0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter   |    
Schizophrenia-Like Psychosis Following Right Putaminal Infarction
Yurinosuke Kitabayashi; Jin Narumoto; Chisato Otakara; Choi Hyungin; Kenji Fukui; Kei Yamada
The Journal of Neuropsychiatry and Clinical Neurosciences 2006;18:561-562.

SIR: Schizophrenic symptoms are sometimes caused by physical disorders affecting brain function. Neuroimaging findings in these cases give useful information for understanding the neuropsychiatric background of schizophrenic symptoms, especially in early stage neurodegenerative disease and focal cerebrovascular disorders. Here, we report a case of schizophrenia-like psychosis following right putaminal infarction.

+

Case Report

The patient was a 40-year-old right-handed Japanese high-school graduate without a history of psychotic illness. Following her father’s death, she developed subacute auditory hallucinations and persecutional delusions (for example, she thought someone was intruding into and wiretapping her house, or believed that her child had been kidnapped). A few days later, she became excitable and tried to strangle her husband, after which she was restrained by her family and admitted to our hospital. On admission, she was alert, and physical and neurological examinations revealed no abnormalities. Laboratory tests were normal. A magnetic resonance imaging (MRI) scan revealed a subacute right putaminal infarction, which was partially extended to the right caudate and insula. The infarction was treated conservatively. Administration of risperidone (5mg/day) was initiated and the psychotic symptoms gradually disappeared. Two months later, the psychotic symptoms had completely disappeared and she was discharged. The regimen of risperidone was tapered off over the following 6 months and no relapse was observed.

+

Comment

Cummings1 noted that subcortical structures (striatum [caudate and putamen], globus pallidus, and thalamus) and the prefrontal cortex form three circuits (dorsolateral prefrontal, lateral orbital, and anterior cingulate circuits) and these circuits mediate many aspects of human behavior. On the other hand, recent neuroimaging studies in schizophrenia have demonstrated morphological and functional abnormalities of the frontal-subcortical circuits, although these results remain ambiguous.2,3

In our patient, a right putaminal infarction, which affects the dorsolateral prefrontal and lateral orbital circuits, caused schizophrenia-like hallucinations and delusions. In contrast, a case of schizophrenia in which hallucinations and delusions disappeared following left putaminal hemorrhage was previously reported.4 In this previous case, it could be speculated that excessive left frontal-subcortical function was associated with schizophrenic symptoms, and that correction of the excess function by left putaminal hemorrhage extinguished the symptoms. Collectively, these findings suggest that left and right frontal-subcortical functional asymmetry (i.e., relative right hemispheric hypofunction or relative left hemispheric hyperfunction) may play a critical role in the appearance of schizophrenic symptoms, especially for hallucinations and delusions.

.
Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 1993; 50:873—880
 
.
Suzuki M, Zhou SY, Takahashi T, et al: Differential contributions of prefrontal and temporolimbic pathology to mechanisms of psychosis. Brain 2005; 128:2109—2122
 
.
Andreasen NC, Paradiso S, O’Leary DS: "Cognitive dysmetria" as an integrative theory of schizophrenia: a dysfunction in cortical-subcortical-cerebellar circuitry? Schizophr Bull 1998; 24:203—218
 
.
Nagara T, Ohara H, Yano K, et al: Disappearance of hallucinations and delusions following left putaminal hemorrhage in a case of schizophrenia. Seishin Shinkeigaku Zasshi 1996; 98:498 (In Japanese)
 
+

References

.
Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 1993; 50:873—880
 
.
Suzuki M, Zhou SY, Takahashi T, et al: Differential contributions of prefrontal and temporolimbic pathology to mechanisms of psychosis. Brain 2005; 128:2109—2122
 
.
Andreasen NC, Paradiso S, O’Leary DS: "Cognitive dysmetria" as an integrative theory of schizophrenia: a dysfunction in cortical-subcortical-cerebellar circuitry? Schizophr Bull 1998; 24:203—218
 
.
Nagara T, Ohara H, Yano K, et al: Disappearance of hallucinations and delusions following left putaminal hemorrhage in a case of schizophrenia. Seishin Shinkeigaku Zasshi 1996; 98:498 (In Japanese)
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 24.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 4.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 20.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 4.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 45.  >
Topic Collections
Psychiatric News
APA Guidelines