Case Report

Psychiatric Presentation in a Patient with Myotonic Dystrophy: A Case Report

Abstract

Myotonic Dystrophy type 1 (DM1) is a progressive life-threatening disorder that affects several systems in the human body. Besides physical involvements, previous studies reported various psychiatric and cognitive presentations in these patients. We presented a 65-year-old patient with adult-onset DM who suffered from multi- system involvement. She has also experienced a series of psychiatric symptoms including depressed mood, insomnia, fatigue, reference delusion, visual and auditory hallucinations besides impaired cognitive functions. With the diagnosis of major depressive disorder with psychotic features, she was treated with Sertraline and Haloperidol. The cognitive impairment was continued after improvement in mood, and donepezil 5 mg was prescribed. Whereas patients with DM1 and with psychiatric manifestations have significantly lower function than those without psychiatric symptoms, clinicians should be aware of the mental status examination and eventual psychiatric disorders in these patients. Our case presentation suggests a multidisciplinary approach to these patients to provide comprehensive health care.

1. Pascual-Gilabert M, Lopez-Castel A, Artero R. Myotonic dystrophy type 1 drug development: A pipeline toward the market. Drug Discov Today [Internet]. 2021; In press. https:// pubmed.ncbi.nlm.nih.gov/33798646/
2. Bird TD. Myotonic Dystrophy Type 1. In: March 2021. Seattle (WA): University of Washington: GeneReviews® [Internet]; 1993. (Adam MP, Ardinger HH, Pagon RA, et al.,). https://www. ncbi.nlm.nih.gov/books/NBK1165/
3. Sharma R. Cognitive and psychiatric disorder in myotonic dystrophy. Eur J Anaesthesiol [Internet]. 2010;27(9):842–3. https://doi.org/10.1097/eja.0b013e328336b973
4. Meola G, Sansone V. Cerebral involvement in myotonic dystrophies. Muscle Nerve [Internet]. 2007;36:294–306. https://doi.org/10.1002/mus.20800
5. Ambrosini PJ, Nurnberg HG. Psychopathology: A primary feature of myotonic dystrophy. Psychosomatics [Internet]. 1979;20(6):393–9. https://doi.org/10.1016/s0033-3182(79) 70797-3
6. Jacobs D, Willekens D, de Die-Smulders C, Frijns J, Steyaert J. Delusional and psychotic disorders in juvenile myotonic dystrophy type-1. Am J Med Genet B Neuropsychiatr Genet [Internet]. 2017;174(4):359–66. https://doi.org/10.1002/ ajmg.b.32524
7. Minier L, Lignier B, Bouvet C, Gallais B, Camart N. A Review of Psychopathology Features, Personality, and Coping in Myotonic Dystrophy Type 1. J Neuromuscul Dis [Internet]. 2018;5(3):279– 94. https://doi.org/10.3233/jnd-180310
8. Bertrand J, Jean S, Laberge L, Gagnon C, Mathieu J, Gagnon J, et al. Psychological characteristics of patients with myotonic dystrophy type 1. Acta Neurol Scand [Internet]. 2015;132:49– 58. https://doi.org/10.1111/ane.12356
9. American Psychiatric Association. Major depressive disorder. In: Diagnostic and statistical manual of mental disorders (5th ed). 2013.
10. Duara R, Loewenstein DA, Potter E, Appel J, Greig MT, Urs R, et al. Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease. Neurology [Internet]. 2008 Dec 9;71(24):1986. http://n.neurology.org/content/71/24/1986
11. Fazekas F, Chawluk J, Alavi A, Hurtig H, Zimmerman R. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. Am J Roentgenol. 1987;149:351–6. https://doi. org/10.2214/ajr.149.2.351
12. Johnson NE, Butterfield RJ, Mayne K, Newcomb T, Imburgia C, Dunn D, et al. Population-Based Prevalence of Myotonic Dystrophy Type 1 Using Genetic Analysis of Statewide Blood Screening Program. Neurology [Internet]. 2021;96(7):e1045– 53. https://doi.org/10.1212/wnl.0000000000011425
13. Kalkman JS, Schillings ML, Zwarts MJ, Van Engelen BGM, Bleijenberg G. Psychiatric disorders appear equally in patients with myotonic dystrophy, facioscapulohumeral dystrophy, and hereditary motor and sensory neuropathy type I. Acta Neurol Scand [Internet]. 2007;115(4):265–70. https://doi. org/10.1111/j.1600-0404.2006.00737.x
14. Colombo G, Perini G, Miotti MV, Armani M, Angelini C. Cognitive and psychiatric evaluation of 40 patients with myotonic dystrophy. Ital J Neurol Sci [Internet]. 1992;13(1):53–8. https:// doi.org/10.1007/bf02222889
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IssueVol 7 No 4 (2022): July-August QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v7i4.11593
Keywords
Myotonic dystrophy DM1 Psychiatric presentations Cognitive impairment
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How to Cite
1.
Radman N, Aghamollaii V, Mirsepassi Z. Psychiatric Presentation in a Patient with Myotonic Dystrophy: A Case Report. CRCP. 2023;7(4):179-182.