Psychosis is more common than previously thought in frontotemporal dementia

FTD is a progressive condition so multiple aspects of cognition, function and behaviour may eventually become affected, and psychiatric states like apathy, depression, anxiety, irritability, agitation and aggression are not uncommon. In contrast, the set of symptoms known as psychosis appeared to be rare until recently.

Psychosis in dementia

Psychosis consists of hallucinations and delusions in a person who is then confused about reality. In other words, a person who appreciates that a hallucination is not real would not be said to be suffering psychosis. The everyday experience of individuals with psychosis is coloured by their hallucinations and delusions, which can drive how they act or think.

Psychosis is common in the major dementias. It is typical of Dementia with Lewy bodies, very common in Alzheimer’s disease and occurs, although to a lesser degree, in vascular dementia. It is also a frequent complication of Parkinson’s disease dementia. The psychosis in most dementias is typically dominated by visual hallucinations, with delusions often consisting of the reactions or rationalizations that follow. However delusions do occur as distinct phenomena, often taking the form of misinterpretations of real or imaginary objects, delusions of infidelity or abandonment, or beliefs such as thinking that spouses or relatives are duplicates of the original person.

Psychosis in FTD

Psychosis was previously believed to be rare in FTD. Seven years ago, investigators in California found psychosis in 2.3% of people with FTD observed for 2 years, much lower than the 17.4% rate seen in those with Alzheimer’s disease. The same year, a working group of the American Neuropsychiatric Association reviewed the medical literature, noting that 1) psychosis is uncommon in FTD, and 2) many subjects with FTD who had been erroneously diagnosed with schizophrenia or a related condition had never suffered hallucinations or delusions. Subsequently, a group in Australia linked psychosis in FTD to the youngest cases (in other words those developing illness before age 40).

A renewed interest in the symptoms of psychosis came when it was noticed that carriers of the C9ORF72 mutation, a major cause of genetic FTD discovered four years ago, frequently suffer psychosis. Indeed several reports describe psychosis, mania and suicidal depression as the first manifestation of the illness.

The latest reviews estimate that 10% of FTD cases suffer psychosis, with higher rates in carriers of the C9ORF72 and progranulin mutations. A group working in Sweden has found an even higher prevalence, 32%, in their cohort of patients that have come to autopsy, with an average age at onset of 58 years and high prevalence of dementia and psychiatric disorders in relatives. Psychosis was equally common in those with tau and TDP-43 pathology, and very frequent in those with FUS pathology, who were also the youngest cases. In contrast to the California study, the observation period was the entire duration of the illness, which may explain the higher prevalence here. Psychosis was common in those in whom neurodegeneration mainly affected the right hemisphere of the brain. In most of the people, the FTD diagnosis was missed during life, and misdiagnosis with a psychiatric disorder was common.

Summary

Psychosis in FTD is more common than we had appreciated, and it was the recognition of psychosis in carriers of the C9ORF72 mutation that highlighted this issue. The prevalence is uncertain but appears highest in hereditary cases and in those with very young onset. This is undoubtedly relevant to patient care, but the risk of missing a diagnosis of FTD, especially in younger patients, also raises diagnostic questions. More research is needed to clarify the prevalence of hallucinations and delusions, their relation to FTD onset and diagnosis, and to learn why and how they develop.

References

Jeste DV, Finkel SI. Psychosis of Alzheimer’s disease and related dementias. Diagnostic criteria for a distinct syndrome. Am J Geriatr Psychiatry. 2000;8(1):29–34.

Mendez MF, Lauterbach EC, Sampson SM, ANPA Committee on Research. An evidence-based review of the psychopathology of frontotemporal dementia: a report of the ANPA Committee on Research. J Neuropsychiatry Clin Neurosci. 2008;20(2):130–149.

Mendez M, Shapira J, Woods R, Licht E, Saul R. Psychotic Symptoms in Frontotemporal Dementia: Prevalence and Review. Dement Geriatr Cogn Disord. 2008 Jan 17;25(3):206–211.

Velakoulis D, Walterfang M, Mocellin R, Pantelis C, McLean C. Frontotemporal dementia presenting as schizophrenia-like psychosis in young people: clinicopathological series and review of cases. Br J Psychiatry. 2009 Apr 1;194(4):298–305.

Snowden JS, Rollinson S, Thompson JC, Harris JM, Stopford CL, Richardson AM, Jones M, Gerhard A, Davidson YS, Robinson A, Gibbons L, Hu Q, DuPlessis D, Neary D, Mann DM, Pickering-Brown SM. Distinct clinical and pathological characteristics of frontotemporal dementia associated with C9ORF72 mutations. Brain. 2012 Mar;135(Pt 3):693–708.

Sha SJ, Takada LT, Rankin KP, Yokoyama JS, Rutherford NJ, Fong JC, Khan B, Karydas A, Baker MC, DeJesus-Hernandez M, Pribadi M, Coppola G, Geschwind DH, Rademakers R, Lee SE, Seeley W, Miller BL, Boxer AL. Frontotemporal dementia due to C9ORF72 mutations: Clinical and imaging features. Neurology. 2012 Sep 4;79(10):1002–1011.

Shinagawa S, Nakajima S, Plitman E, Graff-Guerrero A, Mimura M, Nakayama K, Miller BL. Psychosis in frontotemporal dementia. J Alzheimers Dis. IOS Press; 2014;42(2):485–499.

Landqvist Waldö M, Gustafson L, Passant U, Englund E. Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma? Int Psychogeriatr. 2015 Apr;27(4):531–539.

43% of Americans Risked Their Brain Health for Flu Shots – Did You?

By Dr. Mercola

About 43 percent of the U.S. population opted to get a flu shot last season, a trend that has unfortunately been steadily increasing in the last several years.

According to the U.S. Centers for Disease Control and Prevention (CDC), 8 million more people received the flu shot in 2010, which CDC director Dr. Thomas Frieden told Fox Newsi “is the most people who have ever been vaccinated in this country.”

Most likely, this is a direct result of the massive marketing campaign that is ongoing in the United States, encouraging every person 6 months and older to get a flu shot.

Full article here: http://articles.mercola.com/sites/articles/archive/2011/11/24/more-people-getting-flu-shots.aspx

Psychosis may be triggered by antibody reaction to brain protein

A new study published in the journal Biological Psychiatry investigates the role antibodies may play in cases of psychosis, suggesting that psychosis symptoms such as hallucinations and delusions may be triggered by an antibody response to a protein in the brain.
illustration of brain
According to the researchers, their findings provide “hope that major disability can be prevented for the subset of children experiencing acute psychosis with antibodies.”

It is well known that antibodies defend the body against bacteria and viruses, and that in some people antibodies also attack healthy cells, causing autoimmune disorders.

Less well known is the role autoimmune disorders may play inpsychosis. However, scientists have been aware of a link between immune abnormalities and psychosis for over 100 years.

Only recently, though, have scientists been able to pinpoint the specific mechanisms in the immune system that appear to influence psychosis symptoms, such as the mechanism identified in the new study.

The authors of the new study found an antibody reaction to the dopamine D2 receptor or the N-methyl-D-aspartate (NMDA) glutamate receptor among a subgroup of children experiencing their first episode of psychosis, but no similar antibody response among healthy children.

Full story at:  http://www.medicalnewstoday.com/articles/290534.php

 

Zika virus may cause broader range of brain disorders than previously believed

Study says five patients who tested positive for virus in Brazil reported difficulty with motor functioning while another had trouble with vision and memory

The Zika virus may cause a wider range of brain disorders than previously thought, according to a small study released on Sunday. Scientists already suspect the mosquito and sex-spread virus causes fetal brain disorder and temporary paralysis.

https://www.theguardian.com/world/2016/apr/10/zika-virus-brain-disorders-brazil-study

Zika May Increase Risk of Mental Illness, Researchers Say

Misdiagnosis of schizophrenia in a patient with psychotic symptoms.

Misdiagnosis of schizophrenia in a patient with psychotic symptoms.

Abstract

OBJECTIVE:

A case is presented of a 37-year-old black woman with a 5-year history of a chronic psychotic illness, diagnosed as schizophrenia, who presented to the emergency room complaining of a severe headache, while appearing confused and experiencing visual and auditory hallucinations. The purpose of this case study is to illustrate the way in which the appellation of schizophrenia can be misapplied in a patient with a complicated medical history and poor follow-up evaluation and treatment.

BACKGROUND:

Patients with active psychosis are frequently unable to provide a coherent or comprehensive medical history. In the absence of obvious indications to the contrary, a diagnosis of a primary psychiatric illness is often assumed, especially if this label has been applied in the past. However, the differential diagnosis of psychosis is extensive.

METHODS:

This patient was given a complete psychiatric and neurologic evaluation, and aspects of the history that had been lost or ignored were uncovered and reevaluated.

RESULTS:

A diagnosis other than schizophrenia was made and another treatment, other than antipsychotic drugs, was initiated. The patient responded rapidly with improved cognitive function and resolution of her psychotic symptoms.

CONCLUSIONS:

This case serves to illustrate how the absence of a careful clinical assessment and historical case review, in patients who have been previously labeled as schizophrenic, can perpetuate misdiagnoses and inappropriate treatments. It highlights the importance, especially in patients with an incomplete medical history, of ruling out all organic causes of psychosis to avoid inappropriately labeling someone as having a psychiatric illness.

http://www.ncbi.nlm.nih.gov/pubmed/12464752

The Mind Of A Mass Murderer: Charles Whitman, Brain Damage, And Violence (VIDEO)

On August 1, 1966, Charles Whitman murdered his mother and his wife before traveling to the campus of the University of Texas, climbing inside the tower, andkilling fourteen others. He was dubbed the infamous UT sniper, but his story involves much more than Marine Corps training and a proclivity for violence. In fact, Whitman complained of headaches and an altered mental state in the days and weeks leading up to the killings. His own suicide note read that “I do not really understand myself these days. I am supposed to be an average reasonable and intelligent young man. However, lately (I cannot recall when it started) I have been a victim of many unusual and irrational thoughts.”

 

Whitman knew that something was wrong. His note further reads, “After my death I wish that an autopsy would be performed on me to see if there is any visible physical disorder.” And indeed there was. Whitman was found to have aglioblastoma, a type of brain tumor, pressing against regions of the brain thought to be responsible for the regulation of strong emotions.

 

See full story here