Psychiatry research case reports最新文献

Evidence on the etiopathogenesis and pathophysiology of Trichotillomania remains limited. An explanatory model based on psychological hypotheses suggests that hair-pulling regulates emotional or stressful states and provides temporary relief from negative emotions by reinforcing hair-pulling behaviors. The COVID-19 pandemic represents a stressful situation that may trigger hair-pulling behaviors. In addition, isolation and restrictions have led to negative emotional states, with an impact on hair-pulling conduct.

Here, we present the clinical case of a 29-year-old woman diagnosed with Trichotillomania after contracting COVID-19.

Developmental Coordination Disorder (DCD) has been traditionally thought of as a childhood neurodevelopmental condition and tends to be little known among adult psychiatrists. Nonetheless, it is estimated to occur in about 5% of the general adult population. In the present article, we present 3 cases of DCD diagnosed in adulthood, demonstrating some key challenges that adult psychiatrists face: (i) motor difficulties due to DCD often persists into adulthood; (ii) adults with DCD nonetheless rarely report motor problems as their primary complaint, but rather present with secondary non-motor symptoms such as depressed mood, addiction, or anxiety; and (iii) the evidence base for diagnosis and management of DCD in adult is limited. The growing trend of adults with DCD and their psychiatric vulnerabilities suggest that more evidence is urgently warranted. Finally, for patients, the establishment of a new diagnosis of DCD is often a relief as it explains what they have been experiencing all their lives in being different, awkward and sometimes laughed at.

Organisms in the genus Rickettsia are obligately intracellular gram-negative bacilli that are transmitted to humans via hematophagous arthropod vectors, and rickettsiosis is known to cause limbic encephalitis (LE). Here, we present a case of 10-year retrograde amnesia, cognitive dysfunction, and hippocampal atrophy of the brain following LE caused by rickettsiosis. A 76-year-old woman presented to the Medical Center for Dementia for reexamination and rethinking of the diagnosis of amnesia and cognitive dysfunction. She was diagnosed with rickettsiosis by clinical view and treated with antibiotics three years ago. Head imaging showed a high signal in bilateral amygdala and hippocampus. The current test showed enlarged ventricles, suggesting brain atrophy. This case report suggests that LE caused by rickettsiosis may cause persisting memory impairment, cognitive dysfunction, and brain atrophy. Clinicians must determine appropriate treatment considering the long-term sequelae of rickettsiosis.

Background

A few case series on psychiatric adverse reactions to COVID-19 vaccines have been reported despite the absence of a history of psychiatric disorders. Herein, we report a case of a first episode of acute mania with psychotic features receival of the third mRNA-1273 (Moderna) vaccine.

Case presentation

A 37-year-old man developed talkativeness, grandiose delusions, emotional instability, sleeplessness, excitement, hyperactivity and suicidal behavior 4 days after receiving the third mRNA-1273 (Moderna) COVID-19 vaccine. On the 9^th days after vaccination, he was diagnosed with first-episode acute mania with psychotic features and admitted to the psychiatric institute for the first time. After olanzapine administration, the psychiatric symptoms improved within 4 weeks.

Conclusions

To our knowledge, this is the first report of a first episode of acute mania with psychiatric features associated with the mRNA-1273 (Moderna) vaccine booster. Psychiatrists should be aware of this possibility and be attentive to such a rare and severe adverse effect that could occur within 10 days of vaccination.

The COVID-19 pandemic presented the challenge of long-term ventilation and weaning, especially in the setting of anxiety and other mental illness symptoms. Although sedatives typically are used for patient comfort during ventilation, quetiapine can be an alternative option to combat anxiety during ventilation which can prolong the weaning process. In this case, the use of quetiapine dosed at 25 mg twice a day and 12.5 mg every eight hours allowed the patient's anxiety to abate resulting in successful tracheostomy decannulation. This regimen continues to be relevant with the continued presence of COVID-19 in communities and the increased awareness for improved preparation for future respiratory viral pandemics.

An estimated 1.6 to 3.8 million cases of athletics-related traumatic brain injury (TBI) occur each year in the United States. While several studies have shown that antipsychotics or antidepressants may improve psychiatric symptoms after TBI, the impact on suicidality has not been investigated directly. This case report describes the psychopharmacological management of a former NFL player who met diagnostic criteria for Traumatic Encephalopathy Syndrome (TES), and who presented following a suicide attempt with cognitive impairment, paranoia, hallucinations, and mild parkinsonism. We discuss the patient's course and management, from stabilization during their initial hospitalization, subsequent decompensation as an outpatient, readmission, and improvement in outpatient assisted living with stable psychiatric symptoms. Management included the addition of clozapine to their regimen and marijuana cessation. As new diagnostic criteria are implemented to identify patients with TES without postmortem neuropathological confirmation, this example of the clinical course and treatment of TES may help guide future studies and clinical care. The atypical antipsychotic clozapine may be especially useful in patients presenting with psychosis and suicidality, and pimavanserin may be useful in patients with motor symptoms.

Background

Folie à deux, also known as shared psychotic disorder, is a rare psychiatric syndrome in which a psychotic symptom is transmitted from one individual to another who is usually in close proximity. We report a case of folie à deux in adult monozygotic female twins who presented to the emergency department with disturbed behavior amid the Coronavirus disease 2019 (COVID-19) lock down.

Case report

We present the case of 23-year-old monozygotic female twins, with no past medical or psychiatric history, who presented with a two-week history of irritability, sleeplessness, and hyperreligiosity. They were found to be sharing a similar delusional belief with a religious theme. Routine investigations and brain imaging were unrevealing. The primary case (Twin A) was diagnosed with brief psychotic disorder and started on an oral antipsychotic. The secondary case (Twin B) showed gradual resolution of symptoms after separation from twin A.

Conclusion

This case highlights the complex interplay between genetic and environmental factors in the etiology of delusional symptoms in monozygotic twins.

Background

Changing one's own name is an unusual psychotic symptom in patients with schizophrenia. Particularly, when self-renaming is neither bizarre nor grandiose, such self-renaming may be sometimes underestimated as purposeful and other times necessitates the need to differentially diagnose schizophrenia from dissociative identity disorder (DID). Although self-alteration in schizophrenia has been widely discussed, discussion from the point of view of psychotic self-renaming is lacking.

Case presentation

We present three cases with schizophrenia/schizoaffective disorder where patients changed their own names in the acute phase of their illness. We also present a case with DID for reference. Although our cases showed non-bizarre, non-religious, and non-grandiose self-renaming, this symptom was successfully treated using antipsychotic medications and modified electroconvulsive therapy, suggesting that self-renaming was associated with their psychotic symptoms. Parallel improvements in their hallucinations and delusions, and their subjective reports, indicated that the underlying pathophysiology of psychotic self-renaming was self-alteration. Greater responsivity to antipsychotics, vulnerability of surnames, an attitude of denying one's original name (not hiding the host personality), lack of amnesia, and one or only a few renaming could be features of psychotic self-renaming.

Conclusion

Our case series showed that these patients’ psychotic self-renaming was associated with their self-alteration. Our findings also provide a clinical warning to psychiatrists to not overlook treatable self-renaming in schizophrenia and misdiagnosis of DID in such patients.

A 35-year-old married male (father of two children) live streamed his hanging in a 3 min 46 s video. He was alone at home when he did this act, after bolting it from inside. The victim live-streamed his suicide probably to send a message to his loved ones, who might want to see him in his last moments as well as to explain, without saying a single word, his state of mind. Analysis of the video and the interview with his brother revealed severe depression. We have also discussed about suicide prevention and medico legal importance of live streaming suicide. Since the general public may be the first to respond to a suicide, the case report's goal is to raise public awareness of the seriousness of such acts.