Detailed contribution information
| Contribution title | The Complexity of Differential Diagnoses in Psychotic Symptoms - A Case Report |
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| Contribution code | D3.115 |
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| Form of presentation | Poster |
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| Abstract |
Patient background: We present the clinical case of a 16-year-old patient who came to us for day-clinic treatment with very complex psychiatric symptoms, primarily a persistent delusional disorder. The patient had social behavior disorder and ADHD since toddlerhood. Over time, he also developed an obsessive-compulsive disorder and, in the months prior to admission, a persistent delusional disorder related to body features (body dysmorphophobia), resulting in acute suicidal crises. Clinical presentation and diagnosis: The patient displayed a marked difficulty in social interaction, while being contact-seeking and empathic. An autism spectrum disorder had already been ruled out twice in the case history. An IQ test showed below-average intelligence (IQ 63) with a severe restriction in visual-spatial thinking, which was evident in everyday life situations. Due to the patient's complex, long-standing medical history and diverse symptoms, a comprehensive somatic differential diagnosis was carried out, including the exclusion of autoimmune encephalitis and metabolic disease. Therapy and outcome: Somatic differential diagnosis (among others blood tests, EEG, cMRI, lumbar puncture) did not produce any conclusive findings. Treatment was therefore guided by the psychiatric symptoms. Drug therapy was successfully switched from risperidone to aripiprazole and showed clearly positive effects. The patient also benefited greatly from a daily structure and support from trained staff in everyday life situations to cope better in social situations. Learning points: A somatic differential diagnosis is very important in the case of complex psychiatric symptoms and long-standing medical history. If no causally treatable illness can be diagnosed, treatment should be symptom-based. |