Manifestações psiquiátricas estão presentes em pelo menos um terço dos doentes com cancro. Apesar disso, menos de 50% são devidamente acompanhados. Este artigo contribui para a escassa literatura existente sobre sintomas psicóticos em doentes com tumores neuroendócrinos ‐ uma apresentação rara de uma doença rara. Enfatiza uma possível associação entre tumor carcinoide do pulmão e sintomas psicóticos, discute o diagnóstico diferencial e apresenta uma opção terapêutica psicofarmacológica eficaz, nunca publicada, até onde sabemos. Relatamos o caso de uma doente de 69 anos com um tumor carcinoide atípico do pulmão, sem história psiquiátrica prévia. O quadro clínico caracterizou‐se por ideias delirantes paranoides e autoreferenciais, atividade alucinatória acústico‐verbal, humor depressivo e ansiedade extrema secundários. Foi admitida uma psicose orgânica em provável relação com a sua doença neoplásica, que foi tratada com aripiprazol, com boa resposta e tolerância.

Introduction:Hypothalamic Hamarthoma (HH) is a non-neoplastic nodule resembling the normal gray matter of the hypothalamus. It is usually recognized by its characteristic’gelastic seizures’ and central-type precocious puberty. However, detection of HH in institucionalized people with anti-social and violent behavior has laid some attention in its psychiatric manifestations.Objective:The authors intend to report a clinical case of a patient with rage attacks who was diagnosed with HH, and to make a review of psychiatric symptoms and their treatment in this disorder.Methods:Literature review through Pubmed and report of a clinical case.Results:Patient aged 39 years old with a 10-year history of epilepsy, under levetiracetam 1000 mg id, was referred to Psychiatry consult due to episodic rage attacks with physical violence. During the diagnostic investigation, the patient made a Magnetic Resonance Imaging which detected a 1cm non pedunculated HH in the III ventricle. The patient Mental State Examination was positive for mild cognitive decline and impulse control disorder with immediate regret and insight. The latter disorder was stabilized with quetiapine 300 mg SR bid and antiepileptic therapy.Discussion and Conclusion:This review shows the importance of Magnetic Resonance Imaging in characterization of some psychiatric syndromes. The behavioural abnormalities in patients with HH have not been specifically studied, although typical or atypical antipsychotics plus antiepileptic drugs have a favorable impact. However, aggressiveness is in most cases medically intractable and even with surgery, it can persist at a minor degree.

IntroductionStudies have consistently found that many individuals with psychosis experience significant delays before receiving treatment. DUP refers to the period between the emergence of psychotic symptoms and the initiation of appropriate clinical treatment.ObjectivesTo review current knowledge on the best approach for patients with schizophrenia (SCZ) and prolonged DUP.MethodsNon-systematic review of literature through search on PubMed database, following the terms “DUP and treatment” and “impact of longer DUP”. Two clinical cases are described.ResultsThe clinical cases describe patients with SCZ with DUPs older than 10 years, in whom we could not achieve complete clinical remission after several therapeutic trials and whose prognosis was admitted as reserved. Longer DUP is an independent predictor of poorer outcome in SCZ, including the poor response to treatment and difficulty in achieving remission, predicting treatment resistance. Identifying treatment-resistant patients is crucial due to the importance of initiating clozapine as early as possible since the chances of responding are higher.ConclusionsDUP is a key prognostic variable in psychosis, revealing the significance of early treatment. Patients with long DUP should be regarded as at high risk of poor recovery. The detection of these patients enables clinicians to avoid unnecessary exposure to ineffective treatments while effective interventions are delayed. However, in view of adverse side effects of clozapine, future studies need to examine relevant predictors to detect accurately non-responders. We also suggest further studies to understand if there is correspondence between DUP and different stages of the disease that justify these results.