Psychiatry research case reports最新文献

Background

Little research has addressed maladaptive eating behaviors among patients with schizophrenia. Pica, the eating of nonfood items, and coprophagia, the consumption of feces, occur at higher rates in the early stages of schizophrenia; however, etiology of pica is poorly understood. Understanding primary precipitants of pica among patients with schizophrenia is integral for providing effective treatment. We present a case study on an interprofessional collaboration to ascertain primary diagnosis of a patient exhibiting symptoms of psychosis and pica/coprophagia.

Case presentation

A 22-year-old Hispanic male involuntarily presented to an inpatient facility. His-family reported that for 6 months prior to admission, he did not attend to self-care tasks, began consuming nonfood items, and appeared internally preoccupied. While hospitalized, he maintained similar behavior. He frequently went to the bathroom to consume his feces and urine. If disrupted, he sometimes became physically aggressive and persisted in his behavior. He reported odd beliefs related to nutrition. At times, he rubbed hand sanitizer on his face and body. He was trialed on olanzapine, haloperidol, lorazepam, and paliperidone to address agitation and psychosis. Medical rule-outs for his behavior included cognitive impairment, seizure, central nervous system (CNS) lesion, and substance/alcohol use. He was referred to psychology for an evaluation to determine his primary diagnosis. Findings indicated absence of mood episodes and OCD. His history revealed several risk factors for schizophrenia, and progression of illness was typical of schizophrenia. His pica behaviors declined following implementation of a consistent regimen of paliperidone per court ordered medication petition.

Conclusion

This case report presents a patient with co-occurring pica, coprophagia, and first episode psychosis, a rare and understudied combination of symptoms. He evidenced delusional beliefs related to nutrition, which precipitated maladaptive eating behaviors. The case is relevant for providers observing maladaptive eating behaviors in patients with symptoms of psychosis, suggesting that treating pica with antipsychotic medications may be efficacious. The case study also illustrates the importance of accurate diagnostics and the power of interprofessional collaboration in providing psychiatric care.

We report the case of a 70-year-old woman who received ECT for major depression with psychotic features. The patient was identified to have symptomatic severe cervical degenerative myelopathy during treatment and she received 21 sessions of right unilateral electroconvulsive therapy (ECT) without adverse neurological outcome. Precautions were undertaken to minimize risk of ECT-associated spinal cord injury. ECT was successfully recommenced without precautions following laminectomy.

Primary hypoparathyroidism is caused by parathyroid hormone (PTH) deficiency and characterized by hypocalcemia. Psychiatric manifestations such as mood disorders, however, are uncommon in primary hypoparathyroidism; therefore, neuro-psychiatric manifestations, including mood disorders, in the latter condition can pose a significant diagnostic challenge. Furthermore, co-morbid psychiatric disorders, metabolic conditions, and concurrent (psychotropic) medications can complicate the clinical picture of either of the conditions, including posing substantial diagnostic and management challenges. In this paper, we report a case of primary hypoparathyroidism with catatonia in a patient with a pre-existing bipolar affective disorder (BPAD) with poor response to mood stabilizers and antipsychotic medication for two years.

The girl, of age 18 years presented to the emergency department in a catatonic state characterized by mutism, posturing, stupor, negativism, waxy flexibility, and echolalia (Bush-Francis Catatonia Rating Scale (BFCRS) score was 16). Her symptoms responded poorly to psychotropic medications, moreover, she was overly sensitive to adverse effects of various medication (e.g., very prolonged QTc interval). Laboratory investigations showed that she had severe hypocalcemia, hypomagnesemia, hyperphosphatemia, and alkalosis. Her PTH levels were significantly low. Upon correction of dyselectrolytaemia (through calcium and magnesium supplements) and concurrent intake of tab. Olanzapine, a significant improvement in her symptoms was noticed. After excluding all causes of acquired hypoparathyroidism, we concluded it as primary hypoparathyroidism. The case highlights the importance of having a comprehensive and wider assessment of such atypical presentations of catatonia, especially if it responds poorly to conventional treatments.

Diagnosing comorbid psychosis and avoidant/restrictive food intake disorder (ARFID) may be challenging among severely malnourished patients. Malnutrition is an identified medical cause of psychosis and in patients with ARFID, symptoms mirroring psychosis could be secondary to weight loss versus a “true” thought disorder. Conversely, dietary restriction has been demonstrated in patients with psychosis, which conceivably, could result in the development of ARFID. In this case report, we present a medically hospitalized adolescent male with severe malnutrition, diagnosed with ARFID after 12-months of food avoidance due to sensory sensitivities and fears of gastrointestinal discomfort. A significant decline in his emotional, interpersonal, and cognitive functioning was also reported and attributed to severe malnutrition. With nutritional rehabilitation, the patient's eating behaviors and mental state unexpectedly declined, and he was ultimately diagnosed with comorbid psychosis.

Catatonia is a syndrome characterized by a predominance of neurologic and psychiatric symptoms. There has been sparse but convincing literature building the association between catatonia and aspects of solid organ transplant, however, there have been no cases reported of pediatric catatonia post-hepatic transplant related to cyclosporine. This report summarizes the case of a 12-year-old boy with no preexisting neurodevelopmental concerns or psychiatric illness who received an orthotopic liver transplant secondary to a several year course of hepatic failure due to Budd-Chiari syndrome and went on to develop catatonia along with other neurologic complications. He had a partial response to standard treatments for catatonia; however, it was not until he was switched from a calcineurin inhibitor to another immunosuppressant that his symptoms of catatonia and other neurologic dysfunction fully resolved. Subsequently he was followed for 6 months in the outpatient setting, where he regained and maintained his previous baseline of psychosocial function while tapered off lorazepam conservatively. It is well established that catatonia is underrecognized in medically ill adults, and this is likely the case in pediatric populations as well. Early identification is important to not only begin treatment for catatonia, but to recognize that there is active neurologic dysfunction that may be due to iatrogenic or other exogenous causes.

This case-report describes a patient with Parkinson's Disease (PaD) with an implanted deep brain stimulator, who received electroconvulsive therapy (ECT) for the treatment of a major depressive episode with melancholic features. There was an adequate response to treatment and a lack of significant adverse effects. ECT has shown itself to be a safe and effective treatment in these circumstances if the necessary safety precautions are taken. The effect of ECT on psychomotor features in melancholic depression are outlined and discussed, where a change in psychomotor function could be predictive for treatment outcome. Further research is warranted.

Anorexia nervosa is a serious psychiatric disorder defined by restrictive eating behaviors resulting in an unhealthy low body weight. Patients who have comorbid anorexia nervosa and bipolar disorder have more severe eating disorder symptomology as well as worse long-term prognosis. This case report follows the pharmacologic management of a patient with comorbid anorexia nervosa and bipolar disorder, highlighting important treatment considerations for this population. The patient was treated with antidepressants and mood stabilizers without consideration of the eating disorder for several years. Two psychoactive medications associated with food restriction (selegiline) and weight loss (bupropion) were prescribed after the patient reported concerns about her weight despite a normal body mass index. The bioavailability of another medication, lurasidone, depends on food intake, and the patient started feeling sedated when her restrictive eating remitted. This clinical phenomenon emphasizes the importance of careful psychopharmacological selection in more complex psychiatric patients. Effective treatment of comorbid anorexia nervosa and bipolar disorder requires continued assessment and treatment of disordered eating symptoms in conjunction with prudent psychopharmacological selection.

Ketamine, primarily utilized as an analgesic agent, has gained attention for its diverse applications, including its use as an antidepressant. However, there has been a concerning rise in ketamine misuse in Asia particularly Southeast Asian countries, as a recreational drug. This study aims to analyze the emergence of ketamine abuse in Tehran, Iran, specifically focusing on cases reported at Loghman Hakim Hospital Poison Center (LHHPC). Over the past five years, LHHPC recorded a total of 13 patients admitted with the final diagnosis of ketamine toxicity. We evaluated various parameters including age, dosage, history of habitual abuse, prior addiction issues, time from ingestion to admission, and the duration of hospitalization. Notably, there was a higher prevalence of smoking (p-value: 0.1) and alcohol consumption (p-value: 0.75) in females compared to males. Furthermore, a notable prevalence of a prior history of depression was observed among patients admitted due to ketamine misuse, with a more pronounced occurrence in females (71.4 %) compared to males (50 %). This is the first retrospective case series shedding light on ketamine abuse in Iran. Our study offered valuable insights into the correlation between a history of depression and ketamine misuse and additionally supported findings from existing reviews and case series. This research emphasizes the importance of reporting ketamine abuse cases by various centers to obtain a more comprehensive understanding of the prevalence of ketamine abuse in Iran.

Background

Delirious mania (DM) is a serious and poorly understood neuropsychiatric syndrome with features of mania, delirium, catatonia, and psychosis. Although it was first described in the 1800s, there is no consensus on nosology or diagnostic criteria, exacerbating challenges in detection and treatment. DM is sometimes viewed as a subtype of mania, while others consider it to be a separate entity. There appears to also be a relationship between DM and catatonia, and DM has similarly been responsive to treatment with benzodiazepines and electroconvulsive therapy (ECT). The literature surrounding DM is limited largely to case studies.

Objective

We present two cases of DM observed and treated in a community-based inpatient psychiatric unit to further add to the available literature on this challenging and severe neuropsychiatric syndrome.

Discussion

Diagnosis of DM was complicated by lack of consensus diagnostic criteria; however, both patients displayed symptomatology consistent with the descriptions of DM put forward in the literature. Given the extensive differential diagnosis for DM, consideration was given to a variety of etiologies, including medical, neurological, and toxicological. Clinical severity throughout each patient's hospital course was assessed using Confusion Assessment Method Severity (CAM-S) and Clinical Global Impressions Severity (CGI-S) scales for each day of admission. Signs and symptoms consistent with delirium and catatonia were also displayed by each patient during their hospital course. In each case, the patients were treated with a combination of antipsychotics, mood stabilizers, and benzodiazepines. We posit that this is an effective treatment regimen in cases of DM with catatonia in which ECT is not accessible.

Conclusion

DM is a serious and likely under-recognized clinical phenomenon. A combination of antipsychotics, mood stabilizers, and benzodiazepines may be an effective treatment regimen in DM cases with catatonia where administration of ECT is not possible. Development of a consensus diagnostic criteria is needed to expand research into the management of DM.

Background

Heterozygous germline variants in HRAS can lead to RASopathies, a group of disorders caused by gain-of-function variants in several components and modulators of the Ras-MAPK pathway. Recently, different missense variants, indels and a frameshift variant, have been associated with attenuated or distinctive phenotypes, suggesting a wider clinical spectrum.

Case presentation

We report a pair of twins with shared distinctive features, including mild intellectual disability, anxiety, psychosis, dysmorphism, short stature, early hair loss, vitamin D deficiency, osteopenia and hematuria, harboring a novel de novo nonsense variant in HRAS. Targeted RNA-sequencing demonstrates that this variant affects splicing.

Conclusion

Our report provides evidence that variants affecting transcript processing in HRAS may lead to an attenuated phenotype associated with neuropsychiatric features. Further studies are needed to fully understand the mechanism and phenotypic variability.