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Paranoid personality masking an atypical case of frontotemporal dementia.

Iroka N, Jehangir W, Ii JL, Pattan V, Yousif A, Mishra AK - J Clin Med Res (2015)

Bottom Line: Age of onset is generally in the late fifties, and usually the first presentation involves a change in behavior and emotional blunting.As a result of this diagnosis, she was treated unsuccessfully.A subsequent magnetic resonance imaging (MRI) then showed atrophy of frontal and temporal lobes bilaterally (left more prominent than right) which confirmed the diagnosis of FTD.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Residents, Raritan Bay Medical Center, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA.

ABSTRACT
Frontotemporal dementia (FTD) is a debilitating disease that is well described in the "Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5)", and typically presents with memory impairment, progressive decline in cortical functioning, and behavioral changes. Age of onset is generally in the late fifties, and usually the first presentation involves a change in behavior and emotional blunting. Treatment of FTD involves management of any neurobehavioral symptoms while trials of atypical antipsychotics are ongoing but suggest some efficacy. We present a case of a patient who first presented with severe paranoid personality traits and frank persecutory delusions. This atypical presentation of our patient first led to her incorrect diagnosis of a psychotic disorder and paranoid personality disorder. As a result of this diagnosis, she was treated unsuccessfully. A subsequent magnetic resonance imaging (MRI) then showed atrophy of frontal and temporal lobes bilaterally (left more prominent than right) which confirmed the diagnosis of FTD. The importance of this case involves the atypical presentation of paranoia and delusions, and our patient's incorrect diagnosis based on her clinical presentation led to a trial of unsuccessful treatment. Only after performing an MRI, which showed atrophy, was the patient appropriately treated and deemed medically stable. This case report illustrates the importance of considering a rare presentation of frontotemporal lobe dementia with patients who are in the typical age range and present with paranoia and delusions.

No MeSH data available.


Related in: MedlinePlus

Atrophy of frontal and temporal lobes of right side.
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Figure 2: Atrophy of frontal and temporal lobes of right side.

Mentions: A 57-year-old female was brought to the emergency room by her daughter because the patient was exhibiting signs and symptoms of paranoia and frank persecutory delusions for the past year. She believed that her next door neighbor was watching her and listening to all of her conversations. She also believed that her neighbor had wired the house and that she was being monitored. She had a past history of paranoid personality but has been functional and socially active and had worked for an insurance company as a senior adjuster for about 30 years until 2 years earlier when she was laid off. She is divorced and has two grown children. She had no previous psychiatric admission. Her past medical history was significant for hypertension which was well controlled. Physical examination finding showed blood pressure 135/82 mm Hg, respiration rate 20/min, pulse 85/min, oxygen saturation on room air 100%, and temperature 99.4 °F. She was neatly dressed but was maloderous. On mental status examination, she scored 14 on the Montreal cognitive assessment test. Memory and mini-mental status exam was unremarkable. Other than speech fluency that was reduced, the rest of her physical examination was unremarkable. A complete blood count and complete metabolic profile were within normal limits. Vitamin B12 and thyroid stimulating hormone levels were within normal limits. A computerized tomography (CT) scan of the brain was unremarkable. A diagnosis of paranoid and delusional disorder non-otherwise specified was made, and she was started on olanzapine 2.5 mg daily and was considered for discharge home. The daughter at this time further expressed concerns for safety as she said the patient sometimes forget to pay her utility bills and that her house might be without electricity. At this point, with the new information of the patient’s inability to care for herself, a diagnosis of FTD was considered, taking into account her age and the time frame of her symptoms. The patient was admitted to the hospital, and a subsequent magnetic resonance imaging (MRI) of the brain was obtained which showed atrophy of frontal and temporal lobes bilaterally, left more prominent than right, which confirmed the diagnosis of FTD (Fig. 1, 2). The patient was appropriately treated thereafter with olanzapine 10 mg daily and 5 mg as needed for agitation, and donepezil 5 mg at night as well. She improved symptomatically and was later discharged home to her family in stable condition with appropriate follow-up.


Paranoid personality masking an atypical case of frontotemporal dementia.

Iroka N, Jehangir W, Ii JL, Pattan V, Yousif A, Mishra AK - J Clin Med Res (2015)

Atrophy of frontal and temporal lobes of right side.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356099&req=5

Figure 2: Atrophy of frontal and temporal lobes of right side.
Mentions: A 57-year-old female was brought to the emergency room by her daughter because the patient was exhibiting signs and symptoms of paranoia and frank persecutory delusions for the past year. She believed that her next door neighbor was watching her and listening to all of her conversations. She also believed that her neighbor had wired the house and that she was being monitored. She had a past history of paranoid personality but has been functional and socially active and had worked for an insurance company as a senior adjuster for about 30 years until 2 years earlier when she was laid off. She is divorced and has two grown children. She had no previous psychiatric admission. Her past medical history was significant for hypertension which was well controlled. Physical examination finding showed blood pressure 135/82 mm Hg, respiration rate 20/min, pulse 85/min, oxygen saturation on room air 100%, and temperature 99.4 °F. She was neatly dressed but was maloderous. On mental status examination, she scored 14 on the Montreal cognitive assessment test. Memory and mini-mental status exam was unremarkable. Other than speech fluency that was reduced, the rest of her physical examination was unremarkable. A complete blood count and complete metabolic profile were within normal limits. Vitamin B12 and thyroid stimulating hormone levels were within normal limits. A computerized tomography (CT) scan of the brain was unremarkable. A diagnosis of paranoid and delusional disorder non-otherwise specified was made, and she was started on olanzapine 2.5 mg daily and was considered for discharge home. The daughter at this time further expressed concerns for safety as she said the patient sometimes forget to pay her utility bills and that her house might be without electricity. At this point, with the new information of the patient’s inability to care for herself, a diagnosis of FTD was considered, taking into account her age and the time frame of her symptoms. The patient was admitted to the hospital, and a subsequent magnetic resonance imaging (MRI) of the brain was obtained which showed atrophy of frontal and temporal lobes bilaterally, left more prominent than right, which confirmed the diagnosis of FTD (Fig. 1, 2). The patient was appropriately treated thereafter with olanzapine 10 mg daily and 5 mg as needed for agitation, and donepezil 5 mg at night as well. She improved symptomatically and was later discharged home to her family in stable condition with appropriate follow-up.

Bottom Line: Age of onset is generally in the late fifties, and usually the first presentation involves a change in behavior and emotional blunting.As a result of this diagnosis, she was treated unsuccessfully.A subsequent magnetic resonance imaging (MRI) then showed atrophy of frontal and temporal lobes bilaterally (left more prominent than right) which confirmed the diagnosis of FTD.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Residents, Raritan Bay Medical Center, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA.

ABSTRACT
Frontotemporal dementia (FTD) is a debilitating disease that is well described in the "Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5)", and typically presents with memory impairment, progressive decline in cortical functioning, and behavioral changes. Age of onset is generally in the late fifties, and usually the first presentation involves a change in behavior and emotional blunting. Treatment of FTD involves management of any neurobehavioral symptoms while trials of atypical antipsychotics are ongoing but suggest some efficacy. We present a case of a patient who first presented with severe paranoid personality traits and frank persecutory delusions. This atypical presentation of our patient first led to her incorrect diagnosis of a psychotic disorder and paranoid personality disorder. As a result of this diagnosis, she was treated unsuccessfully. A subsequent magnetic resonance imaging (MRI) then showed atrophy of frontal and temporal lobes bilaterally (left more prominent than right) which confirmed the diagnosis of FTD. The importance of this case involves the atypical presentation of paranoia and delusions, and our patient's incorrect diagnosis based on her clinical presentation led to a trial of unsuccessful treatment. Only after performing an MRI, which showed atrophy, was the patient appropriately treated and deemed medically stable. This case report illustrates the importance of considering a rare presentation of frontotemporal lobe dementia with patients who are in the typical age range and present with paranoia and delusions.

No MeSH data available.


Related in: MedlinePlus