Fahr's disease and psychiatric syndromes: A case series
Mr. X, 65-year-old male who was premorbidly well adjusted and had past history of pulmonary tuberculosis (at the age of 42 years) and blindness of left eye (since the age of 45 years) with no family history of mental disorders, presented with an episodic illness which started at the age of 48 years. The first episode was characterized by depressive features in the form of sadness of mood, crying spells, anhedonia, depressive cognitions, increased sleep, and decreased appetite. For this, he was initially treated with T sertraline with which he showed complete improvement. After a few months of remission, he had symptoms of mania in the form of irritability, increased self esteem, grandiosity, overactivity, overfamiliarity, decreased sleep, and increased appetite. He was managed with antipsychotics with which he improved completely.\nOver the years, he had 4 episodes of mania, each lasting for 2–4 months, associated with marked dysfunction, and would require treatment for the same. Now, he was symptomatic for about 9 months. He initially had symptoms suggestive of moderate depressive episode without somatic symptoms (as per ICD-10) lasting for 8.5 months, followed by manic symptoms (current episode mania with psychotic symptoms) for 2 weeks with marked socio-occupational dysfunction. Initially, diagnosis of bipolar affective disorder, current episode mania with psychotic symptoms, was considered. However, in view of late age of onset (48 years at the time of first episode), he was evaluated for organic causes.\nHis investigations in the form of hemogram, blood biochemistry including serum calcium levels, liver function tests, renal function tests, thyroid function tests, electroencephalogram, and electrocardiogram did not reveal any abnormality. A NCCT of brain showed calcification of basal ganglia in the region of globus pallidus. In view of the BGC, parathyroid hormone estimation was done, which did not reveal any abnormality. Magnetic resonance imaging of brain showed mild cerebral atrophy. In view of the late-onset bipolar affective disorder and BGC in the absence of parathyroid abnormality, a diagnosis of FD was considered. He was managed with T. Olanzapine 10–15 mg/day along with T. Clonazepam up to 2 mg/day with which he achieved remission.