Amir Mufaddel, Ghanem Al Hassani, Ossama T Osman and Shakhbout Al Bedwawi
Community Mental Health Services, Behavioural Sciences Institute, Al Ain Hospital, UAE
Background: Basal Ganglia Calcifications (BGC) have been reported as incidental findings during radiological examination of patients presenting with psychiatric manifestations. It can be asymptomatic or can be associated with diverse clinical symptoms including neurological and psychiatric symptoms.
Objectives: The current study focuses on clinical correlates of BGC in psychiatric patients compared with a group of psychiatric patients who had negative findings on radiological studies.
Methods: The findings discussed in our current paper are derived from data of a cross-sectional retrospective study aiming to investigate the radiological findings in patients admitted to the psychiatric ward in Al Ain Hospital. We identified a group of patients having BGC on radiological examinations, and compared them with 30 patients with negative radiological findings, who were admitted to the psychiatric ward during the same period. Data were analyzed using SPSS version 19.
Results: We identified a total of 15 patients who had BGC. This number represents 5.1% of those who were subjected to radiological investigations (n=295), and 16% of those who had positive radiological findings (n=94). Based on the documented clinical diagnosis; mood disorders were diagnosed in 5 patients (33.3%) with BGC and psychotic disorders were diagnosed in 4 (26.7%) patients including 2 patients with unspecified psychosis and 2 patients with schizophrenia.
Five (33.3%) patients with BGC had one episode of psychiatric symptoms, two (13.3%) had two episodes and 8 (53.3%) had 3 or more episodes. The duration of the current episode was less than one month in the majority of patients (66.6%). The majority of those who had BGC presented with psychiatric symptoms in their 3rd decade (46.7%) and 4th decades (33.3%) of their lives. The age at presentation was significantly higher compared with those who had negative radiological findings who presented at an age less than 29 years in the majority of cases (p=0.001).
Cognitive symptoms were present in 60% of patients with BGC compared with only 6.7% of patients who had negative radiological findings (p=0.001). The majority of patients with BGC (66.7%) had history of chronic medical co-morbidities compared with 20% of the control subjects (p=0.003). Patients with BGC were found to have significantly lower mean calcium levels (P=0.003), and significantly higher C-reactive protein (CRP) compared with control subjects (P=0.049).
Conclusion: BGC should be considered in the differential diagnosis of patients presented with psychiatric symptoms particularly those who are presenting in the 3rd and 4th decades. Prominent cognitive symptoms are common presenting in the course of other symptoms suggestive of psychiatric diagnoses of mood or psychotic disorders. BGC are associated with higher rates of medical comorbidities and physical symptoms, lower calcium levels and higher CRP compared with controls.
Keywords: Psychiatric symptoms, basal ganglia calcification, mood disorders, psychosis, Fahr’s disease.