Psychiatry research case reports最新文献

Acute psychosis is a rare but possible clinical manifestation of hypothyroidism. Often referred to as myxedema psychosis, it is less frequently reported in the subclinical form of hypothyroidism compared to the clinical form, and rarely presents as its first manifestation, in the absence of any physical symptoms or signs. Our case report concerns a 46-year-old woman, with a medical history of a total thyroidectomy and irregular adherence to thyroxine treatment, who presented with a first-episode psychosis of subacute onset dominated by persecutory delusional ideas, formal thought disorder and emotional lability, without evident hypothyroidism signs or symptoms. Investigations revealed an elevated thyroid-stimulating hormone (TSH) and a normal free T4 (FT4). Other medical causes of acute psychosis were excluded, and the diagnosis of psychosis associated with subclinical hypothyroidism was assumed. Treatment with oral levothyroxine combined with olanzapine was initiated, leading to a rapid improvement, with complete remission of symptoms after ten days, concurrently with a gradual normalization of thyroid function. Antipsychotic treatment was suspended three months after discharge, with maintained remission of psychotic symptoms during the two-year follow-up. This clinical case highlights the importance of considering hypothyroidism in the differential diagnosis of a first-episode psychosis, even in the subclinical form and in the absence of physical signs or symptoms. The hormonal replacement therapy, combined or not with antipsychotic medication, leads to excellent prognosis in the majority of cases.

Cannabis contains many chemical entities, including trace amounts of delta-8-tetrahydrocannabinol (Δ⁸-THC). Δ⁸-THC is either naturally extracted from cannabis or synthesized from cannabidiol (CBD) and marketed to consumers over the counter as a legal and “milder” high compared to other THC-containing products. Despite this perception among Δ⁸-THC users, the FDA and CDC have cautioned against Δ⁸-THC ingestion due to reports of serious adverse events, including psychiatric presentations. We describe two patients, aged 19 and 20, who presented with acute psychiatric concerns following reported ingestion of Δ⁸-THC. One patient had manic symptoms only in the context of Δ⁸-THC ingestion and without any previous psychiatric history. The second patient described had impulsive and psychotomimetic symptoms grossly out of proportion to, and more severe than, the symptoms he previously experienced. Both patient's symptoms resolved while abstinent from Δ⁸-THC. These cases demonstrate a potential temporal association between ingestion of Δ⁸-THC containing products and the development of manic or psychotic symptoms, as well as a likely dose-response relationship. They also highlight a growing need for drug-use histories that include specific questions around Δ⁸-THC use. Further investigation is needed regarding the risks associated with Δ⁸-THC use, especially in those with existing psychiatric diagnoses and those at increased risk for psychiatric disorders, and to better understand potential interactions with psychiatric medications.

Though usually mild, neuropsychiatric side effects of intravenous ketamine for depression occasionally result in treatment discontinuation. Two small clinical trials of healthy subjects have indicated that lamotrigine pre-treatment may attenuate these side effects, though two other trials, one in patients with unipolar depression and one in healthy male volunteers, did not support these findings. While case reports and observational studies have documented successful treatment of patients with bipolar depression receiving lamotrigine and ketamine, none have reported on cessation of neuropsychiatric side effects from ketamine after lamotrigine initiation in this patient population. Here we present the case of a patient with treatment resistant bipolar depression successfully pre-treated with lamotrigine to prevent previously experienced severe neuropsychiatric side effects from ketamine. She tolerated the ketamine infusion well and her depressed mood improved rapidly. This case suggests that concurrent treatment with lamotrigine may present an effective tolerability improvement strategy for patients with bipolar depression who have previously experienced neuropsychiatric side effects from ketamine.

Background

: Urethral Polyembolokoilomania is self-insertion of foreign bodies for sexual gratification. Although it is not an infrequent urological emergency, this is the first case reported in available literature from Sri Lanka.

Case presentation

: A 17-year-old male adolescent presented to surgical emergency due to lower abdominal pain and dysuria of 9 days duration. Imaging revealed a foreign body within the bladder. On questioning, he divulged having inserted a piece of wire through the urethra for autoerotic stimulation. He was referred for psychiatric assessment and the foreign body was extracted under general anaesthesia by the genito-urinary team. The psychiatric diagnosis was of Fetishistic Paraphilic Disorder in a patient with borderline IQ. Pharmacotherapy and cognitive behaviour therapy were commenced. The patient defaulted follow-up from the point of discharge from hospital.

Conclusion

: Timely referral of patients with genito-urinary foreign bodies to psychiatric services is important as this presentation is associated with underlying psychiatric disorders. Detection and treatment of underlying psychiatric disorders would mitigate the risk of recurrence.

Background

Osmotic demyelination syndrome (ODS¹) is a rare neurological condition characterized by rapid demyelination of neural cells. It often occurs due to aggressive correction of chronic hyponatremia. However, it might develop in other osmotic stresses like hypernatremia.

Wernicke-Korsakoff syndrome (WKS²) is a complication of thiamine deficiency. It mainly occurs in alcoholic patients, but conditions such as malnutrition might also lead to it.

Here we present a case of anorexia due to a possible major depressive disorder who developed signs and symptoms of hypernatremic ODS and WKS in the setting of chronic malnutrition.

Case presentation

The patient is a 39-year-old woman with a history of anorexia for seven months due to a possible major depressive disorder episode following her mother's death. She was admitted due to impaired consciousness and generalized weakness. On admission, her sodium level was 179 mEq/L, and her MRI showed signs of ODS and WKS. Intravenous fluid gradually dropped the sodium level to 149 mEq/L. Thiamine (1 g IV BID) was also administered due to signs of WKS from day 1. Despite treatments, her consciousness level worsened, and eventually, she died of septic shock followed by cardiac arrest and brain death on the sixth day.

Conclusion

To date, hypernatremia has been argued as a rare cause of ODS. However, the risk of hypernatremic ODS increase when other comorbidities (e.g., malnutrition) are present. Thiamine deficiency might lead to WKS that overlaps with ODS in patients with malnutrition. Primary care physicians are encouraged to detect early signs of major depressive disorder to prevent catastrophic medical and psychiatric complications. Also, Careful monitoring of electrolytes and vitamins and early detection of neurological symptoms are the keys to managing anorexia patients.

Objective

COVID-19 is associated with neuropsychiatric symptoms, including delirium, confusion and neurocognitive disorders. The main aim of this report is to present results of 3-week cognitive rehabilitation augmented with transcranial direct current stimulation (tDCS) in a patients with post-COVID-19 cognitive impairments. We also presented results of quantitative EEG analysis.

Methods

We have complete a non-blinded, 3-week, single-case experimental study consisting of daily cognitive rehabilitation augmented with tDCS stimulation (current: 2.0 mA, anode: left dorsolateral prefrontal cortex (DLPFC), cathode: right DLPFC, duration: 1200 s). Major cognitive functions were evaluated a day before (V1), a day after the 3-week rehabilitation program (V2) and 8 weeks later (V3) using CANTAB cognitive research software. Routine 20-minutes eyes-closed resting EEG were recorded three times at V1, V2 and V3.

Results

Visual memory scores improved at V2 and returned to the baseline level at V3. Mixed results were observed for multitasking, emotion recognition, response speed, attention. No changes or transient decrease at V2 were seen for working memory. There was a significant delta band power decrease (at F4) and increase (at F3), and increase (at F3 and F4) of theta, alpha, and beta band powers after tDCS.

Conclusions

tDCS combined with computer-assisted cognitive rehabilitation may be an effective therapeutic options for patients with COVID-19-related brain-fog. Increased alpha power may be an underlying mechanism or marker of cognitive improvement. Reduced delta band power may be interpreted as normalization of EEG recordings due to tDCS stimulation.

Introduction: Patients with mental illness have a high risk of COVID-19 progression into severe illness, which makes them a candidate for nirmatrelvir/ritonavir therapy. However, certain psychiatric medications are contraindicated with nirmatrelvir/ritonavir. Between January 6th and January 24th, 2022, five patients at an inpatient state psychiatric facility were prescribed nirmatrelvir/ritonavir. Two patients had psychiatric drug interactions with nirmatrelvir/ritonavir that required alteration to their psychiatric medication regimen. One patient's divalproex and haloperidol doses were decreased, and the patient was able to complete their course of nirmatrelvir/ritonavir therapy, then resume their psychiatric medications at their usual doses. Another patient's lurasidone was discontinued and their long-acting injection dosing was decreased. This patient refused to take nirmatrelvir/ritonavir therapy, became more psychotic and delusional, and began refusing all medications. Her nirmatrelvir/ritonavir was discontinued without the patient completing the course and the patient continued to experience paranoia, delusions, and hallucinations. No patients were hospitalized for COVID-19. Although nirmatrelvir/ritonavir is highly effective at reducing COVID-19 hospitalizations and death, it is unclear as to its use for psychiatric patients who have psychotropic drug interactions who have the possibility of decompensating if their psychiatric medication regimen is altered.

Psychotic disorders with childhood onset before age 13 are rare and may have worse prognosis than their adult counterparts, although early detection and treatment may improve outcomes. This paper presents a case of a severe primary psychotic disorder in an 8-year-old child. Early initiation of antipsychotic medication combined with participation in an intensive, 6-month psychiatric day treatment program for children resulted in full remission of psychotic symptoms and a highly successful school reintegration. This case highlights the importance of early pharmacological and psychosocial interventions in improving outcomes in childhood-onset psychosis and potentially altering the course of a chronic and debilitating illness like schizophrenia.

Background

The growth of internet technology has increased gambling activities, particularly among adolescents. Adolescence is critical for developing addictive behaviors like gambling disorder (GD), which can have serious social, psychological, and financial consequences. GD is also known to co-occur with Attention-Deficit/Hyperactivity Disorder (ADHD), and impulsivity is considered a risk factor for GD. Despite the rising rates of gambling and related problems among young people, research on adolescent GD is limited, and there is a lack of research on the link between ADHD and GD compared to other addictive disorders.

Case description

We describe a case report of GD in an adolescent with ADHD who lost more than twice a family's annual income by online gambling in a year and developed depressive symptoms secondarily. We briefly discuss the diagnosis, treatment, and follow-up process.

Conclusion

The case report highlights the link between GD in adolescents with ADHD, emphasizing the need for personalized treatment addressing co-occurring ADHD, GD, and depression and improved research and treatment options.