Psychiatry research case reports最新文献

Recurrent clozapine-induced adynamic bowel obstruction requiring two laparotomies: A case report 复发性氯氮平引起的动力性肠梗阻需要两次剖腹手术：1例报告

Psychiatry research case reports

Pub Date : 2026-01-09 DOI: 10.1016/j.psycr.2026.100309

Archana Poudel , Sanjeev Kumar Mishra , Diwakar Koirala , Ramesh Sapkota , Bivek Mishra , Tek Nath Yogi

Introduction

CIGH is a potentially life-threatening adverse effect that may progress from constipation to adynamic obstruction, ischemia, sepsis, and death. Its early recognition is often delayed due to impaired symptom reporting, polypharmacy, and clozapine’s anticholinergic and anti-serotonergic effects, making vigilance essential in clinical practice.

Case Presentation

We report a 35-year-old man with a chronic psychotic illness on long-term clozapine who presented with acute abdominal pain, distension, bilious vomiting, and five days of constipation. Emergency laparotomy revealed 110 cm of pregangrenous small bowel, necessitating resection and double-barrel ileostomy. Three months later, following ileostomy reversal, he developed recurrent ileus requiring a second laparotomy, which demonstrated adynamic obstruction without mechanical cause, consistent with CIGH. His postoperative course was complicated by severe manic–psychotic relapse requiring antipsychotic re-initiation and electroconvulsive therapy. Multidisciplinary care enabled stabilization, and he was discharged with plans for delayed re-anastomosis once psychiatric control is optimized.

Discussion

This case exemplifies the severe and recurrent nature of CIGH and parallels the broad clinical spectrum reported in the literature, ranging from reversible ileus to fatal gastrointestinal necrosis. Timeliness of diagnosis and intervention determines outcome, as seen in comparable cases where delayed recognition resulted in fulminant ischemia and mortality, whereas early management enabled full recovery.

Conclusion

CIGH should be considered a medical emergency. Routine bowel monitoring, proactive laxative protocols, and a low threshold for imaging or surgical consultation are crucial. Integrated medical–psychiatric management is essential to prevent catastrophic complications and ensure safe continuation of antipsychotic therapy.

cigh是一种潜在的危及生命的不良反应，可能从便秘发展到动力梗阻、缺血、败血症和死亡。由于症状报告受损、多药、氯氮平的抗胆碱能和抗血清素能作用，其早期识别往往被延迟，因此在临床实践中必须保持警惕。我们报告一名35岁男性慢性精神病患者，长期服用氯氮平，表现为急性腹痛、腹胀、胆汁性呕吐和5天便秘。急诊开腹发现110厘米的早产小肠，需要切除和双管回肠造口术。三个月后，在回肠造口术逆转后，患者复发性肠梗阻，需要第二次剖腹手术，表现为无机械原因的动力梗阻，符合CIGH。他的术后过程因严重的躁狂-精神病复发而复杂化，需要抗精神病药物重新启动和电休克治疗。多学科治疗使病情稳定，他出院时计划在精神控制得到优化后进行延迟再吻合。本病例体现了CIGH的严重性和复发性，并与文献报道的广泛临床谱相似，从可逆性肠梗阻到致命性胃肠坏死。诊断和干预的及时性决定了结果，如在可比较的病例中所见，延迟识别导致暴发性缺血和死亡，而早期治疗可以完全恢复。结论cigh应视为一种医疗急诊。常规的肠道监测，积极的泻药方案，低阈值成像或手术咨询是至关重要的。综合医疗精神病学管理是必不可少的，以防止灾难性的并发症和确保安全的抗精神病治疗的延续。

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引用次数: 0

Guiding treatment in obsessive compulsive disorders by a pharmacogenetic approach 用药物遗传学方法指导强迫症的治疗

Psychiatry research case reports

Pub Date : 2026-01-08 DOI: 10.1016/j.psycr.2026.100310

Avigaelle Amory , Aurelie Casterman , Philippe de Timary , Vincent Haufroid

Obsessive-compulsive disorder (OCD) is a common and often enduring neuropsychiatric disorder that results in significant impairments in quality of life. Mostly commonly, its pharmacological management entails a course of a selective serotonin reuptake inhibitors (SSRIs) for ten to twelve weeks, but at higher doses than are typical for treating major depression disorder (MDD). However, the relatively high SSRI doses bring a significant risk for dropout due to side effects in the highly anxious OCD population. We now illustrate through a clinical case study how the use of pharmacogenetics (PGx) in an OCD patient enabled a personalized pharmacological strategy giving better therapeutic response along with lesser risk of untoward side effects. In our case, the patient’s poor clinical responses to initial trials with fluoxetine and escitalopram led us to undertake her pharmacogenetic profiling, which correctly predicted that high dose sertraline would obtain effective management of OCD symptoms. This case report illustrates how PGx assessment can enable physicians to make a more confident and personalized choice of SSRI and dosage, leading to improved patient compliance and a stronger therapeutic response, along with lesser side effects. Pharmacogenetic testing presents an emerging tool for guiding SSRI prescription for OCD, considerably improving the management of these difficult-to-treat patients.

强迫症（OCD）是一种常见且经常持续的神经精神障碍，会导致生活质量的严重损害。最常见的是，它的药理学管理需要10到12周的选择性血清素再摄取抑制剂（SSRIs）疗程，但剂量高于治疗重度抑郁症（MDD）的典型剂量。然而，在高度焦虑的强迫症人群中，相对较高的SSRI剂量会因副作用而带来显著的辍学风险。我们现在通过一个临床案例研究来说明，在强迫症患者中使用药物遗传学（PGx）是如何使个性化的药物策略产生更好的治疗效果，同时减少不良副作用的风险的。在我们的病例中，患者对氟西汀和艾司西酞普兰的初步临床反应不佳，导致我们对她进行了药理学分析，正确地预测了大剂量的舍曲林可以有效地治疗强迫症症状。本病例报告说明了PGx评估如何使医生能够更加自信和个性化地选择SSRI和剂量，从而提高患者的依从性和更强的治疗反应，同时减少副作用。药物遗传学测试提供了一种新兴的工具来指导强迫症的SSRI处方，大大改善了这些难以治疗的患者的管理。

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引用次数: 0

Implementing a classification methodology for serial arson: a case report 实施系列纵火案的分类方法：一个案例报告

Psychiatry research case reports

Pub Date : 2025-12-21 DOI: 10.1016/j.psycr.2025.100308

Palix Julie , Broillet Alain , Abbiati Milena

Early detection of serial arsonists can be challenging for forensic professionals. Serial arsonists account for nearly 20% of all fire setters, but only 1% of these individuals are diagnosed with pyromania and receive appropriate treatment. There is an urgent need for accurate identification to enable more effective management, thus preventing the significant ecological and economic damage caused by these criminal acts.

We present a case of a young serial arsonist responsible for setting 12 deliberate fires over a period of four weeks. The individual had been diagnosed with pyromania in pre-adolescence but was not diagnosed with it during the post-arrest assessment. Using psychiatric and forensic reports, we applied a validated 44-item classification methodology for incendiary acts. We performed multidimensional scaling analysis to examine the characteristics of serial fire setting.

In this case, alcohol abuse and episodes of arson without periods of emotional calm were recurrent. Advanced skills in arson were demonstrated, with a variety of scenarios targeting both objects and people.

The implementation of a classification methodology allowed us to identify additional features that distinguish this case beyond the diagnosis of pyromania. This approach paves the way for more appropriate and effective interventions, particularly those focused on controlling impulsivity.

对法医专业人员来说，早期发现连环纵火犯是一项挑战。连环纵火犯占所有纵火犯的近20%，但这些人中只有1%被诊断为纵火狂并接受了适当的治疗。迫切需要准确识别，以便更有效地管理，从而防止这些犯罪行为造成的重大生态和经济损害。我们提出了一个年轻的连环纵火犯在四周内故意纵火12起的案件。该个人在青春期前被诊断为纵火，但在逮捕后评估期间未被诊断为纵火。利用精神病学和法医报告，我们对纵火行为采用了一种有效的44项分类方法。我们进行了多维尺度分析来检验连环纵火的特征。在这个案例中，酗酒和纵火的发作反复出现，没有一段时间的情绪平静。现场展示了纵火的高级技巧，包括针对物体和人的各种场景。分类方法的实施使我们能够识别除纵火诊断外区分该病例的其他特征。这种方法为更适当和有效的干预铺平了道路，特别是那些专注于控制冲动的干预。

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引用次数: 0

A photo logbook against dissociative amnesias - a case report 一份针对解离性失忆症的照片日志-一份病例报告

Psychiatry research case reports

Pub Date : 2025-12-16 DOI: 10.1016/j.psycr.2025.100307

C Lau , K Seifert , C McCormick , J Taube , A Philipsen , MC Pensel

We report on a 47-year-old female patient who was diagnosed with a complex dissociative disorder, including dissociative identity disorder (DID) and dissociative amnesias in everyday life. Dissociative amnesias represent a major challenge for patients, as they reduce coherence in everyday experience and are accompanied by an impaired sense of agency. The neurobiological background of dissociative amnesia has been little researched, and therapeutic options specifically targeting this symptom are rare. In a photo elicitation interview, the patient reports of amnesias regarding her past, but also of time gaps in everyday life. To structure her experience of time, she reports of taking up to 200 photos of her immediate surroundings with her phone every day, which she regularly reviews in the evening. As an outcome, reviewing these photos provides a structuring frame for her everyday memory, reduces symptoms of perceived time gaps, and thereby increases her reported sense of agency. In addition, the photographic motifs also provide insights into the processing of dissociative experiences, e.g., regarding feelings of fragmentation and disruption. Furthermore, MRI-data of the patient were analysed and results are compatible with overall volume increases of the hippocampus following pattern completion tasks (specifically in CA2/3 subfields), and reduced volumes in CA1 subfields, as previously reported in patients with dissociative amnesia. The case report stresses the usefulness of photographs in complex dissociative disorders, as a complementary diagnostic tool regarding dissociative states and as a therapeutic method against dissociative amnesias. An involvement of the hippocampus is suggested but needs further scientific exploration.

我们报告一位47岁的女性患者，她被诊断为复杂的分离性障碍，包括日常生活中的分离性身份障碍（DID）和分离性遗忘。解离性失忆症对患者来说是一个重大挑战，因为他们日常经历的连贯性降低，并伴有代理感受损。解离性健忘症的神经生物学背景研究很少，专门针对这种症状的治疗方案也很少。在照片引出的采访中，患者报告了对她过去的记忆缺失，以及日常生活中的时间间隔。她说，为了构建自己的时间体验，她每天用手机拍摄多达200张周围环境的照片，并在晚上定期查看。因此，回顾这些照片为她的日常记忆提供了一个结构框架，减少了感知时间间隔的症状，从而增加了她所报告的主体感。此外，摄影主题还提供了对分离体验的处理的见解，例如，关于分裂和破坏的感觉。此外，对患者的mri数据进行了分析，结果与模式完成任务后海马的总体体积增加（特别是在CA2/3子区）和CA1子区体积减少相一致，如先前报道的分离性遗忘症患者。病例报告强调了照片在复杂分离性疾病中的有用性，作为关于分离状态的补充诊断工具和作为治疗分离性失忆症的方法。海马体也参与其中，但需要进一步的科学探索。

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引用次数: 0

Neuroleptic malignant syndrome following alcohol withdrawal: A case report 酒精戒断后抗精神病药恶性综合征1例报告

Psychiatry research case reports

Pub Date : 2025-12-09 DOI: 10.1016/j.psycr.2025.100304

Takeshi Okuda , Shogo Miyashita , Ryota Takeuchi , Yoshiaki Miyagishi , Mitsuru Kikuchi

Background

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening emergency precipitated by the use or withdrawal of dopamine-receptor antagonists or dopaminergic agents. It classically presents with lead-pipe rigidity, hyperthermia, autonomic dysregulation, and altered mental status. Delayed recognition still carries considerable mortality. Alcohol-withdrawal syndrome (AWS) ranges from mild tremor to delirium tremens and overlaps with NMS in fever, agitation, and autonomic instability, making early distinction difficult.

Case

We describe a middle-aged man with alcohol-use disorder who developed NMS during treatment of AWS after intramuscular haloperidol. Given significant hepatic dysfunction, dantrolene was avoided; ICU-level supportive care with continuous intravenous midazolam was provided. He improved clinically and biochemically; lorazepam was tapered off and he was discharged.

Conclusion

Overlapping pathophysiology—particularly reduced central dopaminergic tone in withdrawal states—may lower the threshold for NMS. A high index of suspicion for NMS is warranted in patients with AWS after antipsychotics administration. In the presence of hepatic impairment, drug choice and dosing should be tailored to liver function.

背景：抗精神病药恶性综合征（NMS）是一种罕见但危及生命的紧急情况，由多巴胺受体拮抗剂或多巴胺能药物的使用或停药引起。典型表现为铅管僵硬、高热、自主神经失调和精神状态改变。延迟识别仍然会带来相当大的死亡率。酒精戒断综合征（AWS）的范围从轻度震颤到震颤谵妄，并在发热、躁动和自主神经不稳定方面与NMS重叠，使早期区分变得困难。我们描述了一个中年男性酒精使用障碍，在肌肉注射氟哌啶醇治疗AWS期间发生NMS。鉴于肝功能明显，避免使用丹曲林；icu级别的支持护理提供持续静脉注射咪达唑仑。他在临床和生物化学方面有所改善；劳拉西泮逐渐减少，他出院了。结论重叠病理生理，特别是戒断状态中枢多巴胺能张力降低，可能降低NMS的阈值。在服用抗精神病药物后，AWS患者对NMS的高度怀疑是有根据的。在存在肝功能损害的情况下，药物的选择和剂量应根据肝功能进行调整。

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引用次数: 0

A rare but debilitating disorder: A case report on olfactory reference syndrome 一种罕见但使人衰弱的疾病：嗅觉参考综合征一例报告

Psychiatry research case reports

Pub Date : 2025-12-09 DOI: 10.1016/j.psycr.2025.100305

Mohammed Saud Almubaddil , Faisal Saleh Alsalamah , Reema Abdulaziz Alageel , Nujud Mohammed Bin khunayn , Reem Abdullah Alfulayj , Sultan Alshahrani

Olfactory reference syndrome (ORS) is a persistent and false belief that one emits a foul, unpleasant, or socially offensive body odor that leads to anxiety, depression, and significant functional impairment. Diagnosis remains challenging as it overlaps with multiple psychiatric conditions. Despite DSM-5 categorizing it as a part of “other specified obsessive-compulsive and related disorders,” its classification remains debated. We present a case of a 45-year-old male with persistent foul mouth odor, accompanied by significant anxiety and repetitive hygiene behaviors that impacted his social and occupational functioning. Upon admission, physical and neurological examinations are normal. Mental status examination with Yale-Brown Obsessive-Compulsive Scale reflecting severe obsessive-compulsive symptoms. The patient was started on Cognitive Behavioral Therapy (CBT), with multiple interruptions and restarts of various psychiatric medications. Currently, he is on Aripiprazole 5mg/day, Fluoxetine 20mg/day, and a gradual tapering of Olanzapine. We aimed here to discuss the place of ORS in the diagnostic systems with reference to this case. Our case supports the perspective that olfactory reference syndrome is related to other specified obsessive-compulsive and related disorders classification. Future research should seek to delineate ORS's place within psychiatric classification systems.

嗅觉参照综合征（ORS）是一种持续的错误信念，认为自己散发出难闻、不愉快或冒犯社会的体味，从而导致焦虑、抑郁和严重的功能障碍。诊断仍然具有挑战性，因为它与多种精神疾病重叠。尽管DSM-5将其归类为“其他特定的强迫症及相关疾病”的一部分，但其分类仍存在争议。我们提出一个45岁男性的情况下，持续口臭，伴随着显著的焦虑和重复的卫生行为，影响了他的社会和职业功能。入院时，身体和神经检查正常。用耶鲁-布朗强迫量表进行精神状态检查，反映严重的强迫症状。患者开始接受认知行为疗法（CBT），多次中断和重新开始各种精神药物。目前，他正在服用阿立哌唑5mg/天，氟西汀20mg/天，并逐渐减少奥氮平。我们的目的是在此讨论ORS在诊断系统中的地位。我们的病例支持嗅觉参照综合征与其他特定的强迫症和相关疾病分类相关的观点。未来的研究应该寻求描述ORS在精神病学分类系统中的地位。

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引用次数: 0

Remission of auditory verbal hallucinations following neuronavigated, personalized rTMS guided by EEG, MRI, and auditory evoked potentials: A case report 脑电图、MRI和听觉诱发电位引导下的神经导航、个性化rTMS后听觉言语幻觉的缓解：1例报告

Psychiatry research case reports

Pub Date : 2025-12-08 DOI: 10.1016/j.psycr.2025.100306

Barbora Provaznikova , Anna Monn , Aygün Ertuğrul , Samantha Weber , Erich Seifritz , Johannes Jungwirth , Golo Kronenberg , Sebastian Olbrich , Tobias Welt

Auditory verbal hallucinations (AVH) are a particularly distressing symptom of schizophrenia and are associated with significant reductions in quality of life. Antipsychotic medications fail to produce adequate symptom relief in approximately 25–30 % of patients and are frequently accompanied by adverse side effects, underscoring the need for effective alternative treatment. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive intervention for patients experiencing persistent AVH. While previous studies have explored the effects of rTMS on AVH, this is the first case report, to our knowledge, that combines individual localization of the primary auditory cortex using acoustic evoked potentials (AEP) and precise MRI-based neuronavigation for targeted rTMS application. The changes in auditory hallucinations were assessed through questionnaires and EEG (Electroencephalography), with standardized Low Resolution Brain Electromagnetic Tomography Analysis (sLORETA) used to investigate alterations in functional brain connectivity. We present the case of a 53-year-old male patient with schizoaffective disorder and persistent AVH, in whom AEP and MRI-based neuronavigation were combined to guide individualized rTMS targeting of the left primary auditory cortex. This personalized approach resulted in a rapid and complete remission of AVH after 5 days of rTMS treatment with 1 Hz Protocol. Notably, the clinical improvement was mirrored in source-localized EEG data using sLORETA, which showed reduced activity in the left parietal lobe (Brodmann area 40, postcentral gyrus) across higher frequency bands (Beta and Gamma). This could reflect a downstream or network-level modulation related to auditory processing and AVH symptoms. Further studies are needed to investigate the reproducibility of this approach.

听觉言语幻觉（AVH）是精神分裂症的一种特别令人痛苦的症状，与生活质量的显著下降有关。在大约25 - 30%的患者中，抗精神病药物不能产生足够的症状缓解，并且经常伴有不良副作用，强调需要有效的替代治疗。重复经颅磁刺激（rTMS）已成为一种非侵入性干预治疗持续性AVH患者。虽然之前的研究已经探讨了rTMS对AVH的影响，但据我们所知，这是第一次将使用声诱发电位（AEP）和精确的基于mri的神经导航相结合的初级听觉皮层的个体定位相结合，用于靶向rTMS应用。通过问卷调查和脑电图（EEG）来评估幻听的变化，并使用标准化的低分辨率脑电磁断层扫描分析（sLORETA）来调查脑功能连接的变化。我们报告了一例53岁的男性分裂情感性障碍和持续性AVH患者，在该患者中，AEP和基于mri的神经导航相结合，以指导个体化的rTMS针对左侧初级听觉皮层。这种个性化的方法在1赫兹rTMS治疗5天后导致AVH迅速完全缓解。值得注意的是，临床改善反映在使用sLORETA的源定位脑电图数据中，该数据显示左顶叶（Brodmann区40，中央后回）在更高频段（β和γ）的活动减少。这可能反映了与听觉处理和AVH症状相关的下游或网络水平的调节。需要进一步的研究来调查这种方法的可重复性。

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引用次数: 0

Palliative psychiatry in ultra-treatment resistant schizophrenia with refractory somatic hallucinations: A case report 超治疗难治性躯体幻觉精神分裂症的姑息精神病学治疗一例报告

Psychiatry research case reports

Pub Date : 2025-12-07 DOI: 10.1016/j.psycr.2025.100303

Marian Taiwo , Simrit K. Toor , Myles Turkson , Monique Du Boulay

We report the case of a middle-aged male with ultra-treatment-resistant schizophrenia and severe multimodal hallucinations, including rare and difficult-to-manage somatic hallucinations. Conventional treatment strategies, including multiple antipsychotic regimens, clozapine, and electroconvulsive therapy, provided limited benefit. Care was reframed within a palliative psychiatric framework that prioritized symptom relief, dignity, and quality of life via integration of creative therapies, peer counselling, alongside supportive pharmacotherapy. Despite the persistence of psychotic symptoms, the framework contributed to meaningful improvement in the patient’s well-being and functionality by reducing distress, avoiding polypharmacy with adverse effects, enhancing engagement with treatment, and within the community. This case contributes to the limited clinical literature by demonstrating the structured application of palliative psychiatry in UTRS, highlighting its potential to enhance quality of life even when all evidence-based treatments have been exhausted. This framework offers palliative psychiatry as a humane and practical framework for clinicians to consider in cases of ultra-treatment-resistant schizophrenia when complete symptom remission is unattainable.

我们报告一例中年男性精神分裂症和严重的多模态幻觉，包括罕见和难以管理的躯体幻觉。传统的治疗策略，包括多种抗精神病药物，氯氮平和电休克治疗，提供有限的好处。护理在姑息性精神病学框架内重新制定，通过整合创造性疗法、同伴咨询和支持性药物治疗，优先考虑症状缓解、尊严和生活质量。尽管精神病症状持续存在，但该框架通过减少痛苦、避免有副作用的多种药物、加强对治疗的参与以及在社区内，对患者的健康和功能做出了有意义的改善。本病例通过展示姑息精神病学在UTRS中的结构化应用，为有限的临床文献做出了贡献，强调了即使在所有循证治疗都已用尽的情况下，姑息精神病学仍有提高生活质量的潜力。这个框架提供姑息精神病学作为一个人道和实用的框架，临床医生考虑的情况下，超治疗抵抗精神分裂症，当完全的症状缓解是无法实现的。

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引用次数: 0

New onset psychosis following cannabis discontinuation: A case report 大麻停药后新发精神病1例报告

Psychiatry research case reports

Pub Date : 2025-12-02 DOI: 10.1016/j.psycr.2025.100301

Naing Bajaj , David T. Lardier , Stephen Lewis , Snehal R Bhatt

Background

Substance-induced psychoses are brief psychotic syndromes triggered by substance use that can persist for days to weeks after substance discontinuation. With the rising popularity of cannabis and cannabis-related products, including synthetic cannabinoids, the incidence of cannabis-related psychotic episodes may continue to rise, particularly among geriatric populations where less is known about cannabis effects on psychotic symptoms.

Objective

This case study examines the emergence of psychotic symptoms following abrupt cannabis cessation in a 67-year-old female with pre-existing anxiety and depression.

Case presentation

A 67-year-old Caucasian female developed new-onset paranoid delusions and suicidal ideation approximately four weeks after discontinuing six years of heavy cannabis use (3 grams daily). She required two hospitalizations with treatment including risperidone (Risperdal) and escitalopram. Complete resolution of psychotic symptoms occurred with short-term antipsychotic treatment, which was successfully discontinued after four months.

Conclusions

This case contributes to growing evidence suggesting a potential link between cannabis withdrawal and new-onset psychosis, among vulnerable populations with underlying mental health conditions. The successful resolution with short-term treatment and absence of recurrence after medication discontinuation highlights the temporary nature of this phenomenon.

物质诱发性精神病是由物质使用引发的短暂精神症状，可在停药后持续数天至数周。随着大麻和包括合成大麻素在内的大麻相关产品的日益普及，大麻相关精神病发作的发病率可能会继续上升，特别是在老年人群中，他们对大麻对精神病症状的影响知之甚少。目的：本病例研究探讨了一位67岁女性患者先前存在焦虑和抑郁，突然停止使用大麻后出现的精神病症状。病例表现：一名67岁白人女性在停止6年大量使用大麻（每日3克）约4周后出现新发偏执妄想和自杀意念。她需要两次住院治疗，包括利培酮（利培酮）和艾司西酞普兰。短期抗精神病药物治疗可使精神病症状完全缓解，4个月后成功停用。越来越多的证据表明，在有潜在精神健康状况的弱势群体中，大麻戒断与新发精神病之间存在潜在联系。短期治疗的成功解决和停药后没有复发突出了这种现象的暂时性。

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引用次数: 0

Erratum regarding missing Statements in previously published articles 关于先前发表的文章中缺失陈述的勘误

Psychiatry research case reports

Pub Date : 2025-12-01 DOI: 10.1016/j.psycr.2025.100268

引用次数: 0