Dados do Trabalho

Título

Cerebellum and Psychiatry: The overlooked hub of behavioral neurocircuitry

Apresentação do caso

LHSRV, male, 31 years old, was brought to the psychiatric unit due to a history of manic episodes, psychotic symptoms, impulsiveness, episodes of wandering for long distances and automatic behavior. The patient had no family history of psychiatric disorders. The patient was described as a very shy child, but since an early age he displayed a quite successful academic and professional life. At the age of 25, the patient experienced a manic syndrome associated with psychotic features. He was admitted into a psychiatric unit where he was medicated with risperidone and lithium, leading to full remission of his symptoms. After the manic episode, the patient presented with clinical features of melancholic depression. Two years later, the patient suffered a psychotic relapse, this time with episodes of wandering and automatic behavior. The patient started to walk around parks, neighborhoods and across cities on foot (he used to walk an average of 12 km per day). On one episode he walked from London to Manchester (190 km) and presented himself with injuries on both feet. An MRI was solicited and evinced a left choroidal fissure cyst and mild hypoplasia of inferior cerebellar vermis. Several antipsychotics were administered, with moderate success in remitting his positive symptoms, but without benefits in the treatment of his catatonic features. Clozapine was eventually started, the antipsychotics removed and the patient manifested remarkable improvement of his catatonic and pharmacological-induced symptoms.

Discussão

The medical literature traditionally holds the cerebellum as a motor hub of movement circuitry. However, this old paradigm has been challenged by a great amount of recent evidence. Not only cerebellum is now regarded as a key structure to emotion, cognition and behavior, but it is also heavily associated with mental disorders. In this work, we, under the light of current scientifical research, propose that disorders of the cerebellum may actually hold a strong correlation with classical psychiatric syndromes, such as psychosis, wandering, catatonia and mania.

Comentários finais

This case provides further evidence that cerebellar circuitry is directly correlated with the emergence of psychiatric syndromes.

Palavras-Chave

Cerebellum — Catatonia — Cerebellar Cognitive Affective Syndrome