Delayed diagnosis of multiple sclerosis in a patient with schizoaffective disorder: a case of 'diagnostic overshadowing'

The significance of cerebrospinal fluid analysis in the differential diagnosis of 564 psychiatric patients: Multiple sclerosis is more common than autoimmune-encephalitis

The analysis of cerebrospinal fluid (CSF) is an essential tool for the differential diagnosis of psychiatric disorders caused by autoimmune inflammation or infections. Clear guidelines for CSF analysis are limited and mainly available for schizophrenia and dementia. Thus, insights into CSF changes in psychiatric patients largely derive from research. We analyzed the clinical and CSF data of 564 psychiatric patients without pre-existing neurological diagnoses from March 1998 to April 2020. Primary aim was to detect previously undiagnosed neurological conditions as underlying cause for the psychiatric disorder. Following CSF analysis, 8 % of patients (47/564) were diagnosed with a neurological disorder. This was the case in 12.0 % (23/193) of patients with affective disorders, 7.2 % (19/262) of patients with schizophrenia, and 4.0 % (23/193) of patients with anxiety disorders. The predominant new diagnoses were multiple sclerosis (19/47) and autoimmune encephalitis (10/47). Abnormal CSF findings without any implications for further treatment were detected in 17.0 % (94/564) of patients. Our data indicates that CSF analysis in patients suffering from psychiatric disorders may uncover underlying organic causes, most commonly multiple sclerosis and autoimmune encephalitis. Our findings imply that the incorporation of CSF analysis in routine psychiatric assessments is potentially beneficial.

"Sleeping Beauty Syndrome" and Psychosis as Precursory Symptoms of Multiple Sclerosis: A Rare Case and Literature Review

ABSTRACT

Frequently, patients with multiple sclerosis (MS) experience comorbid psychiatric symptoms. Mental disorders primarily occur simultaneously with or after an MS diagnosis; however, the probability of them being the initial manifestation of the disease is rare. We describe the case of a 22-year-old man who had previously been hospitalized because a single psychotic episode alongside symptoms of Kleine-Levin syndrome and a diagnosis of "acute and transient psychotic disorders." Two years later, he was diagnosed with MS. A literature review of the possibility of a psychiatric episode overshadowing an MS diagnosis is then presented. Clinicians should always consider the possibility of an underlying organicity in a case of psychiatric presentation with atypical features, with special attention being given during the investigation process. This approach will lead to the early diagnosis of an organic disease, which can be treated accordingly and as early as possible.

Understanding the experience of diagnostic overshadowing associated with severe mental illness from the consumer and health professional perspective: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to identify, appraise, and synthesize available qualitative evidence related to diagnostic overshadowing in mental health consumers who present with clinical manifestations of physical illness.

INTRODUCTION

A lived experience of mental illness is associated with compromised physical health and decreased life expectancy. Mental health consumers face greater barriers to accessing treatment for physical illnesses and are less likely to receive appropriate physical care than those without mental illness. Physical illnesses may go underdiagnosed and undertreated in mental health consumers because clinicians tend to focus on the mental illness to the exclusion of other health problems, a phenomenon called diagnostic overshadowing. This systematic review will combine the experiences of mental health consumers and health care professionals to gain deeper understanding of diagnostic overshadowing.

INCLUSION CRITERIA

This review will consider qualitative studies that include the experiences of diagnostic overshadowing in mental health consumers and/or the health care professionals who treat them. Studies conducted in any health care facility or service offering care for physical illnesses will be considered.

METHODS

MEDLINE, CINAHL, PsycINFO, and Scopus will be searched along with sources of gray literature. Studies in English published from 2004 onward will be considered. Retrieval of full-text studies, assessment of methodological quality, and data extraction will be performed independently by two reviewers. Findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach. A ConQual Summary of Findings will be presented.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020186418.

Assessment of Antipsychotic Medications on Social Media: Machine Learning Study

Background: Antipsychotic medications are the first-line treatment for schizophrenia. However, non-adherence is frequent despite its negative impact on the course of the illness. In response, we aimed to investigate social media posts about antipsychotics to better understand the online environment in this regard. Methods: We collected tweets containing mentions of antipsychotic medications posted between January 1st 2019 and October 31st 2020. The content of each tweet and the characteristics of the users were analyzed as well as the number of retweets and likes generated. Results: Twitter users, especially those identified as patients, showed an interest in antipsychotic medications, mainly focusing on the topics of sexual dysfunction and sedation. Interestingly, paliperidone, despite being among one of the newest antipsychotics, accounted for a low number of tweets and did not generate much interest. Conversely, retweet and like ratios were higher in those tweets asking for or offering help, in those posted by institutions and in those mentioning cognitive complaints. Moreover, health professionals did not have a strong presence in tweet postings, nor did medical institutions. Finally, trivialization was frequently observed. Conclusion: This analysis of tweets about antipsychotic medications provides insights into experiences and opinions related to this treatment. Twitter user perspectives therefore constitute a valuable input that may help to improve clinicians' knowledge of antipsychotic medications and their communication with patients regarding this treatment.

Areas of Interest and Stigmatic Attitudes of the General Public in Five Relevant Medical Conditions: Thematic and Quantitative Analysis Using Twitter

BACKGROUND

Twitter is an indicator of real-world performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis.

OBJECTIVE

The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus).

METHODS

Each tweet's content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness's diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated.

RESULTS

We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3% (212/636) vs 1.15% (853/7419; P<.001) and pejorative content 36.2% (231/636) vs 11.33% (840/7419; P<.001). The medical content of the PRT showed the highest scientific appropriateness 100% (391/391) vs 93.66% (6030/6439; P<.001) and had a higher frequency of content about disease prevention. The potential reach and impact of the tweets related to psychosis were low, but they had a high retweet-to-tweet ratio.

CONCLUSIONS

We show a reduced number and a different pattern of contents in tweets about psychosis compared with control diseases. PRT showed a predominance of nonmedical content with increased frequencies of misuse and pejorative tone. However, the medical content of PRT showed high scientific appropriateness aimed toward prevention.

Should a psychotic or manic episode be considered an early manifestation of Multiple Sclerosis? A multiple case study

BACKGROUND

Early manifestations of Multiple Sclerosis (MS) can be atypical and misleading, and several case report studies have highlighted that MS onset sometimes takes the form of a psychotic or manic episode.

METHODS

All neurologists belonging to the French Multiple Sclerosis Observatory network were contacted by email and were asked to find patients with MS who presented with a history of psychiatric episode(s) near MS onset.

RESULTS

Seventeen patients were selected that met the criteria of presenting with psychotic or manic symptoms either before the diagnosis of MS (N=8), or at the time of the first neurological episode or shortly after (N=9). Patients with a history of a psychiatric episode occurring before the first neurological episode were diagnosed on average 7 years later than patients with either a first neurological or a mixed (both neurological and psychiatric) episode. However, psychiatric symptoms in the first group and the first neurological symptoms of MS in the second group occurred at a similar age.

CONCLUSION

Based on this multiple case study, we question whether past psychotic or manic episode should be considered equivalent to a first manifestation of MS.