawi.com/crim/psychiatry/2012/520689/ Purpose of Research. Numerous studies have reported comorbidities, overlapping symptoms, and shared risk factors among cases of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). We present three adolescent males aged 13–16 years with conduct disorder having past history of ADHD and ODD. Principal Result. The symptom profile especially in domains of aggression, hostility, and emotionality as well as the manner of progression from ADHD to ODD and CD in the above cases shows a similar pattern. Conclusion. These common developmental pathways and overlapping symptoms suggest the possibility of a common psychopathological spectrum encompassing the three externalizing disorders. Sayanti Ghosh and Mausumi Sinha Copyright © 2012 Sayanti Ghosh and Mausumi Sinha. All rights reserved. Thu, 11 Oct 2012 11:31:43 +0000 http://www.hindawi.com/crim/psychiatry/2012/503023/ The aim was to assess the efficacy of a modified version of Goal Management Training (GMT) in a person with schizophrenia who had difficulties in attaining the final goal for new and multitasking daily-life situations. GMT is designed to improve abilities in establishing goal-directed plans and carrying them out effectively. Beneficial effects of GMT were measured for several clinical questionnaires, laboratory tasks, and three real-life situations: meal preparation (trained, familiar); washing (nontrained, familiar); meeting preparation (nontrained, unfamiliar). The results revealed improvement in planning and on trained laboratory and meal preparation tasks and a generalization of GMT effects on nontrained laboratory and everyday tasks. Self-esteem also improved. Finally, a two-year followup indicated the durability of the beneficial effects. M.-N. Levaux, F. Larøi, M. Malmedier, I. Offerlin-Meyer, J.-M. Danion, and M. Van der Linden Copyright © 2012 M.-N. Levaux et al. All rights reserved. Thu, 11 Oct 2012 11:17:00 +0000 http://www.hindawi.com/crim/psychiatry/2012/627460/ In the field of psychogeriatrics, the differential diagnosis of depression and dementia, as well as the treatment of depression and comorbid dementia, is an important issue. In this paper, the authors present the case of a 72-year-old woman with Cotard’s syndrome and frontotemporal dementia (FTD) who was admitted to a psychiatric hospital with delusions of negation accompanied by depressive symptoms. Pharmacotherapy over a 2-year hospitalization was unsuccessful, and she was subsequently transferred to our university hospital. A total of 18 sessions of electroconvulsive therapy released her from psychomotor inhibition, appetite loss, and Cotard’s delusions. The indication for electroconvulsive therapy in patients with dementia is discussed. Toshiyuki Kobayashi, Koju Inoue, Katsutoshi Shioda, and Satoshi Kato Copyright © 2012 Toshiyuki Kobayashi et al. All rights reserved. Tue, 09 Oct 2012 18:14:29 +0000 http://www.hindawi.com/crim/psychiatry/2012/642752/ Obsessive-compulsive disorder (OCD) is a chronic condition characterized by obsessions or compulsions that cause distress or interfere with functioning. Selective serotonin reuptake inhibitors are the first-line strategy in the treatment of OCD, but approximately 40% to 60% of patients with OCD fail to respond to them. Several augmentation strategies have been proposed, including the use of atypical antipsychotics and antidepressant combinations. In the present paper we describe the case of a young female patient suffering from severe treatment-resistant OCD who remitted as a result of agomelatine augmentation of escitalopram therapy. Domenico De Berardis, Nicola Serroni, Stefano Marini, Giovanni Martinotti, Francesca Ferri, Gaetano Callista, Raffaella La Rovere, Francesco Saverio Moschetta, and Massimo Di Giannantonio Copyright © 2012 Domenico De Berardis et al. All rights reserved. Tue, 02 Oct 2012 13:12:21 +0000 http://www.hindawi.com/crim/psychiatry/2012/937518/ Introduction. Frontotemporal dementia is a disorder of complex etiology, with genetic components contributing to the disease. The aim of this report is to describe a young patient suffering from frontotemporal dementia, misdiagnosed as schizophrenia, related to a genetic defect on chromosome 1. Case Presentation. A 29-year-old female patient, previously diagnosed as having schizophrenia, was hospitalized with severe behavioural disturbances. She demonstrated severe sexual disinhibition, hyperphagia, lack of motivation, apathy, psychotic symptoms, suicidal thoughts, and cognitive deterioration. Focal atrophy of frontal and anterior temporal structures bilaterally was found on brain MRI, as well as bifrontal hypo perfusion of the brain on SPECT scan. The diagnosis of frontotemporal dementia was made clinically, according to Lund and Manchester groups and Neary diagnostic criteria. Chromosomal analysis was conducted and revealed decrease in length of heterochromatin on the long arm of chromosome 1 (46, XX, 1qh-). Parental karyotypes were normal. Discussion. Frontotemporal dementia, and particularly early-onset cases, can be often misdiagnosed as schizophrenia, with negative impact on case management. Genetic testing could be an aid to the correct diagnosis, which is crucial for optimal patient care. Philippos Gourzis, Maria Skokou, Panagiotis Polychronopoulos, Evanthia Soubasi, Irene-Eva Triantaphyllidou, Christos Aravidis, Antonia-Ioanna Sarela, and Zoe Kosmaidou Copyright © 2012 Philippos Gourzis et al. All rights reserved. Tue, 02 Oct 2012 11:20:16 +0000 http://www.hindawi.com/crim/psychiatry/2012/596162/ Cognitive adaptation training (CAT) improves functional outcome in outpatients with schizophrenia living in the United States of America. The efficacy of CAT has never been demonstrated for patients living in a residential facility. We describe how CAT was delivered to two chronically hospitalized patients with schizophrenia living in The Netherlands. CAT was delivered for 8 months, and consisted of weekly home visits by a psychiatric nurse. Both patients improved on measures of functional outcome used in the US studies. These results indicate that CAT may improve outcomes, even in patients that have been hospitalized for several years. Piotr J. Quee, Harald Schneider, Saskia van Slogteren, Durk Wiersma, Richard Bruggeman, and Dawn I. Velligan Copyright © 2012 Piotr J. Quee et al. All rights reserved. Sun, 30 Sep 2012 09:31:20 +0000 http://www.hindawi.com/crim/psychiatry/2012/747104/ Background. Previous studies suggested dysfunction of the autonomic nervous system (ANS) in schizophrenia patients, but the mechanism remains unclear. Recently, the measurement of salivary alpha-amylase (sAA) has been considered a useful tool for evaluating ANS, especially the sympathoadrenal medullary system. Furthermore, there was a report that patients with schizophrenia showed much higher sAA level than normal controls. Methods. We present the case of a 51-year-old female with catatonic schizophrenia. She needed the treatment of electroconvulsive therapy (ECT). We evaluated her sAA level and her psychiatric symptoms during the treatment. Results. Before ECT treatment, she showed high sAA level. Her sAA level decreased during the course of ECT, and this attenuation was accompanied by improvement of schizophrenic symptoms. Conclusion. We consider that measurement of the sAA level may be one of the useful biological markers for assessment of psychotic state and efficacy of treatment in patients with schizophrenia. Masa Ieda, Tsuyoshi Miyaoka, Kiminori Kawano, Rei Wake, Takuji Inagaki, and Jun Horiguchi Copyright © 2012 Masa Ieda et al. All rights reserved. Sun, 30 Sep 2012 08:28:11 +0000 http://www.hindawi.com/crim/psychiatry/2012/851785/ Obsessive compulsive disorder is still considered primarily an anxiety disorder, though historically there has always been a question of whether obsessive-compulsive symptoms may be more properly considered psychotic in nature, the so-called schizo-obsessive disorder or subtype. A case is presented here of a middle-aged man with debilitating obsessive-compulsive symptoms of sudden onset in his late teens. Given the nature of onset and symptomatology, and the failure of prior therapies, the case was approached as a primary psychotic disorder. The neuroleptic-naive patient had remarkable response to low-dose antipsychotic medication, as well as to psychodynamic psychotherapy modeled along the lines of neuroplasticity. The case illustrates the blurred distinctions among anxiety, mood, and psychotic disorders and the improved outcomes when the proper underlying disorder is addressed. Elliott B. Martin Jr. Copyright © 2012 Elliott B. Martin Jr. All rights reserved. Sat, 29 Sep 2012 14:29:47 +0000 http://www.hindawi.com/crim/psychiatry/2012/261251/ Pulmonary embolism is a serious, life-threatening condition and most commonly derives from deep vein thrombosis of the lower extremities. Once deep vein thrombosis (DVT) reaches a proximal vein (i.e., popliteal vein or higher), pulmonary embolism reportedly occurs in up to 50% of patients. Case Presentation. We report on an inpatient with major depressive disorder in a catatonic state in whom an asymptomatic proximal deep vein thrombosis of 11 × 70 mm was detected through routine screening, using doppler ultrasound scanning. Anticoagulant therapy was immediately started and continued for three months, which resulted in resolution of the deep vein thrombosis. Discussion. To our knowledge, this is the first description of asymptomatic proximal DVT that was detected in a psychiatric inpatient setting. In light of the reported causal relationship between DVT and pulmonary embolism, screening for DVT can be of high clinical value in patients with psychiatric disorders, especially when their physical activity is highly compromised. Takuto Ishida, Takeshi Katagiri, Hiroyuki Uchida, Takefumi Suzuki, Koichiro Watanabe, and Masaru Mimura Copyright © 2012 Takuto Ishida et al. All rights reserved. Sun, 23 Sep 2012 13:56:16 +0000 http://www.hindawi.com/crim/psychiatry/2012/497160/ Tourette syndrome (TS) is a neurodevelopmental disorder with chronic and disabling impacts on multiple domains of functioning in children. Treatment of TS is often complicated by comorbid conditions. We present a 12-year-old boy with severe symptoms of Tourette syndrome (TS), with prominent and markedly disabling vocal tics, who failed to respond to substantial doses of risperidone and haloperidol, given for a prolonged period. Satisfactory outcome was achieved with exposure and response prevention, adjunct to medication. Comorbid ADHD was treated with stimulants with no exacerbation of tics. Hemamali Perera and Chittahari Abayanayaka Copyright © 2012 Hemamali Perera and Chittahari Abayanayaka. All rights reserved. Wed, 05 Sep 2012 09:42:23 +0000 http://www.hindawi.com/crim/psychiatry/2012/624235/ Objectives. To explore factors underlying the onset of delusional parasitosis; a condition in which an individual has a fixed, false belief that he/she is infested with insects. Case Description. MJ is a 57-year-old female who presents with symptoms of fatigue and AD/HD. Upon treatment with extended release mixed amphetamine salts, the patient displayed symptoms of delusional parasitosis. After eventual discontinuation of this medication, her delusions resolved. Comments. In order to maintain confidentiality, all identifying information was removed. To this end, please note that MJ is a fictitious name. Martha Buscarino, Jaime Saal, and Joel L. Young Copyright © 2012 Martha Buscarino et al. All rights reserved.