Psychiatry research case reports最新文献

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.

Kleine-Levin syndrome is a rare neurological sleep disorder characterized by periodic episodes of hypersomnolence often associated with behavioral manifestations including cognitive impairment, derealization, hyperphagia, and disinhibited behavior. Affected individuals exhibit normal cognitive abilities and social functioning in between episodes. Current literature has documented comorbid psychiatric disorders that have emerged in patients with Kleine-Levin syndrome. While there have been previous case reports of new-onset psychosis in those with Kleine-Levin syndrome, there is little documentation of psychosis complicated by scale-assessed catatonia in Kleine-Levin syndrome patients. Additionally, in the rare literature cases where Kleine-Levin syndrome patients are found to be experiencing catatonia outside of a Kleine-Levin syndrome episode, psychotic symptoms are either absent or unclear. We uniquely present a detailed description illustrating the work-up and treatment of a Kleine-Levin syndrome patient experiencing a new-onset episode of psychosis complicated by catatonia. This patient's catatonic symptoms were evaluated using the Bush Francis Catatonia Rating Scale, and there was remarkable improvement with the administration of lorazepam. Our case shows how catatonia-complicated psychosis can be correctly identified in patients with a history of Kleine-Levin syndrome and subsequently treated with benzodiazepines. Documenting this workflow and the subsequent outcomes will help establish clinical strategies for properly identifying and treating behavioral conditions seen in Kleine-Levin syndrome patients.

In recent years, catatonia has been recognized to manifest from psychiatric, medical, and neurological conditions. This is a case of a 49-year-old Caucasian male with a history unspecified psychosis who presented to the emergency department with confusion. Following resolution of his conditions, subsequent visits noted in this study were later attributed to catatonia and psychosis due to non-adherence with his antipsychotic medication. Poor responses to lorazepam which lead to agitation, prompted the use of other benzodiazepines with the hopes to provide alternative therapeutic responses. The use of midazolam, intramuscularly and orally, was shown to be consistently effective for this patient's case of catatonia and his subsequent admissions. This case is unique as there is sparse literature supporting the utilization of oral midazolam in the context of catatonia.

This case report highlights the case of a woman from Senegal with PICA disorders switching from kaolin a substance commonly used in african woman population, to paper PICA in the context of anxiety disorder.

Tramadol is a centrally acting analgesic with opioid and monoaminergic actions. Tramadol is commonly prescribed for the treatment of moderately severe pain conditions. However, non-medical use of tramadol as well as tramadol poisoning is becoming a world concern. Studies have reported the potential risk of seizures in individuals who abuse tramadol. Here, we present the case of a 22-year-old female presenting with episodes of generalized tonic-clonic seizures after orally ingesting 1900 to 2100 mg tramadol, with a brief literature review. In addition, the case presented with seizure manifestations after tramadol dose tapering, de-escalation, and withdrawal periods. The case also presented that the patient benefited from fluoxetine during her craving days, although fluoxetine was prescribed to relive her stress. In addition, the case presented with tramadol abuse relapse and seizure induction after discharge. We suggest clinicians to focus on the potential occurrence of seizures during tramadol withdrawal and intoxication periods. Further studies need to be performed to identify the mechanisms and relationship of tramadol use with the onset of seizures. Relapse prevention needs to be a long-term strategy with continuous motivational interview and maintenance biological treatment.

Background

The management of Treatment Resistant Schizophrenia is one of psychiatry's biggest challenges, for which clozapine is one of the few indicated treatments. Although its effectiveness, clozapine is not devoid of adverse effects such as Obsessive-Compulsive Symptoms, which can lead to poorer prognosis. Early identification of these symptoms can prevent from inaccurately identifying them as psychotic symptoms, potentially resulting counterproductive therapeutic choices and poorer outcomes

Case Presentation

A 22-year-old man, diagnosed with paranoid schizophrenia, was admitted in a psychiatric ward due to aggravated psychotic symptoms. The symptomatology was resistant to various antipsychotic regimens, so it was decided to begin clozapine titration. The patient fully recovered, but after 1 month he complained of seeing violent images of his mother dead. This phenomenon, for which he had insight, was experienced as ego-dystonic, leading to a diagnosis of obsessive symptoms, in the form of intrusive images. Causality with clozapine was assumed and the dosage was decreased, with a simultaneous add-on with aripiprazole, leading to the full remission of the symptomatology.

Conclusion

Obsessive-Compulsive Symptoms are frequent in patients undergoing clozapine treatments. Its early diagnosis and therapeutic management can decrease the anguish in these individuals, improving prognosis and quality of life.

Background

Dissociative identity disorder (DID) is a complex and controversial psychiatric condition in which one person maintains at least two separate and distinct personalities. Patients with DID often report a history of childhood abuse and may have other comorbid psychiatric conditions. Psychosocial stressors may be triggers for DID inception or recurrence. While anesthetic agents, in particular ketamine, may induce a temporary dissociative state, it has not yet been reported that anesthesia can precipitate a dissociative identity.

Case report

We report a case of a woman with a history of childhood sexual abuse and past suicide attempt who experienced an episode of dissociative identity on emergence from anesthesia. The episode resolved within 90 min and the patient was discharged home safely on hospital day two.

Conclusion

This case adds to the literature of potentially precipitating factors of DID and we provide a unifying mechanistic hypothesis linking anesthesia to functional brain connectivity.

We describe a case of a teenage boy with the initial presentation of severe catatonia at age 8, which led to the subsequent diagnosis of autism spectrum disorder on background of mild to moderate intellectual disability and strong family history for severe mental illness. The evolution of his symptoms over the next few years included a relapsing pattern of catatonia, the development of psychotic symptoms and then a sustained manic episode. The aetiology of catatonia in young people is discussed, including the risks of diagnostic overshadowing in the context of neurodevelopmental disorders. Finally, treatments including benzodiazepines and ECT are discussed in relation to this dramatic and potentially life-threatening syndrome.

The Monarch external Trigeminal Nerve Stimulation (eTNS) device has been approved by the U.S Food and Drug Administration (FDA) for non-pharmaceutical treatment of attention-deficit/hyperactivity disorder (ADHD) in children. Previous research into the use of eTNS to treat other psychiatric and neurological disorders has shown the device to be well-tolerated with few adverse events. Here, we report on the use of eTNS treatment in a case series of four children with ADHD in Denmark, using the NeuroSigma Monarch eTNS stimulator.

Four children aged 7–12 years, newly diagnosed with ADHD and treatment naïve, tested the device for four weeks. During the intervention the parents were interviewed three times, two and four weeks after the start of intervention and again two weeks after the end of intervention. In this qualitative study a semi-structured interview guide was used with topics including user friendliness, general experience with the intervention, potential adverse events and the parents' experience with changes in the children's ADHD symptoms, sleep and wellbeing.

Our results showed that the Monarch eTNS stimulator is user-friendly. It should be noted that one child, who is known to move excessively during sleep, got tangled in the cables. This required that the parents often checked him at night. Due to the novelty of this type of intervention, we observed that it was essential that the reason for using eTNS as a treatment is communicated appropriately at school and to the children's peers, for the child to feel understood and accepted. We found that the current intensity had to be increased for three out of the four children during the four-week experiment to enable the parents to report on potential changes in ADHD symptoms. The child who received the highest current intensity also displayed the most pronounced decrease in ADHD symptoms as indicated by the parents. The sleep patterns of three of the children potentially changed during the intervention. The parents of two children reported that they observed the children having a longer and deeper sleep. One child with bedtime avoidance improved, as he now went straight to bed and fell asleep much faster. Two children stopped waking up at night and going to their parents’ beds. These observations indicate that they had a better sleep quality, and this is a topic for further investigation. Only few mild adverse events were reported.