Schizophrenia-Like Psychosis and Dandy-Walker Variant Comorbidity: Case Report
30-year-old female patient with a 2-year history of psychosis presented with schizophrenia-like symptoms including, auditory and visual hallucinations, sense of insecurity, delusions of reference, of persecution, of being controlled; inapropriate and labile affect; irritability, aggression, workplace absenteeism, sleep disruption, and having suicidal and homicidal thoughts was brought to the emergency department with her brother and sister. The patient was being followed in different outpatient clinics with irregular use of various psychotropic medications such as risperidone, olanzapine, sertraline etc. This was her first hospitalization. About two weeks before admission, she manifested strange behaviors (covering toilet windows with toothpaste, having a knife under the bed to sleep, occasionally trying to attack to relatives with a knife). Premorbid educational performance and social adjustment were reported as normal. Family history of psychosis in one of his brother was reported. No remarkable anomaly was found by physical examination and laboratory testing. The mental status examination revealed slowness of thought, stereotypic and vicious thought content, blunted affect, absence of spontaneous speech, psychomotor retardation, social withdrawal, poor rapport and lack of insight. Borderline intelligence activity was found on Weschler Adult Intelligence Scale-revised in Turkish (WAISRT) and full intelligence quotient was 75. Her overall cognitive functions were obviously impaired; (poor attention, impaired recent and remote memory, visuospatial distortion, simple arithmetic) but the abstract reasoning was roughly good. Electroencephalogram revealed moderate bioelectric disorganization in each frontal and right temporooccipital regions and the presence of sharp wave discharges in the both centroparietal regions was reported. MR scanning disclosed cerebellar vermis hypoplasia and large cerebellar medullary system in the 4th ventricular posterior cisterna magna (keyhole deformity) that is compatible with Dandy-Walker variant (). Initial treatment with Risperidone 50 mg depot and 6 mg/day p.o, biperiden 4 mg/day p.o treatment and lorezepam 2.5 mg/day p.o achieved nearly 35% reduction in Positive and Negative Symptoms Scale (PANSS) scores (from 144 to 90) within 10 days. Treatment with injectable risperidone 50 mg fortnightly eliminated positive psychotic symptoms and most of the negative symptoms within two months except social isolation.