Executive Dysfunction Secondary to Internal Frontal Hyperostosis in Treatment-Resistant Schizophrenia: A Case Report
Bibliographic record
Abstract
Background: Internal Frontal Hyperostosis (IFH) is a radiologically defined thickening of the inner table of the frontal bone that can compress prefrontal cortices, contributing to neuropsychiatric symptoms.1 Its coexistence with treatment-resistant schizophrenia (TRS) complicates diagnosis and management. Objective: To describe the case of a patient with TRS and comorbid IFH, focusing on the clinical evolution, executive dysfunction, and the utility of early neuroimaging. Case Presentation: A 43-year-old female patient with schizophrenia since age 18 was clinically unstable despite treatment with clozapine (600 mg/day) and adjunctive pharmacotherapy. She exhibited psychomotor retardation, concrete thought, and behavioral dyscontrol. Non-contrast cranial computed tomography revealed bilateral frontal bone thickening (2.45 cm) consistent with IFH, with compression of both frontal lobes. The Montreal Cognitive Assessment (16/30) indicated moderate cognitive impairment with prominent executive deficits. The patient was discharged with multidisciplinary follow-up. Discussion: Persistent executive dysfunction despite optimized pharmacotherapy suggests that the IFH contributed to pseudorefractoriness by compressing the dorsolateral prefrontal cortex, potentially blunting the response to clozapine. Conclusions: IFH may act as an anatomical modifier in schizophrenia, exacerbating executive dysfunction. Early neuroimaging can uncover structural contributors to treatment refractoriness and guide multidisciplinary management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".