Background: The cerebellum has traditionally been regarded as an organ of motor coordination. However, the importance of the cerebellum in psychiatric disorders, behavior, and cognition is increasingly being recognized. There is no consensus concerning treatment of schizophrenia-like psychosis after cerebellar pathology. Reports describe the use of several antipsychotics, either alone or in combination with antidepressants or lithium. Clozapine is used for the treatment of refractory schizophrenia, but there are no reports of its use in the abovementioned situation.Case Presentation: We report the case of a 20-year-old woman who developed a schizophrenia-like psychosis after rupture of arteriovenous malformation at 13 years of age. The psychotic symptoms proved to be resistant to treatment, and several psychopharmacological schemas were tried. The clinical picture only showed consistent improvement with the combined use of clozapine and valproate. Conclusions:The relationship between chronic psychosis and cerebellar pathology remains poorly understood. Cases like the present one suggest that clozapine and valproate may be used safely and effectively in refractory schizophrenia-like psychosis associated with cerebellar pathology.

Data regarding 24-hour periods starting 45 minutes before kick-off was collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized according to time frame (during and after the match), urgency level, and paired accordingly.Results: A total of 14 relevant periods (7 match and 7 non-match) were analyzed, corresponding to a total of 5861 admissions. During the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; p = 0.05) in less urgent admissions (triage levels green-blue). Compared to controls, post-match time frames showed a global increase in admissions (5.6%; p = 0.45), significant only when considering less urgent ones (18.9%; p = 0.05). Discussion: A decrease in the total number of emergency department attendances occurred during the matches, followed by a subsequent increase in the following hours. These variations only reached significance among visits triaged green-blue. Conclusion: During major sports events an overall decrease in emergency department admissions seems to take place, especially due to a drop in visits associated with less severe conditions.

Munchausen syndrome is a disorder in which patients intentionally produce symptoms mimicking physical or psychiatric illnesses with the aim to assume the sick role and to gain medical attention. Once a patient receives a Munchausen syndrome diagnosis every complaint made thence tends to be regarded with scepticism by clinical staff. However, it is possible that a bona fide illness, which might be disregarded, may coexist in these patients. We report a case of MS mimicking psychiatric disease with concomitant genuine acute physical illness. Despite the initial doubts about the veracity of the latter, due to its prompt recognition, treatment was successful.

In Portugal, offenders found not guilty by reason of insanity (NGRI), may be given a restricted order to a special hospital as an alternative to prison. In European countries there is a recognized need for data concerning this special population. The aim of the present study was to examine the characteristics of all the NGRI subjects (n = 274) detained in the country in a descriptive and retrospective survey conducted in January 2009. Offence committed, demographic factors, diagnosis at admission, background of substance abuse and diagnostic stability were recorded. Schizophrenia was the commonest diagnosis (51.5%). Mean population age was 42.6 years, with only 6.2% women. Homicide was the most common offense (41.2%). A background of substance abuse was found in 42.3% of subjects. There were significant differences in the schizophrenia and mental retardation patient groups when compared individually with the other diagnoses concerning homicide and arson as the offence. Mean duration of inpatient stay did not differ significantly between diagnoses. The findings also point to poor follow-up of the NGRI patients after admission.

Since Bell's original description delirious mania (DM) has been repeatedly rediscovered and renamed, resulting in much confusion as to its meaning.Definitions range from mania with self-limited temporalspatial disorientation to a fatal, delirious catatonic syndrome with euphoric mood, high fever and autonomic instability. Moreover, it remains unclear whether DM is a specific clinical entity or an unspecific, unpredictable complication of mania, and whether it is a useful diagnostic category. Objective: To identify the frequency and clinical features of DM and mania with delirium. Methods: We reviewed all admissions to our acute inpatient unit with mania, hypomania or mixed affective state, in 2006 and 2007. Cases with delirious features and cases with a working diagnosis of DM, were reviewed in detail. The three groups (no delirium, delirious features and DM) were compared for general demographic and clinical variables, as well as features specifically associated with DM (e.g., catatonia; nakedness; inappropriate toileting; unexplained fever, etc). Results: We found 100 patients with mania, hippomania or mixed affective state. 14 had medically unexplained delirium, 4 of them with a final diagnosis of DM. DM cases (but not non-DM mania cases with delirious features) had extremely long durations of stay, acute onset, hypertermia, catatonia, autonomic instability, anarchic sleep, shouting/coprolalia, delirium persisting for over a week, and were more likely to receive ECT. Moreover, in three of them DM occurred in most manic/mixed affective episodes. Conclusion: DM is a rare occurrence in bipolar disorder. It has typical clinical features and may be recurrent.