Refractory psychosis and prominent cognitive deficits in a patient with mega-cisterna magna

We present a case of refractory psychosis with prominent cognitive deficits in a patient with ‘mega-cisterna magna’, a congenital defect within the ‘Dandy-Walker Complex’ continuum. The 21-year-old female had a 3-year history of refractory psychotic symptoms despite adequate antipsychotic treatment....

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Bibliographic Details
Published in:Progress in neuro-psychopharmacology & biological psychiatry 2007-03, Vol.31 (2), p.561-563
Main Authors: Ferentinos, Panayotis P., Kontaxakis, Vassilis P., Havaki-Kontaxaki, Beata J., Paplos, Konstantinos G., Pappa, Dimitra A., Soldatos, Constantin R.
Format: Article
Language:English
Subjects:
Adult
Amisulpride
Biological and medical sciences
Cerebellum
Cognition Disorders - etiology
Cognition Disorders - pathology
Cognitive deficits
Dandy-Walker Complex
Dandy-Walker Syndrome - complications
Dandy-Walker Syndrome - pathology
Female
Galantamine
Humans
Magnetic Resonance Imaging
Medical sciences
Mega-cisterna magna
Neuropharmacology
Pharmacology. Drug treatments
Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)
Psycholeptics: tranquillizer, neuroleptic
Psychology. Psychoanalysis. Psychiatry
Psychopharmacology
Psychosis
Psychotic Disorders - etiology
Psychotic Disorders - pathology
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Summary:We present a case of refractory psychosis with prominent cognitive deficits in a patient with ‘mega-cisterna magna’, a congenital defect within the ‘Dandy-Walker Complex’ continuum. The 21-year-old female had a 3-year history of refractory psychotic symptoms despite adequate antipsychotic treatment. CT and MRI scans disclosed ‘mega-cisterna magna’. Thorough neuropsychological testing recorded extensive deficits. Treatment with amisulpride 1200 mg/day resulted in a 30% decrease in PANSS score within 2 months. Then galantamine 8 mg/day was added and PANSS score decreased further by 27% within 2 weeks. Cognitive and social functioning was overall much improved. The effect was sustained in a 24 months follow-up. It is postulated that even a less extended cerebellar lesion, such as mega-cisterna magna, can be associated with psychosis, and in some cases with treatment refractoriness or cognitive dysfunction. Adjuvant galantamine may improve cognitive and psychosocial functioning in these patients.
ISSN:0278-5846
1878-4216
DOI:10.1016/j.pnpbp.2006.10.013