Psychiatry research case reports最新文献

Posterior reversible encephalopathy syndrome (PRES) is a critical neurological condition characterized by symptoms such as altered mental state, seizures, and visual disturbances. Essential hypertension is the most commonly associated risk factor. PRES has also been linked to alcohol intoxication. In this case report, we present the case of a 60-year-old male with a history of chronic alcoholism who developed PRES during an episode of acute hypertensive crisis. The patient's alcohol withdrawal delirium, exacerbated by alcohol use, was managed with benzodiazepines. Treatment of PRES typically involves addressing the underlying cause and providing symptomatic care. Prompt management is crucial in suspected PRES cases to prevent complications.

Hikikomori, firstly described in Japan, is a psychosocial condition characterized by severe and prolonged social withdrawal. Hereby we describe two case vignettes of youth Hikikomori-like severe social withdrawal in a young 29-years-old girl with 7-years prolonged and severe social withdrawal condition and in a 18-years-old boy with 4-years prolonged social withdrawal and concomitant secondary Internet Gaming Disorder.

The conventional approach for initiating clozapine treatment involves gradual titration of the dosage over a period of several weeks in order to minimize adverse reactions. However, some patients are unable to tolerate the standard titration regimen and develop multiple side effects. This case report describes a 59-year-old Caucasian man who experienced eosinophilic colitis, potentially attributable to excessively rapid titration schedule. Through examination of the relative risks and benefits of various clozapine titration protocols, this case illuminates the feasibility, safety, and efficacy of these strategies in actual clinical practice. Individualized titration approaches are imperative in order to optimize clozapine initiation for each patient. Formal monitoring and documentation of outcomes can inform development of evidence-based standards for this complex process.

Clozapine is considered one of the best effective strategies in treatment-resistant schizophrenia (TRS), despite up to 60 % of clozapine-treated patients not adequately and/or fully achieving a clinical response either partial remission (clozapine-resistant treatment, CRT). Hence, several combination strategies to clozapine have been investigated in CRT. Hereby, we describe a 50-year-old CRT male patient successfully managed with brexpiprazole augmentation strategy. The patient was assessed at the baseline, weekly up to week 4 and monthly after that up to week 16, with the following psychopathological rating scales: Clinical Global Impression - Improvement (CGI-I), Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS) Calgary Depression Scale for Schizophrenia (CDSS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Anxiety (HRS-A), Barnes Akathisia Scale (BARS), and Abnormal Involuntary Movement Scale (AIMS). At 1-month follow-up, he already showed a considerable improvement at the psychopathological assessment (63 % total PANSS reduction). At 4-month follow-up, a further 50 % PANSS total reduction was observed from the baseline. After 1-year of clozapine-brexpiprazole treatment, the patient was also administered an online metacognitive training (MCT) as adjunctive intervention, by reporting a further clinical improvement.

In this paper, we report the case of a man in his 60 s with a first onset obsessive-compulsive disorder following a traumatic brain injury. Although not the most prevalent clinical presentation, obsessive-compulsive symptoms have been reported after traumatic brain injury. Psychopathology in post-traumatic brain injury context is not infrequent, however reported cases of post-traumatic brain injury obsessive compulsive disorder are described as rare in the current literature. An examination of the patient's mental state revealed obsessive thoughts of dirt and contamination, accompanied by compulsive cleaning and sanitizing behaviors with 3 years of evolution, with onset 2 years after traumatic brain injury and right frontopolar hemorrhage. While obsessive compulsive disorder and obsessive-compulsive symptoms tend to be recognizable psychiatric phenomena, neurobehavioral sequelae in a post-traumatic brain injury context can present multiple manifestations and resemble obsessive compulsive phenomena, without actually constituting obsessive compulsive disorder. This is a rare presentation of a post-traumatic brain injury obsessive compulsive disorder with very few similar cases described to date.

Stiff person syndrome (SPS) is characterised by severe progressive muscle stiffness, which can be mistaken for immobility and rigidity in catatonia. We present the case of a 72-year-old woman who suffered from progressive stiffness and spasms in her axial muscles and extremities. The psychiatry team was consulted to consider the possibility of a primary psychiatric diagnosis of catatonic depression, given the negative test for Anti-GAD and anti-DPPX antibodies, two of the most common antibodies proposed for the causation of SPS. Assessing, and diagnosing catatonia and depression in SPS is challenging for clinicians, as many symptoms and signs mimic all three conditions. This case illustrates the possibility of the superimposition of catatonia over SPS. A meticulous history, examination, and investigation are imperative to differentiate the conditions. Diagnosing psychiatric disorders is essential for a better outcome and integrated clinical care in SPS.

Marchiafava-Bignami disease (MBD), characterized by corpus callosum degeneration due to chronic patient with alcohol dependence, is a rare condition. In its clinical appearance, two main subtypes have been identified. It is known as the mild type that progresses with severe and mild symptoms that cause changes in consciousness and coma and can easily be overlooked among the signs of alcohol withdrawal. Although there are some difficulties in the diagnosis and differential diagnosis, early diagnosis and appropriate treatment approaches can prevent permanent disability and the development of coma. There are opinions that the administration of high doses of thiamine, vitamin B complexes, and steroids may be beneficial. In the diagnostic approach, corpus callosum degeneration is detected in brain neuroimaging. The prognosis of MBD may vary from patient to patient. This study, a fifty-six-year-old male patient who presented with atypical psychiatric complaints and was followed up with the diagnosis of MDD with alcohol use disorder is presented. It is aimed to contribute to the literature by discussing the patient's clinical appearance, diagnosis, and treatment in light of current literature findings.

Background

Clozapine, a pharmacologically complex second-generation antipsychotic, is the standard of care for treatment resistant schizophrenia. Abrupt cessation of clozapine can lead to severe medical complications like cholinergic rebound, psychiatric decompensation, and the development or reappearance of catatonia. Malignant catatonia, an acute and life-threatening form of catatonia with autonomic dysfunction and instability, has been observed to occur secondary to clozapine withdrawal. Malignant catatonia has a significant mortality rate and requires prompt diagnosis and treatment with lorazepam and/or electroconvulsive therapy. There have been few published cases observing malignant catatonia secondary to clozapine withdrawal, and even fewer cases reporting successful treatment with electroconvulsive therapy

Objectives

To identify and present new cases of malignant catatonia secondary to clozapine withdrawal that were successfully treated with electroconvulsive therapy.

Methods

We present a series of 3 cases (3 case reports) of patients who developed catatonic symptoms with autonomic instability after abruptly discontinuing clozapine.

Results

In all three cases, malignant catatonia was diagnosed and initially treated with lorazepam with little effect. With worsening autonomic instability and catatonic symptoms, and minimal improvement with lorazepam, patients were ultimately effectively treated with electroconvulsive therapy.

Conclusion

Malignant catatonia should be considered early in patients presenting with catatonic symptoms, abnormal behavior, and autonomic dysfunction in the setting of abrupt clozapine discontinuation. Although the first line treatment for catatonia and malignant catatonia is lorazepam, benzodiazepine medications alone may not be sufficient in cases of clozapine withdrawal. Electroconvulsive therapy has been shown to be an effective treatment in managing malignant catatonia in the setting of clozapine withdrawal.

Introduction

Repetitive Transcranial Magnetic Stimulation (rTMS) shows promise for treating sequelae of traumatic brain injury (TBI) including headache and depression. The few studies examining rTMS for cognitive recovery after TBI have reported mixed outcomes. The role of rTMS in cognitive recovery remains unclear.

Case presentation

A 23-year-old woman with persistent executive dysfunction after severe TBI primarily affecting the right prefrontal region underwent 19 sessions of rTMS treatment (2,000 pulses of 1 Hz stimulation delivered to right dorsolateral prefrontal cortex [DLPFC]) 12 months after the injury while continuing cognitive rehabilitation. Response to treatment was evaluated using neuropsychological testing, EEG, and rehabilitation assessments. Significant improvements were observed in basic attention, working memory, processing speed, and executive function. EEG changes were consistent with suppression of pathologic and enhancement of normal neurophysiologic activity in the prefrontal regions. The patient made significantly more progress in rehabilitation in the six months following conclusion of rTMS treatment.

Discussion

This case demonstrates that low frequency rTMS delivered to right DLPFC can produce significant changes in oscillatory activity and in basic attention, working memory, and executive functioning after TBI, and may enhance rehabilitation outcomes. This case further demonstrates that neuropsychological testing and EEG may be employed to guide rTMS treatment of cognitive deficits following TBI.