Psychosis and brainstem malformations: A case series.

BACKGROUND

First episode psychosis can be secondary to many psychiatric and medical conditions including congenital neurological abnormalities. This case series explores the association between first-episode psychosis and structural brainstem malformations-Dandy-Walker variant, Arnold-Chiari malformation, and aqueductal stenosis.

CASES: Case 1: A 16-year-old male presented with disorganized behavior and affective symptoms; Magnetic resonance imaging (MRI) revealed a Dandy-Walker variant. Significant improvement was achieved only with clozapine. Case 2: An 18-year-old male with irritability, disinhibition, and poor medication response was found to have Arnold-Chiari Type I malformation; clinical recovery occurred following electroconvulsive therapy. Case 3: A 17-year-old male with psychosis, seizures, and borderline intellect demonstrated aqueductal stenosis; symptom recurrence followed medication discontinuation but improved post-seizure.

CONCLUSION

Brainstem malformations may underlie certain psychoses via cerebellar dysfunction and predictive processing deficits. Early recognition and multidisciplinary management are vital, and further research into cerebellar contributions to psychosis is warranted.