Abstract
Background. A 48 year-old woman presented with an 18 month history of bizarre and complex delusions on a background of social, behavioral and cognitive decline over several years. Her psychosis progressed despite receiving high doses of antipsychotics. The patient's father also had a psychotic episode in his 40s. He subsequently developed motor neuron disease, which caused his death at 68 years of age.
Investigations. Physical examination, neuropsychological testing, nerve conduction studies, brain MRI and transcranial magnetic stimulation.
Diagnosis. On the basis of the patient's age at onset of the delusions, imaging findings and family history, a diagnosis of frontotemporal dementia (FTD) was favored over a primary psychotic disorder. The ubiquitin-positive and TAR DNA binding protein 43-positive inclusions that were found at autopsy confirmed the diagnosis of FTD.
Management. The patient was treated with various antipsychotics at high doses; however, her delusions continued to progress. No disease-specific treatments for FTD currently exist.
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Acknowledgements
Written consent for publication was obtained from the patient's family. This study was supported by a NHMRC Postgraduate Scholarship to C. T. Loy.
Désirée Lie, University of Calfornia, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
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The authors and the Journal Editor H. Wood declare no competing interests. The CME questions author D. Lie has served as a nonproduct speaker for "Topics in Health" for Merck Speaker Services.
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Loy, C., Kril, J., Trollor, J. et al. The case of a 48 year-old woman with bizarre and complex delusions. Nat Rev Neurol 6, 175–179 (2010). https://doi.org/10.1038/nrneurol.2010.3
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DOI: https://doi.org/10.1038/nrneurol.2010.3
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