Psychiatry research case reports最新文献

Lithium is widely used as a mood stabilizer in psychiatry. As a medication, it has a very narrow therapeutic index and carries the risk of numerous adverse effects, including thyroid endocrinopathies. While hypothyroidism caused by lithium is well-documented in the medical literature, incidences of lithium-induced hyperthyroidism have been elusive and etiologically difficult to define. Herein we present the case of a 32-year-old woman with multiple psychiatric comorbidities and no history of thyroid disease who developed hyperthyroidism within one month of starting lithium therapy. This case report is one of the few in the literature documenting this rare phenomenon where the initiation of lithium therapy closely precedes the onset of thyrotoxicosis. We also discuss the potential pathogenesis of lithium-induced hyperthyroidism, with special emphasis on silent thyroiditis as the most likely cause of our patient's presentation.

Background

Applications of the use of serotonin agents are increasing in daily practice because they are less toxic. However, it is still necessary to pay attention to the risk of mortality. The effect of using serotonin agents is serotonin syndrome (SS). Clinical manifestations of SS can vary, from an altered mental state to disorders of the neuro-muscular, and gastrointestinal tract. Gastrointestinal symptoms need to be identified immediately so that SS does not worsen and become severe.

Case report

A woman, 20 years old, came to the hospital with the chief complaint of nausea for approximately 4 h, accompanied by headache, shaking and stiff hands, and abdominal pain. She had just taken 21 pills of 25 mg sertraline 4 h earlier. Physical examination revealed normal blood pressure, tachycardia, and mild abdominal pain. But no tremor, clonus, or rigid extremities were found. Laboratory and radiological examinations were normal. An electrocardiogram (ECG) is regular sinus tachycardia.

Conclusion

Clinical manifestations of SS can alter the mental state, and also can occur in the neuro-muscular and gastrointestinal tract. If clinical manifestations are found in the gastrointestinal tract on the use of preparations that can increase blood serotonin levels, then the symptoms are considered to be moderate and must be treated immediately.

Over the past three decades, the development of knowledge about muscle dysmorphia has enabled the scientific community to gain a better understanding of its etiopathogenesis and mechanism. However, few cases have been described, due to the absence of screening protocols and treatment guidelines. The aim of the current study was to evaluate muscle dysmorphia symptomatology, through an integrative psychological assessment, in two young women bodybuilders. In the first case study, we will focus on Mrs. I., who practices recreational bodybuilding, suffers from muscle dysmorphia with a form of eating disorder, and uses illegal APEDs. For the second case study, we will focus on Mrs L., who suffers from muscle dysmorphia, but with a predominant form of body dysmorphic disorder. The two case studies provided a nuanced view of muscle dysmorphia symptomatology, leading to a better understanding of this pathology and its comorbidities, particularly in relation to eating disorders, body dysmorphic disorders and pathological exercise. Our study highlights the importance of an integrative psychological assessment of muscle dysmorphia and shows the interest of using a pluri-modal approach in its diagnostic, whether for the field of psychopathology or sports psychology.

Approximately 15–30 % of individuals diagnosed with PTSD experience high levels of dissociation, a condition categorized in the DSM-V as a dissociative subtype of PTSD (PTSD-D). Despite the rising number of studies supporting mindfulness-based interventions (MBIs) for the treatment of PTSD, literature on mindfulness and dissociation remains scarce and discording. While best practices for offering mindfulness for dissociative patients remain unclear, integrating choice points into MBIs may be aligned with trauma-informed principles and effective in countering loss of self-agency associated with trauma. In this article, we present a case study from a larger randomized controlled trial of an individual with PTSD-D who successfully completed an 8-week MBI while displaying active dissociation symptoms throughout the group. Follow-up interviews with stakeholders in the patient's care as well as pre-and post-intervention assessments indicate that the patient had a positive experience with the mindfulness training and improved self-regulation. Analysis of the case study suggests that the mindfulness training may have been safe and effective for this patient due to the integration of choice points throughout the mindfulness training and promotion of structural safety. We expand on this by further discussing six influencing factors that contributed to the outcome of the case study and can serve as a reference for clinicians, researchers, and instructors who wish to offer MBIs safely to patients with PTSD-D.

Most patients with bipolar disorder do not develop the symptoms until 18 years. With peak onset of 20–40 years, about 90% of cases are reported to have onset prior to age 50 years. Population-based surveys revealed a decrease in the prevalence of bipolar disorder with age, but 6–8% of all new cases of bipolar disorder developing in persons ≥60 years of age The elderly bipolar disorder patients often comorbid with dementia, presented many psychiatric symptoms. This condition is difficult to distinguish from overactivity, agitation, and excitation in behavior and psychological symptoms of dementia and delirium. Therefore, older age bipolar disorder is not well understood and are under- investigated. Herein, we presented three cases of older age bipolar disorder with dementia to discuss the possibility of biological overlaps between BD and dementia, as well as treatment options.

Anorexia nervosa is a serious psychiatric disorder characterized by restrictive eating leading to an unhealthy low body weight. Anorexia nervosa is associated with infertility and increases the risks for preterm infants as well as low birth weight and small-for-gestational age infants. Treatment for anorexia nervosa includes acceptance and tolerance that all foods can be nourishing; helping individuals with anorexia nervosa eat more variety and types of food is a cornerstone in treatment. Gestational diabetes mellitus is a common pregnancy complication associated with fetal macrosomia and pre-eclampsia. Its management includes monitoring both carbohydrate intake and blood glucose levels. In a woman with anorexia nervosa prior to pregnancy who subsequently developed gestational diabetes, disordered eating cognitions and restrictive eating behaviors increased after beginning monitoring for gestational diabetes mellitus, with weight loss and a preterm delivery. Dietary counseling related to gestational diabetes mellitus should be individualized for patients with a history of anorexia nervosa.

Individuals with sexual orientation-themed obsessive-compulsive disorder (SO-OCD) typically experience persistent, intrusive doubt about their sexual orientation despite having an established sexual identity. SO-OCD has been studied almost exclusively among heterosexual samples, highlighting the need for more reports on the phenomenology of SO-OCD among members of the lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) community. A clear understanding of the presentation and treatment of SO-OCD in LGBTQ+ individuals is an essential first step to affirmative care. Therefore, we presented a case example of a lesbian cisgender woman (Danielle [pseudonym]) describing her experience with SO-OCD, doubting her sexuality, and wondering “Am I actually attracted to men?” In this case example, we illustrated how Danielle's comfort and stability in her sexual identity prior to the onset of her SO-OCD symptoms helped rule out sexual orientation questioning or internalized homophobia. We also discuss how much of Danielle's experience with her SO-OCD symptoms overlapped with those of heterosexual patients described in the literature. We conclude with a call to action among clinicians working with all patients with SO-OCD to conduct assessment and therapy procedures in an affirmative manner.

Menopause represents a physiological phase in the woman aging process that marks the end of fertility, but also increases vulnerability for physical and mental symptoms and represents a risk for onset or exacerbation of psychiatric disorders. We aim to present a case of menopause-associated psychosis and also conduct a literature review emphasizing the pathophysiology hypotheses and management particularities. We present a case of a 51-years-old woman who had her first episode of psychosis at menopausal transition period, with the need of hospitalization for stabilization and further etiologic study. Beyond the psychotic symptoms, she experienced several menopause-associated symptoms that caused incapacity. She became stabilized with paliperidone 9 mg/day, olanzapine 2.5 mg/day and lorazepam 2.5 mg/day but did not return to her premorbid functioning. Months later she developed depressive and cognitive symptoms, in relation to negative symptoms and antipsychotics side-effects, which improved after the switch to cariprazine 4.5 mg/day. Postmenopausal women represent an especially vulnerable group for psychosis and the side effects associated with antipsychotic treatment. Therefore, antipsychotics with elevated risk for extra-pyramidal side-effects should be avoided or used with caution and augmentation with selective estrogen-receptor modulators might be a valuable choice for eligible patients. The understanding of underlining mechanisms involved and potential additional risk factors for menopause-associated psychosis is essential for the prevention and early treatment and can promote advances in etiologic theories, treatment approaches, and overall women's health. Furthermore, there is a need for guidelines that provide a concise and precise description of experimental evidence and support for clinical practices. This should include prescribing information that takes hormone levels into account and clinical trials with postmenopausal women. Further studies in psychosis should start investigating and aggregating data according not only to sex, but also to hormonal status.

There is limited literature outlining the practical management of severe health anxiety in patients attending specialist physical health settings (in this case, diabetes mellitus-Type 1, T1DM). This case outlines how a patient engaged in a multi-modal care plan involving a shared formulation, blended-care cognitive behavioural therapy (BCCBT) and pharmacotherapy. BCCBT is the combination of face-to-face CBT and internet-delivered CBT (iCBT) into one integrated treatment protocol. It also highlights some of the barriers to his care. The patient made gradual and significant improvements; and on completion reported better function at work, reduced health checking behaviours and decreased functional impacts of somatic pain. The patient was male, in his early 30′s, with a history of T1DM since childhood. He presented to the hospital outpatient endocrine clinic. Online mental health screening revealed clinical range levels on validated measures of both general anxiety and health-related anxiety. He was referred to our health anxiety clinic and met criteria for Somatic Symptom Disorder (SSD).