DOI: 10.36347/sjmcr.2021.v09i02.015

Pages: 174-177

The psychotic disturbances in a patient can either have an organic cause or a functional cause. One of the organic causes is the presence of any space occupying lesion in the brain like the Arachnoid cyst. We present the case report of a 15-year-old adolescent male who presented with insidious development of psychotic symptoms in the form of delusional ideas of referential and persecutory content, of varying intensity with second person auditory hallucinations, disturbance of sleep and behaviour in form aggression. He was admitted in our ward and his medical work up was within normal range including the neurological examination except for the neuroimaging studies that revealed an arachnoid cyst in the right temporal region with a marked mass effect on right temporal lobe. The neurosurgery consult suggested conservative management for the same and the patient was managed on antipsychotic (Risperidone) along with an anticonvulsant (Levetiracetam) during the hospital stay when his psychotic and aggressive symptoms started improving. Our case emphasises the importance of considering an organic cause like any space occupying lesion in the brain (arachnoid cyst in our case) for induction of psychopathological symptoms, even those of schizophrenia. It is difficult to be absolutely certain whether the lesion had influence on the patient's presenting psychiatric symptoms or not. However, due to the anatomical and neuropsychological changes, one cannot exclude the possibility that the lesion played a significant role in this case. This raises considerable problems when it comes to choosing a therapeutic strategy in such a patient like whether the surgical intervention for the arachnoid cyst would change the course, prognosis and the outcome of the psychiatric symptoms or whether the psychopharmacological intervention would be sufficient for a better outcome and quality of life of the patient.