Pub Date : 2025-10-04DOI: 10.1016/j.psycr.2025.100293
Delisa G. Brown , Amber M. Jarnecke , Tanya C. Saraiya , Elizabeth J. Santa-Ana , Kevin M. Gray , Jane J. Joseph , Sudie E. Back
Alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are common co-occurring diagnoses that disproportionately affect racial minorities and women. Black/African American women are more likely to experience racial trauma, which compounds AUD+PTSD comorbidity. Limited research has investigated the effect of racial trauma on AUD+PTSD using functional magnetic resonance imaging (fMRI). We used a novel script-driven imagery procedure during MRI for racial trauma in a 26-year-old, self-identifying Black woman enrolled in a 12-week randomized clinical trial for individuals with AUD+PTSD. During a baseline fMRI scan, the participant listened to personalized audio scripts of an index traumatic event cue (i.e., “PTSD cue”), an alcohol-related cue, a racial trauma cue, and a neutral cue. This case report describes comparisons of brain reactivity between the racial trauma and PTSD cue, and the racial trauma and alcohol cue. In this Black woman with AUD+PTSD, the racial trauma cue elicited unique activation patterns in sensorimotor and interoceptive brain regions. These patterns partially overlapped with but were distinct from activations observed during PTSD and alcohol cues. Racial trauma showed greater activation than the PTSD cue in self-referential (e.g. posterior cingulate cortex) and sensorimotor regions, and broader activation than the alcohol cue across temporal, occipital, and frontal regions. These findings suggest racial trauma may engage unique neural pathways related to emotional pain, self-referential processing, and hypervigilance. While preliminary, this case study offers insights into the neurobiological signature of racial trauma and underscores the need to include culturally specific stressors in trauma and addiction research.
{"title":"Neural reactivity to a racial trauma cue in an African American woman with alcohol use disorder and PTSD: Case report","authors":"Delisa G. Brown , Amber M. Jarnecke , Tanya C. Saraiya , Elizabeth J. Santa-Ana , Kevin M. Gray , Jane J. Joseph , Sudie E. Back","doi":"10.1016/j.psycr.2025.100293","DOIUrl":"10.1016/j.psycr.2025.100293","url":null,"abstract":"<div><div>Alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are common co-occurring diagnoses that disproportionately affect racial minorities and women. Black/African American women are more likely to experience racial trauma, which compounds AUD+PTSD comorbidity. Limited research has investigated the effect of racial trauma on AUD+PTSD using functional magnetic resonance imaging (fMRI). We used a novel script-driven imagery procedure during MRI for racial trauma in a 26-year-old, self-identifying Black woman enrolled in a 12-week randomized clinical trial for individuals with AUD+PTSD. During a baseline fMRI scan, the participant listened to personalized audio scripts of an index traumatic event cue (i.e., “PTSD cue”), an alcohol-related cue, a racial trauma cue, and a neutral cue. This case report describes comparisons of brain reactivity between the racial trauma and PTSD cue, and the racial trauma and alcohol cue. In this Black woman with AUD+PTSD, the racial trauma cue elicited unique activation patterns in sensorimotor and interoceptive brain regions. These patterns partially overlapped with but were distinct from activations observed during PTSD and alcohol cues. Racial trauma showed greater activation than the PTSD cue in self-referential (e.g. posterior cingulate cortex) and sensorimotor regions, and broader activation than the alcohol cue across temporal, occipital, and frontal regions. These findings suggest racial trauma may engage unique neural pathways related to emotional pain, self-referential processing, and hypervigilance. While preliminary, this case study offers insights into the neurobiological signature of racial trauma and underscores the need to include culturally specific stressors in trauma and addiction research.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100293"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-26DOI: 10.1016/j.psycr.2025.100292
Emmanuel Annor, David Finch, Madeline Pollak, Dhanalakshmi Ramasamy, Elizabeth Mutter
First-episode psychosis (FEP) in adolescents poses challenges when distinguishing between primary psychiatric disorders and organic causes like autoimmune encephalitis. Mycoplasma pneumoniae can lead to neuropsychiatric symptoms, including psychosis. However, its connection to first-break psychosis has not been fully studied. The diagnostic challenge grows with the use of substances, especially cannabis. In this study, we discuss two adolescent cases of first-break psychosis associated with Mycoplasma and cannabis use. In Case 1, a 15-year-old girl experienced treatment-resistant psychosis, with multiple antipsychotic medications failing to help. An evaluation showed cerebrospinal fluid (CSF) pleocytosis and high Mycoplasma IgM/IgG antibodies. She showed significant improvement 48 h after completing doxycycline. In Case 2, a 17-year-old boy displayed disorganized thoughts, hallucinations, and dystonic movements. Laboratory tests revealed CSF pleocytosis and positive Mycoplasma serology. He responded well to intravenous immunoglobulin and azithromycin, returning to his usual level of functioning. Both patients had used cannabis and were initially diagnosed with substance-induced psychosis before the organic causes were found. These cases emphasize the need to consider infectious and autoimmune factors in adolescents with sudden, treatment-resistant psychosis, even when there is a history of substance use. Their positive response to antimicrobial and immunomodulatory treatment suggests that early recognition and treatment of Mycoplasma-associated encephalitis may lead to better outcomes and help avoid long-term psychiatric issues.
{"title":"First-break psychosis and mycoplasma-associated encephalitis: a case series highlighting the role of cannabis use, immune-based interventions, and antipsychotic treatment","authors":"Emmanuel Annor, David Finch, Madeline Pollak, Dhanalakshmi Ramasamy, Elizabeth Mutter","doi":"10.1016/j.psycr.2025.100292","DOIUrl":"10.1016/j.psycr.2025.100292","url":null,"abstract":"<div><div>First-episode psychosis (FEP) in adolescents poses challenges when distinguishing between primary psychiatric disorders and organic causes like autoimmune encephalitis. Mycoplasma pneumoniae can lead to neuropsychiatric symptoms, including psychosis. However, its connection to first-break psychosis has not been fully studied. The diagnostic challenge grows with the use of substances, especially cannabis. In this study, we discuss two adolescent cases of first-break psychosis associated with Mycoplasma and cannabis use. In Case 1, a 15-year-old girl experienced treatment-resistant psychosis, with multiple antipsychotic medications failing to help. An evaluation showed cerebrospinal fluid (CSF) pleocytosis and high Mycoplasma IgM/IgG antibodies. She showed significant improvement 48 h after completing doxycycline. In Case 2, a 17-year-old boy displayed disorganized thoughts, hallucinations, and dystonic movements. Laboratory tests revealed CSF pleocytosis and positive Mycoplasma serology. He responded well to intravenous immunoglobulin and azithromycin, returning to his usual level of functioning. Both patients had used cannabis and were initially diagnosed with substance-induced psychosis before the organic causes were found. These cases emphasize the need to consider infectious and autoimmune factors in adolescents with sudden, treatment-resistant psychosis, even when there is a history of substance use. Their positive response to antimicrobial and immunomodulatory treatment suggests that early recognition and treatment of Mycoplasma-associated encephalitis may lead to better outcomes and help avoid long-term psychiatric issues.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100292"},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olanzapine, a second-generation antipsychotic, is widely used for the treatment of schizophrenia and mood disorders but is associated with various side effects, including rare cases of peripheral edema. We report a case of a 48-year-old female with bipolar II disorder who developed bilateral pitting ankle edema 10 days after initiating olanzapine therapy. Clinical examination and investigations ruled out cardiac, renal, hepatic, and endocrine causes. The edema resolved completely within two weeks of discontinuing olanzapine and switching to amisulpride. Although peripheral edema is an uncommon adverse effect, it may mimic serious medical conditions, leading to unnecessary investigations. Several mechanisms have been proposed, including α1-adrenergic and 5-HT2 receptor blockade, contributing to vasodilation and fluid retention. This case highlights the need for clinicians to be aware of this potential reaction, allowing for timely identification and appropriate management. Reporting such cases contributes to post-marketing surveillance and supports safer, more informed use of antipsychotic medications like olanzapine.
{"title":"Olanzapine-induced ankle edema: A case report on a rare adverse effect","authors":"Sabina Dahal , Rishi Ram Banjade , Pramod Kumar Kafle","doi":"10.1016/j.psycr.2025.100291","DOIUrl":"10.1016/j.psycr.2025.100291","url":null,"abstract":"<div><div>Olanzapine, a second-generation antipsychotic, is widely used for the treatment of schizophrenia and mood disorders but is associated with various side effects, including rare cases of peripheral edema. We report a case of a 48-year-old female with bipolar II disorder who developed bilateral pitting ankle edema 10 days after initiating olanzapine therapy. Clinical examination and investigations ruled out cardiac, renal, hepatic, and endocrine causes. The edema resolved completely within two weeks of discontinuing olanzapine and switching to amisulpride. Although peripheral edema is an uncommon adverse effect, it may mimic serious medical conditions, leading to unnecessary investigations. Several mechanisms have been proposed, including α1-adrenergic and 5-HT2 receptor blockade, contributing to vasodilation and fluid retention. This case highlights the need for clinicians to be aware of this potential reaction, allowing for timely identification and appropriate management. Reporting such cases contributes to post-marketing surveillance and supports safer, more informed use of antipsychotic medications like olanzapine.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100291"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.psycr.2025.100290
Arul Sangani , Pegah Yakhchalian , Kimia Mondegari , Olivia Erickson , Fahad Molla
{"title":"Exploring Neuropsychiatric Sequelae Arising from Complications of Serotonin Syndrome: A Case Report","authors":"Arul Sangani , Pegah Yakhchalian , Kimia Mondegari , Olivia Erickson , Fahad Molla","doi":"10.1016/j.psycr.2025.100290","DOIUrl":"10.1016/j.psycr.2025.100290","url":null,"abstract":"","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100290"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-09DOI: 10.1016/j.psycr.2025.100289
Daniele Cavaleri , Filippo Fabio Barbieri , Alessandra Bartoccetti , Massimiliano Manzato , Marco Otto Maria Toscano , Giuseppe Carrà , Francesco Bartoli
Black hairy tongue (BHT), a benign condition characterized by hypertrophy of the filiform papillae and discoloration of the dorsal tongue, is commonly associated with antibiotic use, poor oral hygiene, lifestyle factors, and general health issues. By contrast, psychotropic drug-induced BHT is rare and typically emerges weeks to months after treatment initiation. We report the case of a 42-year-old male patient with recurrent major depressive disorder and prior use of different psychotropic medications who developed BHT within days of initiating clomipramine on two separate occasions. In the first trial, BHT resolved shortly after clomipramine discontinuation. On the second occasion, considering the effectiveness of the treatment, the absence of concerning symptoms, and the exclusion of other causes through multidisciplinary evaluation, the patient remained on clomipramine. Despite oral hygiene measures, BHT persisted. Close temporal association, reproducibility upon re-challenge, resolution upon discontinuation during the first trial, and absence of alternative explanations supported a definite causal link, as indicated by the Expanded Naranjo Adverse Drug Reaction Probability Scale. Chronic smoking and prolonged chlorhexidine mouthwash use may have contributed, though these were unlikely the individual causes. To our knowledge, this is the first report of clomipramine-induced BHT with such rapid onset and recurrence. This case highlights the importance of recognizing BHT as a potential early-onset side effect of tricyclic antidepressants, particularly clomipramine. Prompt recognition, interdisciplinary assessment, and consideration of the risk-benefit balance are essential. Although an idiosyncratic reaction – independent of clomipramine-induced xerostomia – can be hypothesized, further research is needed to clarify the mechanisms underlying antidepressant-induced BHT.
{"title":"Rapid-onset black hairy tongue following clomipramine initiation and rechallenge: A case report","authors":"Daniele Cavaleri , Filippo Fabio Barbieri , Alessandra Bartoccetti , Massimiliano Manzato , Marco Otto Maria Toscano , Giuseppe Carrà , Francesco Bartoli","doi":"10.1016/j.psycr.2025.100289","DOIUrl":"10.1016/j.psycr.2025.100289","url":null,"abstract":"<div><div>Black hairy tongue (BHT), a benign condition characterized by hypertrophy of the filiform papillae and discoloration of the dorsal tongue, is commonly associated with antibiotic use, poor oral hygiene, lifestyle factors, and general health issues. By contrast, psychotropic drug-induced BHT is rare and typically emerges weeks to months after treatment initiation. We report the case of a 42-year-old male patient with recurrent major depressive disorder and prior use of different psychotropic medications who developed BHT within days of initiating clomipramine on two separate occasions. In the first trial, BHT resolved shortly after clomipramine discontinuation. On the second occasion, considering the effectiveness of the treatment, the absence of concerning symptoms, and the exclusion of other causes through multidisciplinary evaluation, the patient remained on clomipramine. Despite oral hygiene measures, BHT persisted. Close temporal association, reproducibility upon re-challenge, resolution upon discontinuation during the first trial, and absence of alternative explanations supported a definite causal link, as indicated by the Expanded Naranjo Adverse Drug Reaction Probability Scale. Chronic smoking and prolonged chlorhexidine mouthwash use may have contributed, though these were unlikely the individual causes. To our knowledge, this is the first report of clomipramine-induced BHT with such rapid onset and recurrence. This case highlights the importance of recognizing BHT as a potential early-onset side effect of tricyclic antidepressants, particularly clomipramine. Prompt recognition, interdisciplinary assessment, and consideration of the risk-benefit balance are essential. Although an idiosyncratic reaction – independent of clomipramine-induced xerostomia – can be hypothesized, further research is needed to clarify the mechanisms underlying antidepressant-induced BHT.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100289"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-07DOI: 10.1016/j.psycr.2025.100288
Hammad Khan , Lelanie Ayala , Carol Parise
Major depressive disorder (MDD) is one of the most common mental disorders in the United States. Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of major depression. However, the frequency and duration of the treatment schedule make compliance difficult for many patients. Accelerated theta-burst transcranial magnetic stimulation (TBS-rTMS), which involves multiple sessions of TMS in a single day, has shown promise for improved clinical outcomes despite a shorter treatment duration. We present a case of a 24-year-old woman with MDD with treatment-resistant depression (TRD) who was treated with accelerated TBS-rTMS at an inpatient psychiatric facility. The patient underwent 46 treatments of TBS-TMS per day over 5 days at 110 % of motor threshold in addition to group and 1:1 therapy and medications. The patient showed improvement on the Montgomery-Åsberg Depression Rating Scale (MADRS), Patient Health Questionnaire-9 (PHQ-9), Becks Depression Inventory (BDI), and General Anxiety Disorder-7 (GAD-7) over the 5-day course of treatment. One year later, PHQ-9, BDI, and GAD-7 scores were sustained. This case suggests that TBS-rTMS be considered for cases of MDD with TRD that do not respond to other forms of therapy.
{"title":"Implementation of accelerated transcranial magnetic stimulation treatment for an individual with treatment-resistant depression: A case report","authors":"Hammad Khan , Lelanie Ayala , Carol Parise","doi":"10.1016/j.psycr.2025.100288","DOIUrl":"10.1016/j.psycr.2025.100288","url":null,"abstract":"<div><div>Major depressive disorder (MDD) is one of the most common mental disorders in the United States. Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of major depression. However, the frequency and duration of the treatment schedule make compliance difficult for many patients. Accelerated theta-burst transcranial magnetic stimulation (TBS-rTMS), which involves multiple sessions of TMS in a single day, has shown promise for improved clinical outcomes despite a shorter treatment duration. We present a case of a 24-year-old woman with MDD with treatment-resistant depression (TRD) who was treated with accelerated TBS-rTMS at an inpatient psychiatric facility. The patient underwent 46 treatments of TBS-TMS per day over 5 days at 110 % of motor threshold in addition to group and 1:1 therapy and medications. The patient showed improvement on the Montgomery-Åsberg Depression Rating Scale (MADRS), Patient Health Questionnaire-9 (PHQ-9), Becks Depression Inventory (BDI), and General Anxiety Disorder-7 (GAD-7) over the 5-day course of treatment. One year later, PHQ-9, BDI, and GAD-7 scores were sustained. This case suggests that TBS-rTMS be considered for cases of MDD with TRD that do not respond to other forms of therapy.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100288"},"PeriodicalIF":0.0,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.psycr.2025.100287
Hager Koraym, Patrick Drummond, Kasra Manoocheri, Liliya Gershengoren, Robert Mazgaj, Brian Hanrahan
{"title":"Psychiatric sequelae of osmotic demyelination syndrome: a literature review and novel case of mania","authors":"Hager Koraym, Patrick Drummond, Kasra Manoocheri, Liliya Gershengoren, Robert Mazgaj, Brian Hanrahan","doi":"10.1016/j.psycr.2025.100287","DOIUrl":"10.1016/j.psycr.2025.100287","url":null,"abstract":"","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100287"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.psycr.2025.100286
Ibrahim Abdulrahman Alsuwailem , Abdullah Alsubhi , Lama Faiz Aljuaid
Background
Hyperactive delirium is a dangerous and under-studied complication in critically ill patients. Management is often complicated by QTc (corrected QT interval) prolongation associated with standard antipsychotics. Cariprazine, a dopamine D₂/D₃ partial agonist with minimal cardiac risk, may offer an alternative, though its role in delirium remains unexplored. Emerging real-world evidence supports cariprazine’s use in treatment-resistant psychiatric conditions, providing indirect support for its consideration in medically complex patients (Martiadis et al., 2024)
Case Presentation
A 33-year-old male with end-stage renal disease, sepsis, and prolonged QTc developed severe hyperactive delirium during an ICU admission. Despite trials of olanzapine (Zyprexa), lorazepam (2 mg IV q6h), and haloperidol (5 mg IV q6h), his agitation persisted. He required intubation for safety and sedation. Supportive care included dialysis, broad-spectrum antibiotics, oxygen supplementation (nasal cannula, high-flow, then intubation), IV fluids, and enteral feeding. Psychiatry was re-consulted on June 3 and confirmed hyperactive delirium. On June 4, cariprazine 1.5 mg was administered via NG tube (capsule powder dissolved in 30 mL water). Within 48–72 h, his behavior improved, coinciding with correction of metabolic derangements, resolution of sepsis, and stabilization of renal function. He was successfully extubated and discharged psychiatrically and medically stable.
Conclusion
This case suggests that cariprazine may be a potential alternative in ICU patients with hyperactive delirium and QTc concerns. However, clinical improvement was multifactorial, reflecting both psychiatric pharmacotherapy and comprehensive ICU management. This single case highlights the importance of multidisciplinary care and should be considered hypothesis-generating.
背景：多活动性谵妄是危重症患者的一种危险并发症，研究尚不充分。与标准抗精神病药物相关的QTc（校正QT间期）延长常常使治疗复杂化。Cariprazine是一种多巴胺D₂/D₃部分激动剂，具有最小的心脏风险，可能提供另一种选择，尽管它在谵妄中的作用仍未被探索。新出现的真实世界证据支持卡吡嗪在治疗难治性精神疾病中的使用，为在医学复杂患者中考虑使用卡吡嗪提供了间接支持（Martiadis等，2024）病例介绍：一名患有终末期肾病、败血症和延长QTc的33岁男性在ICU入院期间出现了严重的多动性谵妄。尽管进行了奥氮平（再普乐）、劳拉西泮（2mg IV q6h）和氟哌啶醇（5mg IV q6h）的试验，他的躁动仍然存在。为了安全起见，他需要插管和镇静。支持治疗包括透析、广谱抗生素、补氧（鼻插管、高流量、插管）、静脉输液和肠内喂养。6月3日再次咨询精神科，确诊为过度活跃谵妄。6月4日，卡吡嗪1.5 mg经NG管给药（胶囊粉末溶解于30 mL水中）。在48-72小时内，患者的行为得到改善，代谢紊乱得到纠正，败血症得到缓解，肾功能稳定。他成功拔管出院，精神状态和医学稳定。结论本病例提示，卡吡嗪可能是ICU患者多动性谵妄和QTc担忧的潜在替代方案。然而，临床改善是多因素的，反映了精神药物治疗和综合ICU管理。这个单一的病例强调了多学科治疗的重要性，应该被认为是假设的产生。
{"title":"Cariprazine for hyperactive delirium in a medically complex ICU Patient: A case report","authors":"Ibrahim Abdulrahman Alsuwailem , Abdullah Alsubhi , Lama Faiz Aljuaid","doi":"10.1016/j.psycr.2025.100286","DOIUrl":"10.1016/j.psycr.2025.100286","url":null,"abstract":"<div><h3>Background</h3><div>Hyperactive delirium is a dangerous and under-studied complication in critically ill patients. Management is often complicated by QTc (corrected QT interval) prolongation associated with standard antipsychotics. Cariprazine, a dopamine D₂/D₃ partial agonist with minimal cardiac risk, may offer an alternative, though its role in delirium remains unexplored. Emerging real-world evidence supports cariprazine’s use in treatment-resistant psychiatric conditions, providing indirect support for its consideration in medically complex patients (Martiadis et al., 2024)</div></div><div><h3>Case Presentation</h3><div>A 33-year-old male with end-stage renal disease, sepsis, and prolonged QTc developed severe hyperactive delirium during an ICU admission. Despite trials of olanzapine (Zyprexa), lorazepam (2 mg IV q6h), and haloperidol (5 mg IV q6h), his agitation persisted. He required intubation for safety and sedation. Supportive care included dialysis, broad-spectrum antibiotics, oxygen supplementation (nasal cannula, high-flow, then intubation), IV fluids, and enteral feeding. Psychiatry was re-consulted on June 3 and confirmed hyperactive delirium. On June 4, cariprazine 1.5 mg was administered via NG tube (capsule powder dissolved in 30 mL water). Within 48–72 h, his behavior improved, coinciding with correction of metabolic derangements, resolution of sepsis, and stabilization of renal function. He was successfully extubated and discharged psychiatrically and medically stable.</div></div><div><h3>Conclusion</h3><div>This case suggests that cariprazine may be a potential alternative in ICU patients with hyperactive delirium and QTc concerns. However, clinical improvement was multifactorial, reflecting both psychiatric pharmacotherapy and comprehensive ICU management. This single case highlights the importance of multidisciplinary care and should be considered hypothesis-generating.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100286"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Schizophrenia is a chronic psychiatric disorder characterized by positive symptoms (e.g., hallucinations, delusions), negative symptoms (e.g., avolition, blunted affect), and general psychopathology (e.g., anxiety, cognitive deficits). Long-acting injectable (LAI) antipsychotics such as aripiprazole are effective for controlling positive symptoms, yet negative symptoms and general psychopathology often persist, impairing functional recovery and quality of life. Interest has grown in treatments that target non-dopaminergic pathways. Xanomeline–trospium chloride (KarXT, Cobenfy™)—a central M1/M4 muscarinic agonist combined with a peripheral anticholinergic—represents a novel adjunctive approach. This case series describes the use of KarXT in patients maintained on LAI aripiprazole who had persistent negative and general psychopathology symptoms, with the aim of exploring potential clinical benefit through cholinergic modulation.
Cases
Four male patients (ages 20–29) with schizophrenia, all stabilized on LAI aripiprazole, presented with residual negative symptoms such as avolition, blunted affect, and emotional withdrawal, along with general psychopathology symptoms, despite adequate control of positive symptoms. Adjunctive KarXT (xanomeline 50 mg / trospium 20 mg BID, titrated to xanomeline 100 mg / trospium 20 mg BID) was administered for 10 weeks. Positive and Negative Syndrome Scale (PANSS) assessments were conducted by trained raters. Across cases, reductions were observed in total PANSS scores (mean reduction 32.1 %), with the largest changes in negative and general psychopathology subscales. Patients also reported subjective improvements in motivation, social engagement, and emotional expressiveness.
Discussion
Findings from prior randomized controlled trials have shown KarXT to reduce PANSS scores, though its effects on negative symptoms remain under investigation. In this small, uncontrolled case series, observed improvements may reflect potential benefit, but causality cannot be inferred. The absence of a control group, potential placebo effects, and concurrent treatments are important limitations. Compared with options such as clozapine, which may be limited by side effects and monitoring requirements, KarXT may represent a tolerable adjunctive strategy warranting further controlled study.
Conclusion
Adjunctive KarXT in patients with schizophrenia stabilized on LAI aripiprazole was associated with observed improvements in negative and general psychopathology symptoms in this small case series. These preliminary findings support further investigation in larger, randomized controlled trials to determine efficacy, safety, and optimal use in real-world clinical settings.
{"title":"Beyond stabilization: Augmenting LAI aripiprazole with xanomeline–trospium in schizophrenia – A case series","authors":"Parinda Parikh , Aatish Dutta Bhatta , Alisha Arul Alphonse , Jeremy Kays , Shaurya Kumar Singh , Himani J Suthar , Arnesh Shukla , Mahiya Buddhavarapu , Arushi Kaushik-Chandra , Zoe Gellert , Mina Oza","doi":"10.1016/j.psycr.2025.100285","DOIUrl":"10.1016/j.psycr.2025.100285","url":null,"abstract":"<div><h3>Background</h3><div>Schizophrenia is a chronic psychiatric disorder characterized by positive symptoms (e.g., hallucinations, delusions), negative symptoms (e.g., avolition, blunted affect), and general psychopathology (e.g., anxiety, cognitive deficits). Long-acting injectable (LAI) antipsychotics such as aripiprazole are effective for controlling positive symptoms, yet negative symptoms and general psychopathology often persist, impairing functional recovery and quality of life. Interest has grown in treatments that target non-dopaminergic pathways. Xanomeline–trospium chloride (KarXT, Cobenfy™)—a central M1/M4 muscarinic agonist combined with a peripheral anticholinergic—represents a novel adjunctive approach. This case series describes the use of KarXT in patients maintained on LAI aripiprazole who had persistent negative and general psychopathology symptoms, with the aim of exploring potential clinical benefit through cholinergic modulation.</div></div><div><h3>Cases</h3><div>Four male patients (ages 20–29) with schizophrenia, all stabilized on LAI aripiprazole, presented with residual negative symptoms such as avolition, blunted affect, and emotional withdrawal, along with general psychopathology symptoms, despite adequate control of positive symptoms. Adjunctive KarXT (xanomeline 50 mg / trospium 20 mg BID, titrated to xanomeline 100 mg / trospium 20 mg BID) was administered for 10 weeks. Positive and Negative Syndrome Scale (PANSS) assessments were conducted by trained raters. Across cases, reductions were observed in total PANSS scores (mean reduction 32.1 %), with the largest changes in negative and general psychopathology subscales. Patients also reported subjective improvements in motivation, social engagement, and emotional expressiveness.</div></div><div><h3>Discussion</h3><div>Findings from prior randomized controlled trials have shown KarXT to reduce PANSS scores, though its effects on negative symptoms remain under investigation. In this small, uncontrolled case series, observed improvements may reflect potential benefit, but causality cannot be inferred. The absence of a control group, potential placebo effects, and concurrent treatments are important limitations. Compared with options such as clozapine, which may be limited by side effects and monitoring requirements, KarXT may represent a tolerable adjunctive strategy warranting further controlled study.</div></div><div><h3>Conclusion</h3><div>Adjunctive KarXT in patients with schizophrenia stabilized on LAI aripiprazole was associated with observed improvements in negative and general psychopathology symptoms in this small case series. These preliminary findings support further investigation in larger, randomized controlled trials to determine efficacy, safety, and optimal use in real-world clinical settings.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100285"},"PeriodicalIF":0.0,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-25DOI: 10.1016/j.psycr.2025.100284
Adem T. Can , Jim Lagopoulos
This case report describes the complete and sustained resolution of urge urinary incontinence in a 50-year-old woman diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) Level 1, and complex post-traumatic stress disorder (cPTSD), following initiation of lisdexamfetamine. The patient experienced urge urinary incontinence for years, which resolved entirely within weeks of commencing lisdexamfetamine at a therapeutic dose for ADHD. This clinical observation raises the possibility of a previously unrecognised neuroregulatory effect of stimulant pharmacotherapy on central bladder control mechanisms. This case suggests the need for further investigation into the interplay between neurodevelopmental disorders, psychiatric comorbidity, and lower urinary tract function.
No published data to date have identified lisdexamfetamine as a modulator of continence. Limited evidence exists for atomoxetine in paediatric nocturnal enuresis, but stimulant effects on adult urge incontinence remain undocumented.
{"title":"Complete resolution of urge urinary incontinence following treatment of ADHD with lisdexamfetamine: a case report","authors":"Adem T. Can , Jim Lagopoulos","doi":"10.1016/j.psycr.2025.100284","DOIUrl":"10.1016/j.psycr.2025.100284","url":null,"abstract":"<div><div>This case report describes the complete and sustained resolution of urge urinary incontinence in a 50-year-old woman diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) Level 1, and complex post-traumatic stress disorder (cPTSD), following initiation of lisdexamfetamine. The patient experienced urge urinary incontinence for years, which resolved entirely within weeks of commencing lisdexamfetamine at a therapeutic dose for ADHD. This clinical observation raises the possibility of a previously unrecognised neuroregulatory effect of stimulant pharmacotherapy on central bladder control mechanisms. This case suggests the need for further investigation into the interplay between neurodevelopmental disorders, psychiatric comorbidity, and lower urinary tract function.</div><div>No published data to date have identified lisdexamfetamine as a modulator of continence. Limited evidence exists for atomoxetine in paediatric nocturnal enuresis, but stimulant effects on adult urge incontinence remain undocumented.</div></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"4 2","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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