Chiari Malformation with Depression and Sever Psychosis; a case report

Background and Aim : Introduction: We introduce a patient who has been evaluated for headache and some psychiatric symptoms from two years ago, and the diagnosis of type I chiari has been introduced to her. She has experienced episodes of depression and, after assessments, she has been advised to undergo decompression surgery. In the recent episode of the disease, severe symptoms of depression with psychotic feature were seen and the patient complained of headache in the occipital area and nausea. Along with these recent symptoms, the patient suffers from a long-standing obsessive-compulsive disorder from adolescence, which has been under proper medical control, along with a family history of obsessive-compulsive disorder in the patient s mother. The presence of neurological symptoms associated with anatomical cerebral malformation and accompanying severe psychiatric manifestations in the patient that some of them are with family history and some of them are without it, together with different therapeutic responses in this patient, are specific features of this introduction.Methods : case: The patient is a 41-year-old woman with a history of treatment-resistant headaches over the past two years, who has had affective and psychotic symptoms in parts of this period. In the imaging survey, type 1 Chiari malformation is presented to the patient.In the recent period, the patient suffers from exacerbation of headache accompanied by nausea, depressed episode, auditory and visual hallucinations accompanied with suicidal and filicidal idea, and ultimately accompanied by medication, due to the severity of the symptoms undergoing electroconvulsive therapy. Also, after two years of unwillingness to undergo surgery, the patient admitted to the neurosurgeon to assess, and, if necessary, undergo surgery.Results : As it seems, there may be a relationship between type 1 chiari and some psychiatric manifestations of this patient. Such demonstrations, due to such anatomical or functional association, give rise to an inadequate response to pharmaceutical therapy with periodic recurrence. other psychiatric events unrelated to this process generally depend on the type of response seen in the usual psychiatric disorders and the likelihood of having a family history and long-term control of symptoms is more. Also, in this article, we investigate the possible effect of chiari malformation on mood and psychosis manifestation, not only through the effect of compression on the brain stem, spinal cord or cervical spine, but also on the indirect side effects of this abnormality, by making changes in neurotransmitters. In addition, while referring to the functions of the cerebellum in non-motor function including cognitive and emotional domains, the likelihood of the effects of type I chiari malformation, on mood and psychotic disorders have been evaluated from this perspective.Conclusion : It is necessary to pay attention to all diagnostic and therapeutic aspects of psychiatric disorders accompanied with neurological disorders. The use of imaging techniques at the right time, attention to therapeutic treatments, and considering surgical procedures according to the circumstances are essential in managing these conditions.

کلیدواژه ها:

Chiari Malformation ، Depression ، Sever Psychosis