The use of quetiapine in treatment of acute psychotic symptoms in an adolescent patient with primary brain calcification: a case report

• Published in: BMC psychiatry 2019-02, Vol.19 (1), p.67-67, Article 67
• Main Authors: Plemeniti Tololeski, Barbara, Debeljak, Maruša, Perkovič Benedik, Mirjana, Rigler, Tristan, Kyriakopoulos, Marinos, Kotnik, Primož, Šurlan Popovič, Katarina, Drobnič Radobuljac, Maja
• Format: Article
• Language: English
• Subjects: Acute psychosis; Adolescent; Adolescent Behavior - psychology; Analysis; Antidepressants; Antipsychotics; Basal ganglia; Brain; Brain Diseases - complications; Brain Diseases - drug therapy; Brain research; Calcification; Calcification (ectopic); Calcification (Physiology); Calcinosis - complications; Calcinosis - diagnostic imaging; Calcinosis - drug therapy; Calcium; Care and treatment; Case Report; Case reports; Case studies; CAT scans; Child & adolescent psychiatry; Cognitive ability; Computed tomography; Delusions; Dementia; Diagnosis; Extrapyramidal disorders; Extrapyramidal system; Fear & phobias; Female; Genes; Hallucinations; Headache; Headaches; Health aspects; Hospitals; Humans; Intelligence; Nervous system diseases; Neurodegenerative diseases; NMR; Nuclear magnetic resonance; Patients; Pediatrics; Primary brain calcification; Psychiatry; Psychological symptoms; Psychosis; Psychotic Disorders - complications; Psychotic Disorders - drug therapy; Quetiapine; Quetiapine Fumarate - therapeutic use; Sertraline; Suicidal behavior; Suicides & suicide attempts; Teenage girls; Teenagers; Thalamus; Tomography; Women; Women's health; Youth
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-019-2047-1

Primary brain calcification (PBC), a neurodegenerative disorder with characteristic calcium deposits in the basal ganglia and other brain areas, typically presents with various neurological and psychiatric symptoms in the fourth or fifth decade of life or later. We present the case of a patient with psychiatric manifestations much earlier than usual, in the second decade of life. The case of an adolescent female with acute psychotic symptoms, emotional instability, disorganized and suicidal behavior, stereotypical movements, below average intelligence and a three-year history of headaches is reported. Among others, the presentation included tactile hallucinations with secondary hypochondriacal delusions, which are rarely described in this diagnosis. Massive calcinations in the area of the basal ganglia and thalamus were determined by computerized tomography. Other causes of brain calcification were excluded. No causative mutations were found in selected genes. All the symptoms apart from lower intellectual abilities improved with quetiapine and sertraline. The patient showed no side effects. This case report highlights the successful use of quetiapine for symptomatic treatment of acute psychosis due to PBC in an adolescent without exacerbating extrapyramidal symptoms.