Thread by @JRBneuropsiq

Clinical case! 🧠💭🧵
1/7 A 26-year-old woman from a rural region of Mexico presented in a state of catatonia. At age 21, she begun to exhibit aggressiveness. At age 23, she started having difficulties handling money, she constantly misplaced things. Sometimes she was disoriented

2/7 At age 26, 2 days after delivering her first child, she had a (first) psychotic episode, with incoherent speech, disorganized behavior, aggressiveness, visual & auditory hallucinations. She neglected her newborn, saying repeatedly that the child was not hers.

3/7 Psychotic symptoms were mixed with periods of catatonia. She recieved risperidone 2 mg/day, which worsened the catatonic states. She was referred to our hospital. On admission, risperidone was suspended. We observed immobility, mutism, staring, posturing, waxy flexibility...

4/7 The Bush-Francis Catatonia Rating Scale severity score was 26. A cognitive examination was not possible at that time due to catatonia. Routine laboratory studies, cerebrospinal fluid examination, and the EEG study were normal. Magnetic resonance imaging scans are shown below.

5/7 Family history revealed that the patient’s father &
several relatives had an undiagnosed illness characterized by choreoathetotis, aggressiveness, & cognitive decline. We evaluated her father and found prominent choreoathetotic movements & dementia.

6/7 Polymerase chain reaction confirmed Huntington Disease in our patient, with 17/45 cytosine-arginine-guanine repeats at the Huntington gene in the 4p chromosome. After improvement of catatonia, she had bradykinesia & dystonia, instead of choreoathetosis

7/7 She remains stable on maintenance with lorazepam, amantadine and levodopa/carbidopa. Unfortunately, HD is progressive, leads to dementia & eventually death.

Source: pubmed.ncbi.nlm.nih.gov/22123587/

Neuropsychiatric symptoms are common in movement disorders:
pubmed.ncbi.nlm.nih.gov/32071931/

We learned many things from this case. Neurological patients with movement disorders may present with unexpected psychiatric disturbances & worsening with antipsychotics may be considered a red flag
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