The Psychiatric Masquerade of a Frontal Lobe Lesion: Lessons from a Late-Onset Case

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Main Authors: Ahmed, Syed ayaan, Jilani, Abdurrahman, Asadullah, Abdullah
Format: Recurso digital
Published: Zenodo 2025
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author Ahmed, Syed ayaan
Jilani, Abdurrahman
Asadullah, Abdullah
author_facet Ahmed, Syed ayaan
Jilani, Abdurrahman
Asadullah, Abdullah
contents <p>Background: Neuropsychiatric symptoms are frequently encountered in dementia and may include<br>delusions, hallucinations, and behavioral disturbances. However, the coexistence of factitious disorder<br>(previously termed Munchausen syndrome) in elderly patients with dementia is exceedingly rare. The<br>presence of uncontrolled diabetes mellitus further complicates the clinical course, influencing both<br>cognitive decline and therapeutic decisions.<br>Case Presentation: We report the case of a 68-year-old man with uncontrolled type 2 diabetes mellitus who<br>presented with persecutory delusions, fluctuating cognitive impairment, and repeated fabrication of<br>seizure-like episodes. Clinical findings were incongruent with reported symptoms. Laboratory<br>investigations revealed poor glycemic control, while neuroimaging demonstrated only mild cerebral<br>atrophy. The inconsistency between subjective reports and objective findings raised suspicion of factitious<br>disorder, which coexisted with underlying dementia and psychosis. A multimodal treatment plan including<br>strict glycemic control, cautious use of antipsychotics, and caregiver psychoeducation was implemented.<br>Conclusion: This case underscores the diagnostic complexity when factitious disorder co-occurs with<br>dementia and psychosis in an elderly patient with uncontrolled diabetes. It highlights the importance of<br>integrating metabolic, neurological, and psychiatric perspectives for accurate diagnosis and effective<br>management. Clinicians should remain vigilant for factitious presentations in older adults, particularly<br>when inconsistencies arise between patient reports and objective findings.</p>
format Recurso digital
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institution Zenodo
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publishDate 2025
publisher Zenodo
record_format zenodo
spellingShingle The Psychiatric Masquerade of a Frontal Lobe Lesion: Lessons from a Late-Onset Case
Ahmed, Syed ayaan
Jilani, Abdurrahman
Asadullah, Abdullah
<p>Background: Neuropsychiatric symptoms are frequently encountered in dementia and may include<br>delusions, hallucinations, and behavioral disturbances. However, the coexistence of factitious disorder<br>(previously termed Munchausen syndrome) in elderly patients with dementia is exceedingly rare. The<br>presence of uncontrolled diabetes mellitus further complicates the clinical course, influencing both<br>cognitive decline and therapeutic decisions.<br>Case Presentation: We report the case of a 68-year-old man with uncontrolled type 2 diabetes mellitus who<br>presented with persecutory delusions, fluctuating cognitive impairment, and repeated fabrication of<br>seizure-like episodes. Clinical findings were incongruent with reported symptoms. Laboratory<br>investigations revealed poor glycemic control, while neuroimaging demonstrated only mild cerebral<br>atrophy. The inconsistency between subjective reports and objective findings raised suspicion of factitious<br>disorder, which coexisted with underlying dementia and psychosis. A multimodal treatment plan including<br>strict glycemic control, cautious use of antipsychotics, and caregiver psychoeducation was implemented.<br>Conclusion: This case underscores the diagnostic complexity when factitious disorder co-occurs with<br>dementia and psychosis in an elderly patient with uncontrolled diabetes. It highlights the importance of<br>integrating metabolic, neurological, and psychiatric perspectives for accurate diagnosis and effective<br>management. Clinicians should remain vigilant for factitious presentations in older adults, particularly<br>when inconsistencies arise between patient reports and objective findings.</p>
title The Psychiatric Masquerade of a Frontal Lobe Lesion: Lessons from a Late-Onset Case
url https://doi.org/10.5281/zenodo.17976017