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Psychosis and brainstem malformations: A case series.

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Structural brainstem malformations like Dandy-Walker variant, Arnold-Chiari malformation, and aqueductal stenosis can cause first episode psychosis. Early recognition and multidisciplinary management are crucial for these neurological conditions.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Medical Imaging

Background:

  • First episode psychosis can stem from various psychiatric and medical conditions.
  • Congenital neurological abnormalities are an underrecognized cause of psychosis.
  • This case series focuses on structural brainstem malformations as potential underlying causes.

Purpose of the Study:

  • To explore the association between first-episode psychosis and specific structural brainstem malformations.
  • To present cases illustrating this association.
  • To highlight the importance of recognizing these malformations in psychosis.

Main Methods:

  • Case series design.
  • Review of three cases of first-episode psychosis.
  • Magnetic resonance imaging (MRI) to identify brainstem malformations.
  • Clinical presentation and treatment response documented.

Main Results:

  • Case 1: Dandy-Walker variant associated with psychosis, improved with clozapine.
  • Case 2: Arnold-Chiari Type I malformation linked to psychosis, recovered with electroconvulsive therapy.
  • Case 3: Aqueductal stenosis presented with psychosis, seizures, and borderline intellect, with symptom recurrence.

Conclusions:

  • Structural brainstem malformations may contribute to psychosis through cerebellar dysfunction and altered predictive processing.
  • Early identification and comprehensive management are essential for patients with psychosis secondary to brainstem malformations.
  • Further research is needed to understand the cerebellum's role in psychosis.