Initial 'schizophrenia-like' psychosis in Pick's disease: case study with neuroimaging and neuropathology, and implications for frontotemporal dysfunction in schizophrenia.

'Schizophrenia-like' psychosis has not been reported previously as a prodrome of Pick's disease, a dementia of frontotemporal pathology. A woman having a consistent clinical diagnosis of typical schizophrenia who developed increasing affectivity and cognitive deficits was examined by computed tomography and brain biopsy. This presentation was found to be associated with left frontotemporal atrophy, left sylvian fissure abnormalities and enlargement of the anterior and temporal horns of the left lateral ventricle. On biopsy, all the neuropathological hallmarks of Pick's disease were present. Unusually, some specific aspect of Pick's disease in this patient appears initially to have disturbed brain function in a manner reproducing some fundamental aspect(s) of schizophrenia itself; left frontotemporal dysfunction would appear to be a relevant common denominator.