Neurocysticercosis and Psycho-social Trauma
This chapter describes a patient with neurocysticercosis who presented with psychotic features. He came to Cairns, Queensland, Australia as a refugee following his experiences of civil unrest in Rwanda. A review of the current literature on neurocysticercosis is described including an introduction, clinical presentation of neurocysticercosis, diagnosis, treatment, case presentation, clinical course, Axis 1-IV diagnoses and discussion highlighting psychosocial trauma. A history of the genocide he survived in Rwanda in 1994 is summarised along with a discussion of traumatic or dissociative psychosis that was included in his differential diagnosis. The patient was admitted through the Emergency Department where he was assessed and treated in a medical ward with the involvement of the Psychiatric Liaison Team and Infectious Disease Team. CT and MRI of the brain confirmed the diagnosis of neurocysticercosis. Medical treatment was administered for neurocysticercosis and community psychiatric and medical follow-up were undertaken.
Medical treatment of neurocysticercosis was successful but the patient subsequently developed a seizure disorder that was treated effectively and subsequently resolved without the need for continuing medication. The patient’s psychotic disorder was treated with medication and supportive psychotherapy. His delirium cleared quickly after two days treatment with an antipsychotic was given. Unresolved grief related to psycho-social trauma was addressed as an on-going process during his community psychiatric treatment.
Neurocysticercosis is rare and should be considered in immigrants from countries that have endemic neurocysticercosis. A small minority of patients present with psychosis. This patient who survived extensive trauma presented with psychosis that required assessment for traumatic or dissociative psychosis.
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Cairns Base Hospital Mental Health Unit, Cairns, Queensland, Australia.
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