精神分裂症还是神经退行性疾病前驱期？一位 35 岁女性首次精神病发作的结局。
Schizophrenia or neurodegenerative disease prodrome? Outcome of a first psychotic episode in a 35-year-old woman.
机构信息
Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
出版信息
Psychosomatics. 2012 May-Jun;53(3):280-4. doi: 10.1016/j.psym.2011.04.005. Epub 2012 Jan 28.
Abstract
BACKGROUND
Patients with early onset neurodegenerative disease can present with a clinical syndrome that overlaps with schizophrenia, and it is not uncommon for these patients to undergo long-term care in psychiatric settings rather than receiving more appropriate care by neurologists specializing in their disease.
CASE REPORT
A 35-year old woman who presented with new-onset delusions, eating abnormalities, disorganized behavior, lack of insight, disinhibition, and stereotypical motor behaviors was diagnosed with schizophrenia and institutionalized. Later she was found to have a MAPT tau S356T mutation and a focal pattern of brain atrophy consistent with frontotemporal dementia (FTD).
CONCLUSION
Physicians should be aware of the potential overlap in symptoms and age of onset between some forms of FTD and schizophrenia, and should include FTD in the diagnostic differential for adult patients with new onset, rapidly progressive personality changes or behavioral symptoms such as binge eating, high levels of social disinhibition, or progressive mutism.
摘要
背景
早发性神经退行性疾病患者可能出现与精神分裂症重叠的临床综合征，这些患者经常在精神科环境中接受长期护理，而不是由专门治疗其疾病的神经科医生提供更合适的护理。
病例报告
一位 35 岁女性，出现新发妄想、进食异常、行为紊乱、缺乏洞察力、失抑制和刻板运动行为，被诊断为精神分裂症并入院治疗。后来发现她携带 MAPT tau S356T 突变和局灶性脑萎缩模式，符合额颞叶痴呆（FTD）。
结论
医生应该意识到某些形式的 FTD 和精神分裂症在症状和发病年龄上存在潜在重叠，对于出现新发、快速进展的人格改变或行为症状（如暴食、高度社交失抑制或进行性缄默）的成年患者，应将 FTD 纳入鉴别诊断。
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