Menstrual psychosis: a bipolar disorder with a link to the hypothalamus.

Curr Psychiatry Rep. 2011 Jun;13(3):193-7.

Source

University of Birmingham, Lower Brockington Farm, Bredenbury, Bromyard, Herefordshire, United Kingdom. i.f.brockington@bham.ac.uk

Abstract

The literature on menstrual psychosis is briefly reviewed in this article. There are about 80 cases with substantial evidence, and about 200 other possible cases. The clinical features are generally those of manic depressive (bipolar) disorder. The diagnosis requires the accurate dating of the onsets of episodes and of menstrual bleeding. Obtaining a baseline of several carefully dated episodes is also important in finding the best way to arrest the periodic illness. Although conventional psychotropic drugs can shorten episodes, they do not prevent recurrences. For this, unconventional treatments appear to be more effective, especially thyroid hormone and clomiphene. Patients with menstrual psychosis usually have abnormal menstruation, such as anovulatory cycles, luteal defects, or periods of amenorrhea. This, and the occurrence of episodes before the menarche, suggests that the interaction between the bipolar diathesis and menstruation is in the hypothalamus.

PMID:
21424263
[PubMed – indexed for MEDLINE]

Manganese and acute paranoid psychosis: a case report.

J Med Case Reports. 2011 Apr 12;5(1):146. [Epub ahead of print]

Verhoeven WM, Egger JI, Kuijpers HJ.

Abstract

ABSTRACT:

INTRODUCTION: Manganese regulates many enzymes and is essential for normal development and body function. Chronic manganese intoxication has an insidious and progressive course and usually starts with complaints of headache, fatigue, sleep disturbances, irritability and emotional instability.

Later, several organ systems may be affected and, due to neurotoxicity, an atypical parkinsonian syndrome may emerge. With regard to neuropsychiatry, an array of symptoms may develop up to 30 years after intoxication, of which gait and speech abnormalities, cognitive and motor slowing, mood changes and hallucinations are the most common. Psychotic phenomena are rarely reported.

CASE PRESENTATION: We describe the case of a 49-year-old Caucasian man working as a welder who was referred to our facility for evaluation of acute paranoid psychotic behavior. Our patient’s medical history made no mention of any somatic complaints or psychiatric symptoms, and he had been involved in a professional career as a metalworker. On magnetic resonance imaging scanning of his brain, a bilateral hyperdensity of the globus pallidus, suggestive for manganese intoxication, was found. His manganese serum level was 52 to 97nmol/L (range: 7 to 20nmol/L).

A diagnosis of organic psychotic disorder due to manganese overexposure was made. His psychotic symptoms disappeared within two weeks of treatment with low-dose risperidone. At three months later, serum manganese was decreased to slightly elevated levels and the magnetic resonance imaging T1 signal intensity was reduced. No signs of Parkinsonism were found and a definite diagnosis of manganese-induced apathy syndrome was made.

CONCLUSION: Although neuropsychiatric and neurological symptoms caused by (chronic) manganese exposure have been reported frequently in the past, in the present day the disorder is rarely diagnosed.

In this report we stress that manganese intoxication can still occur, in our case in a confined-space welder, and may present clinically with a paranoid psychotic state that necessitates a rapid diagnostic procedure in order to avoid the permanent structural brain damage that may occur with chronic exposure.

PMID: 21486469 [PubMed – as supplied by publisher]

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Charlie Rose: The brain series part 1 The great mysteries of the human brain. ” The Charlie Rose Brain Series explores one of sciences final frontiers, the study of the human brain.
Over the next year Charlie will interview the most knowledgeable scientists and researchers in hopes of illuminating a new topic of study. Each monthly episode will examine different subjects of the brain, including perception, social interaction, aging and creativity.
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He received the Nobel Prize in physiology or medicine in 2000 for his research into the biological mechanisms of learning and memory. ”
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