Meeting abstract

https://doi.org/10.24869/spsih.2026.234

Which Came First – Psychosis or Organic Disease? The Importance of Somatic Assessment in First-Episode Psychosis

Ana Kolovrat ; Department of Psychiatry, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia *
Monika Golemović Mikić ; Department of Psychiatry, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia
Tatjana Prvulović Mirković ; Department of Psychiatry, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia
Ivona Pleša ; Department of Psychiatry, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia
Sergej Nadalin ; Department of Psychiatry, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia; School of Medicine, Catholic University of Croatia, Ilica 242, 10000 Zagreb, Croatia
Hrvoje Kožul ; Department of Psychiatry, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia
Marija Ratković ; Department of Neurology, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia
Dubravka Ergović ; Department of Psychiatry, General Hospital „Dr. Josip Benčević“, Andrije Štampara 42, 35000 Slavonski Brod, Croatia

* Corresponding author.

Abstract

A group of authors presents a patient who sought
treatment for the first time at the age of 31 with
a clinical picture of acute psychotic disorder. They
describe psychological changes over the previous
three years that have now culminated and manifested
in the form of disorganized behavior,
distractibility, paranoia, social and occupational
dysfunction, with increasingly pronounced aggressive
outbursts (verbal and physical), accompanied
by auditory and suspected visual hallucinations.
The patient, completely lacking insight
into his condition and convinced that he is entirely healthy, refused any form of treatment. He
was treated under compulsory hospitalization.
The clinical picture met the criteria for an endogenous
process of the schizophrenic type. The
demanding treatment was further complicated
by the development of side effects. After the
patient’s acute state had stabilized, diagnostic
workup was initiated. Routine CT imaging revealed
bilateral hypodensities of the deep white
matter of unclear etiology. Further assessment
was specifically directed, and a neurologist established
the diagnosis of an active demyelinating
disease, relapsing–remitting multiple sclerosis.
The diagnostic workup fulfilled the revised Mc-
Donald criteria for establishing the diagnosis –
supratentorial and infratentorial lesions showing
activity, positive cerebrospinal fluid findings, and
a high titer of free kappa light chain Ig in the cerebrospinal
fluid. All criteria were met for introducing
cladribine as first-line therapy in a person
at high risk of progression of neurological disability.
Through multidisciplinary collaboration and
adjustment of therapy, the psychotic symptoms
were completely resolved. The patient actively
participated in the assessment and treatment of
the neurological disease. Conclusion: Although
the initial clinical picture was consistent with
schizophrenia, detailed diagnostic workup and
identification of a somatic disease led to revision
of the diagnosis to organic psychosis. For further
treatment and maintenance of the patient’s
functioning, multidisciplinary collaboration and
follow-up are required to improve outcomes and
quality of life.

Keywords

psychosis; multiple sclerosis; somatic workup; multidisciplinary approach

Hrčak ID:

352619

URI

https://hrcak.srce.hr/352619

Publication date:

15.6.2026.

Article data in other languages: croatian

Visits: 0 *