RESUMEN
OBJECTIVE: The aim of this study is to equalize the influence of age-related changes and to test the hypothesis that specific structural brain changes are mediating the development of unique clinical features in late-onset paranoid psychosis (LOPP). BACKGROUND: Findings of unique white matter lesions have been recently described in patients with LOPP. These findings have not been consistent, however, when age-matched normal subjects have been used as a control group. METHOD: Magnetic resonance imaging data were compared in 13 patients with LOPP, mean age 66.33, and 35 elderly patients with early-onset paranoid schizophrenia (PSCH), mean age 63.89. Patients in the LOPP group differed from the PSCH group by the mild degree or absence of negative symptoms, the absence of formal thought disorders, and by prevalence of female patients. RESULTS: Analysis of the magnetic resonance imaging data revealed statistically significant differences between the LOPP and PSCH groups. White matter hyperintensity was almost threefold more frequent in LOPP than in PSCH groups, 69.2% versus 22.9% respectively. Ventricular enlargement and cortical atrophy were more frequent in the PSCH group, reaching, for moderate to severe abnormalities, 28.6% for ventricular enlargement and 22.9% for cortical atrophy; moderate to severe abnormalities were absent in all 13 patients of the LOPP group. CONCLUSIONS: These data point to the possibility that late-onset paranoid psychosis is a distinct clinicopathological entity, with white matter hyperintensity mediating the development of LOPP in a significant percentage of the cases. The vascular origin of white matter lesions in LOPP is suggested.
Asunto(s)
Encéfalo/patología , Trastornos Paranoides/diagnóstico , Esquizofrenia Paranoide/diagnóstico , Edad de Inicio , Anciano , Trastornos Cerebrovasculares/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos Paranoides/patología , Trastornos Paranoides/psicología , Escalas de Valoración Psiquiátrica , Esquizofrenia Paranoide/patología , Esquizofrenia Paranoide/psicología , Índice de Severidad de la EnfermedadRESUMEN
The authors present a follow-up of a previously described patient with obsessive-compulsive disorder (OCD). Her condition continued to worsen, and she died 5 years after disease onset. Neuropathological findings were consistent with the diagnosis of Pick's disease. They revealed, in addition to the "knife-edge" frontotemporal atrophy, striking atrophy with extensive neuronal loss and gliosis involving the caudate nuclei and, to a lesser degree, the putamens and globus pallidus. Neuroimaging data had showed isolated atrophy of the caudate nuclei in the early stages of Pick's disease in this patient when OCD was the leading clinical manifestation. Relevant literature is reviewed, and the role of caudate nuclei atrophy in the development of OCD is discussed.
Asunto(s)
Demencia/diagnóstico , Trastornos Neurocognitivos/diagnóstico , Trastorno Obsesivo Compulsivo/diagnóstico , Adulto , Atrofia , Encéfalo/patología , Demencia/patología , Demencia/psicología , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Trastornos Neurocognitivos/patología , Trastornos Neurocognitivos/psicología , Neuronas/patología , Trastorno Obsesivo Compulsivo/patología , Trastorno Obsesivo Compulsivo/psicología , Tomografía Computarizada por Rayos XRESUMEN
The authors present two cases of patients with craniopharyngiomas who meet the DSM-III-R criteria for intermittent explosive disorder. Episodes of rage developed before and/or after surgery for removal of the craniopharyngioma. Magnetic resonance imaging revealed hypothalamic-hypophyseal involvement. It is suggested that hypothalamic lesions played a major role in the development of aggressive behavior in both cases.
Asunto(s)
Agresión/fisiología , Craneofaringioma/fisiopatología , Sistema Hipotálamo-Hipofisario/fisiopatología , Trastornos Neurocognitivos/fisiopatología , Neoplasias Hipofisarias/fisiopatología , Violencia , Adulto , Agresión/psicología , Craneofaringioma/psicología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Trastornos Neurocognitivos/psicología , Examen Neurológico , Pruebas Neuropsicológicas , Neoplasias Hipofisarias/psicologíaRESUMEN
Head computed tomography and magnetic resonance imaging scanning were done in 23 patients with organic mental syndromes. Violent behavior was observed in 14 patients. A nonviolent group consisted of nine patients. Five cases of local lesion in the anterior-inferior temporal lobe were revealed in the violent group. It is suggested that the release of programs for violent behavior may result from the unilateral destruction of amygdaloid nuclei or adjacent structures coupled with the paroxysmal stimulation of preserved limbic structures by the mechanisms of kindling.