Atypical psychotic symptoms and Dandy-Walker variant

Area of Science:

• Neurology
• Psychiatry
• Neuroimaging

Background:

• New-onset psychosis typically responds to antipsychotic medications.
• Congenital brain malformations can complicate psychosis treatment.
• The Dandy-Walker variant is a rare cerebellar malformation.

Observation:

• A patient presented with atypical psychotic symptoms.
• The patient had an undiagnosed Dandy-Walker variant.
• Previous antipsychotic trials (oral and long-acting injectable) were ineffective.

Findings:

• The patient's psychotic symptoms eventually improved with paliperidone palmitate.
• Neuroimaging revealed a congenital cerebellar malformation (Dandy-Walker variant).
• This case demonstrates a successful treatment outcome with a specific antipsychotic in a complex case.

Implications:

• Neuroimaging is crucial for diagnosing atypical psychosis presentations.
• Identifying underlying brain malformations aids treatment selection.
• Paliperidone palmitate may be effective for treatment-resistant psychosis associated with cerebellar malformations.