Mood symptoms Associated with CADASIL Syndrome: A Case Report

Abstract

ObjectiveTo discuss the psychiatric symptoms that are associated with CADASIL syndrome Abstract Cerebral:Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare type of hereditary disease involving the small cerebral vessels. The clinical symptoms are various and include recurrent ischemic strokes, migraine with aura, seizures with epilepsy, psychiatric problems such as mood disturbances, and progressive cognitive decline leading to dementia. This disease needs awareness amongst the psychiatrists even though it is discussed much more in neurology literature. Psychiatric symptoms are seen in 20–41% of patients with CADASIL syndrome (1, 2). Psychiatric symptoms are actually the initial presentation in 15% of the cases. (3) The psychiatric disturbance most reported are mood disturbances (9–41%) especially depression. Here a 42-year-old African American female was brought to the hospital emergency room after she was found wandering in the streets. Psychiatry was consulted for altered mental status. Upon evaluation by the psychiatric consult service she was only oriented to person, depressed, anxious and complaining of headaches. Initial CT scan showed marked small vessel disease and old lacunar infarcts in the basal ganglia and right corona radiata. Magnetic Resonance Imaging (MRI) of the brain showed acute infarcts in the right posterior frontal and right parietal lobes along with old infarcts. Her symptoms and findings on imaging were consistent with CADASIL syndrome. Once the diagnosis was confirmed and prior records were obtained patient was resumed on an antidepressant and anxiolytic.ConclusionThe purpose of this case report was to discuss psychiatric symptoms associated with CADASIL syndrome. Although there has been research showing a relationship between vascular disease and depression, a review of the literature suggests that there needs to be more research done to explore other psychiatric disturbances that may be seen with this syndrome. Psychiatric symptoms that are untreated can have the potential to further impact the quality of life therefore psychiatrists need to be aware of this syndrome in order to treat these patients promptly.References1 https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0778-8 2 http://dx.doi.org/10.32474/OJNBD.2018.01.000101 3 https://pdfs.semanticscholar.org/47f6/5952ee3c5dcf2a61345f704914b17fa8dc0d.pdf

Cognition, mood and behavior in CADASIL

“…Mood disturbances are most often reported between 30 and 60 years of age, in the presence of some cognitive changes, and after the occurrence of the first stroke event [45] . However, in some cases, they can be also inaugural and occur in the absence of any other symptom or cognitive deficit [24] .…”

“…At advanced stages of the disease, there is often severe cognitive impairment, disability and functional dependence. On the other hand, psychiatric symptoms may be inaugural and lead to misdiagnosis or diagnostic delays at the onset of the disease [ 24 , 25 ]. In patients first evaluated by psychiatrists because of mood or behavioral disturbances, the diagnosis is often raised secondarily because of a suggestive family history, MRI abnormalities detected incidentally, or, an unusual response to psychotropic treatments [26] .…”

Associations Among Parental Caregiving Quality, Cannabinoid Receptor 1 Expression-Based Polygenic Scores, and Infant-Parent Attachment: Evidence for Differential Genetic Susceptibility?

“…However, despite being an important factor in predicting attachment patterns, parental caregiving quality does not explain as much variance as one might expect ( De Wolff and van Ijzendoorn, 1997 ; van Ijzendoorn et al, 1999 ; Bailey et al, 2017 ). There has been evidence to support associations between attachment patterns and several sociodemographic factors such as maternal age ( Esma et al, 2018 ), socioeconomic status ( Acevedo et al, 2012 ), migration background ( Keller, 2018 ), infant sex ( Weinberg et al, 1999 ; David and Lyons-Ruth, 2005 ), infant gestational age ( Wille, 1991 ), descriptive factors such as maternal depression ( Kohlhoff and Barnett, 2013 ), social support ( Jacobson and Frye, 1991 ), and infant birth weight ( Wille, 1991 ; Weiss et al, 2000 ). In addition, there is a growing body of evidence suggesting that individuals’ genetics may influence attachment patterns ( Lakatos et al, 2000 , 2002 ; Belsky and Beaver, 2011 ; Luijk et al, 2011 ; Belsky et al, 2015 ; Pappa et al, 2015 ; Golds et al, 2020 ).…”