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Geschwind's syndrome in a patient with schizophrenia João Gama Marques, Joana Teixeira, Maria João Carnot
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S0165-1781(15)00254-1 http://dx.doi.org/10.1016/j.psychres.2015.05.008 PSY8883
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Cite this article as: João Gama Marques, Joana Teixeira, Maria João Carnot, Geschwind's syndrome in a patient with schizophrenia, Psychiatry Research, http://dx.doi.org/10.1016/j.psychres.2015.05.008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Geschwind’s syndrome in a patient with schizophrenia To the Editors: Geschwind’s syndrome is a temporolimbic neuropsychiatric syndrome, first described in 1975 by Drs. Waxman and Geschwind (1975). It is characterized by hypergraphia, hyperreliogisity, hyposexuality and viscosity (Trimble et al., 1997). It is usually described in a subset of patients with temporal lobe epilepsy, but it may arise from any temporolimbic lesion (Mungas, 1982). Here, we report on a 47-year-old single male patient of Portuguese descent who was admitted to a psychiatric ward due to disorganized behavior, with soliloquy and wandering. The patient had a previous diagnosis of paranoid schizophrenia since the age of 19, although he had been in a quite stable condition for the last 12 years. He had been previously treated with olanzapine, 10.mg/day, but he had abandoned his medication just 6 months before our observation. There were no other personal antecedents; nor was there a family history of neuropsychiatric disease. Psychiatric examination presented the following psychopathological findings: for almost 1 month, he had been listening to the “voice of God,” which gave him instructions about his “holy mission.” At the same time, he had been feeling “persecuted by other people in the village.” His family also reported continuously strange behavior in the last 7 years. He talked a lot about God, and for a large part of the time he had been praying or writing hundreds of pages of his “sacred scriptures,” which were described as some kind of a pseudo-theological book, full of childish-like “mystical symbols.” During this period, he was also very irritable, especially toward a teenage girl living in his neighborhood, though without showing any kind of erotic interest on her or in any other person. The results of physical examination, routine laboratory tests, including toxicology screening, brain computed tomography and 24-h electroencephalogram were normal. As the patient’s response was not satisfactory to second generation antipsychotic monotherapy, he was treated with a combination of olanzapine, 15 mg/day, plus haloperidol, 10 mg/day. After 3 weeks of treatment, the patient no longer presented any kind of delusions or hallucinations. Although the patient was discharged with full remission of psychotic symptoms, he still presented the previously described symptoms compatible with hypergraphia, hyperreligiosity, hyposexuality and viscosity. Although Geschwind’s syndrome has already been described in schizoaffective disorder (O’Connell et al., 2013), this is, to our knowledge, the first case report of the condition in a patient with
schizophrenia. As brain morphological findings in schizophrenia include reductions in the size of medial temporal lobe structures (Marsch et al., 1994), we believe Geschwind’s syndrome may possibly exist more frequently than reported (but go unrecognized) in patients with chronic schizophrenia. Further research on patients of this type could contribute to a better understanding of both Geschwind’s syndrome and schizophrenia. The patient presented here adds to the recent literature indicating that Geschwind’s syndrome is not exclusively associated with major temporolimbic lesions but may also be found in psychiatric patients without neurological known damage.
References Marsh, L., Suddath, R.L., Higgins, N., Weinberger, D.R., 1994. Medial temporal lobe structures in schizophrenia: relationship of size to duration of illness. Schizophrenia Research 11 (3), 225238. Mungas, D., 1982. Interictal behaviour abnormality in temporal lobe epilepsy. A specific syndrome or a non-specific psychopathology? Archives of General Psychiatry 39 (1), 108-111. O’Connell, K., Keaveney, J., Paul, R., 2013. A novel study of comorbidity between schizoaffective disorder and Geschwind syndrome. Case Reports in Psychiatry 486064; doi: 10.1155/2013/486064. Trimble, M.R., Mendez, M.F., Cummings, J.L., 1997. Neuropsychiatric symptoms from the temporolimbic lobes. Journal of Neuropsychiatry and Clinical Neuroscience 9 (3), 429-438. Waxman, S.G., Geschwind, N., 1975. The interictal behaviour syndrome of temporal lobe epilepsy. Archives of General Psychiatry 32 (12), 1580-1586.
João Gama Marques* Joana Teixeira Maria João Carnot Centro Hospitalar Psiquiátrico de Lisboa 1749-002 Lisboa, Portugal Corresponding author: [email protected]
5 May 2015