Characterizing organic delusional syndrome

Inter-ictal and post-ictal psychoses in frontal lobe epilepsy: a retrospective comparison with psychoses in temporal lobe epilepsy

There have been few studies of the psychopathology of patients with frontal lobe epilepsy (FLE). The majority of studies of both inter-ictal and post-ictal psychoses have strongly suggested the influence of temporal lobe disturbance on psychoses. Patients with organic brain damage or schizophrenia, however, sometimes show frontal lobe dysfunction. The purpose of this study was to better understand the effect, if any, of frontal lobe disturbance and seizure on psychopathology. Patients were divided into four groups based on epilepsy type and preceding seizures; 8 with FLE/inter-ictal psychosis, 3 with FLE/post-ictal psychosis, 29 with temporal lobe epilepsy (TLE)/inter-ictal psychosis, and 8 with TLE/post-ictal psychosis. Psychopathologic symptoms were retrospectively reviewed based on case notes, using a modified brief psychiatric rating scale (BPRS). Psychomotor excitement, hostility, suspiciousness, and hallucinatory behaviour were prominent features in all four groups. Six orthogonal factors were derived by factor analysis from the original data based on the 18 BPRS items. FLE patients with inter-ictal psychosis showed marked hebephrenic characteristics (i.e. emotional withdrawal and blunted effect). Our findings suggest that patients with FLE can exhibit various psychiatric symptoms. However, their psychotic symptoms, hebephrenic symptoms in particular, may often be overlooked.

Organic delusional disorder in psychiatric in-patients: comparison with delusional disorder

Organic delusional disorder (ODD) is rarely diagnosed in psychiatric in-patients, and may be misdiagnosed as delusional disorder (DD) from a similar clinical presentation. The aim of the present study was to investigate the characteristics of ODD and to make a comparison with those of DD patients. Patients who conformed to DSM-III-R criteria for ODD were recruited from an 8-year psychiatric in-patient database. Matching controls were DD patients admitted over the same time period. The prevalence of ODD according to DSM-III-R criteria was 0.4% of total admissions and 2.9% of organic mental disorders. Compared to DD patients, ODD patients less often had a family psychiatric history, and had an older age of onset of psychiatric disorder, longer hospital stays and lower treatment dosage of antipsychotic drugs. It is suggested that a detailed medical history and examination are needed in patients with delusion, especially in patients with a late onset of psychiatric symptoms and no family psychiatric history.

Characterizing organic mood syndrome, manic type

The purpose of this study is to provide the first empirically based description of the clinical features of organic mood syndrome, manic type (OMS-M). During a recent 5-year period, 14,889 new patients presented for initial evaluation and care at our institute. Of these patients, a total of 12 cases of OMS-M were diagnosed. Evaluations were conducted using the Initial Evaluation Form, which was developed to be compatible with the DSM-III. The symptom profile of OMS-M was compared with that of "functional" manics (bipolar disorder, manic type [BD-M]). A variety of associated clinical factors were also assessed. The OMS-M patient demonstrated somewhat less severe acute symptomatology but more longstanding functional impairment than in BD-M. OMS-M patients also displayed a lower age at onset of illness and a higher level of perinatal problems and developmental delays compared with BD-M patients. The OMS-M group displayed a low family burden of mania. The most striking distinguishing feature of OMS-M was the prevalence of neurological disorders, with a surprisingly high prevalence of seizure disorders. Seizure disorders were more prevalent in OMS-M than in other organic brain syndromes (OBS).

Characterizing organic mood syndrome, depressed type

In this report, a first comprehensive description of the clinical features of patients with organic mood syndrome, depressed type (OMS-D), in a psychiatric hospital population is presented. This description is based on information from 130 OMS-D patients among 14,889 patients who presented for initial evaluation over a 5-year period. This description includes an enumeration of the common clinical symptoms of this syndrome. Following this, the severity of the symptoms of OMS-D are compared with those of its crude "functional" equivalent of major depressive disorder, single episode (MDD-SE). In addition, associated factors are presented concerning demographics, level of functioning, comorbidity, electroencephalographic and computed tomographic abnormalities, and current physical problems. These findings provide preliminary support for the validity of this diagnostic category, and provide relevant information concerning proposed changes in this category as listed in the DSM-IV Options Book.