Case Reports in Psychiatry最新文献

Schizophrenia-spectrum disorders are characterized by psychotic symptoms, including hallucinations, delusions, and disorganized thinking. Schneider's first-rank symptoms (FRS)-including thought broadcasting and experiences of external control-are clinically salient but not ergonomic and require careful differential diagnosis. The emergence of new-onset psychosis in midlife, particularly in individuals without prior psychotic history, warrants a broad biopsychosocial evaluation. We present the case of a 47-year-old male with chronic major depressive disorder and complex developmental trauma who developed abrupt FRS-like phenomena (prominently thought broadcasting) and auditory hallucinations following a period marked by (1) severe pneumonia with lung abscess, (2) escalating anxiety and depressive distress, (3) exposure to substances including reported synthetic cannabinoids ("Spice") with a urine toxicology positive for amphetamines, and (4) neuromodulation via 20 sessions of transcranial magnetic stimulation (TMS). Concurrently, the patient experienced a severe psychosocial/legal stressor (investigation related to child sexual exploitation material), associated with profound shame and fear. Rather than attributing symptoms to a single trigger, this case highlights a convergence model-medical inflammation, substance toxicity, trauma-related vulnerability, and acute legal stress-potentially disrupting cerebral homeostasis and precipitating psychosis and suicidality. Treatment included discontinuation of TMS, pharmacologic stabilization, and intensive psychotherapy, with partial remission of psychotic symptoms. There is a need for structured monitoring for emergent psychosis and multidimensional suicide risk in high-risk patients receiving neuromodulation.

Postictal worsening of psychosis can be described as the development or exacerbation of psychotic symptoms following a seizure. Patients on clozapine for treatment-resistant schizophrenia are at an increased risk for seizures and subsequent postictal worsening of psychosis. Because patients with schizophrenia may experience ongoing psychotic symptoms, it may be difficult to appreciate the development of postictal worsening of psychosis in these patients. We present the case of a 49-year-old woman with a longstanding history of schizophrenia treated with clozapine who presented to the emergency department (ED) after experiencing a seizure. In the following days, she and her mother reported an exacerbation of psychotic symptoms, which was ultimately attributed to a postictal worsening of psychosis. She was successfully treated after being prescribed an increased nightly dose of clozapine. This dose was eventually reduced to the usual dose she had been taking prior to the postictal exacerbation of psychosis. We also briefly describe a recurrent episode the patient experienced approximately 1 year later. This case contributes to the literature by offering one potential management strategy for postictal worsening of psychosis in a patient with a primary psychotic disorder.

An important aim of the new mental health act implemented in the Netherlands in 2020 was to shift the focus from hospitalization to treatment. The act provides an option for patients' compulsory treatment at home (CTH). Unlike compulsory community treatment (CCT), which allows mental health workers to hospitalize patients involuntarily if they do not comply with treatment. CTH is not provided elsewhere in the world. This case report concerns a patient who, to avoid hospitalization, received CTH in the form of compulsory medication and was able to recover at home. Retrospectively, she and the mental health team both positively evaluated this use of CTH. The parties involved all concluded that CTH restricted the patient's autonomy less than hospitalization, it did not influence the therapeutic relationship, and the CTH could be delivered in a way that it did not compromise participants' safety. This case report shows that, in some situations, CTH can avoid hospitalization. Care should nonetheless be taken to assess its appropriateness, to discuss any preconditions, and to evaluate the use of compulsory treatment in dialog with the patient and significant others.

[This corrects the article DOI: 10.1155/crps/9655675.].

Background: Autism spectrum disorders (ASDs) involve deficits in social communication and interactions as well as restricted, repetitive behaviors that can be reliably diagnosed in children as young as 14 months old, mostly by 36 months old, although signs of ASD may be present before then.

Case presentation: We present a case of a 5-year-old male who was diagnosed with ASD at 48 months and was found to no longer meet criteria for ASD upon reevaluation at 62 months after receiving medication treatment for his underlying attention-deficit/hyperactivity disorder (ADHD) and severe mood dysregulation.

Conclusions: In this report, we discussed the need to consider a broad differential of diagnoses that may resemble ASD and the need to reevaluate a child for ASD, especially if their ASD symptoms were mild on initial evaluation.

We report a 58-year-old woman with bipolar I disorder on long-term lithium and aripiprazole who developed a progressive asymmetric resting tremor and rigidity. Despite stopping both agents, the tremor persisted for more than a year. Dopamine transporter imaging showed reduced uptake in the left putamen, confirming idiopathic Parkinson's disease (PD) with superimposed drug-induced parkinsonism (DIP). Management included discontinuing lithium, switching aripiprazole to quetiapine to limit motor worsening, and starting carbidopa-levodopa. Motor symptoms improved, but hypomanic symptoms emerged and required psychiatric dose adjustments, while apathy remained prominent. The case illustrates diagnostic overshadowing in bipolar disorder (BD) and highlights two practical lessons. When parkinsonian signs are atypical or persist after medication changes, consider idiopathic PD rather than attributing symptoms to side effects. Care is best delivered through close collaboration between psychiatry and neurology to balance dopaminergic therapy with mood stabilization.

Background: Clozapine has shown to be effective as an off-label treatment for aggressive behavior in patients with borderline personality disorder (BPD) and mild intellectual disability (MID). However, there is a lack of empirical evidence for its efficacy in these patient populations and results are so far heterogeneous.

Case presentation: A 40-year-old woman diagnosed with BPD and MID with severe and treatment-resistant aggressive behavior was treated off-label with clozapine. A carefully administered treatment with slow titration led to a significant reduction in self-aggressive behavior and termination of aggressive behavior towards others over a 26-week observation period.

Conclusions: Our case highlights the potential efficacy of clozapine as an off-label treatment for severe and treatment-resistant aggressive behavior in patients with combined BPD and MID. Clozapine should be considered as a therapeutic option in severe and complex cases.

Despite the robust body of evidence supporting the efficacy and safety of electroconvulsive therapy (ECT) in the treatment of severe psychiatric disorders, this procedure remains at the center of social debate, often influenced by historical prejudice. Such misconceptions have contributed to restricted access, which typically occurs either through costly private practice or in large academic centers within the public health system. Among the clinical conditions for which ECT is considered a first-line treatment, malignant catatonia stands out-a rare and potentially fatal syndrome characterized by psychomotor disturbances and severe autonomic instability. If not treated promptly, its mortality rate may reach up to 50%. This case report describes the successful treatment of malignant catatonia in a patient with schizophrenia, in whom ECT sessions were administered intermittently and without a subsequent maintenance phase during inpatient care at a specialized psychiatric hospital affiliated with the Unified Health System in the state of São Paulo, Brazil. After 10 sessions, there was complete remission of the catatonic state, followed by hospital discharge for outpatient follow-up. After 16 months, the patient maintained psychiatric stability, medication adherence, and partial independence in daily activities, with no new episodes of psychiatric decompensation. The case underscores the effectiveness of ECT in achieving remission of a rare and potentially life-threatening disorder.

Background: Clozapine-associated myocarditis (CAM) is the most common inflammatory adverse effect under clozapine treatment. In the absence of equally effective therapeutic alternatives for treating treatment-resistant schizophrenia (TRS), clinicians are often faced with the question of whether to rechallenge clozapine in patients who have experienced CAM. However, there is a lack of standardized protocols and published case reports of successful clozapine rechallenge following CAM.

Case presentation: A 40-year-old patient diagnosed with paranoid schizophrenia experienced CAM during his first clozapine treatment. Four years later, he was successfully rechallenged using a recently published standardized protocol involving a very slow titration schedule.

Conclusions: Our case adds to the limited number of published cases of successful clozapine rechallenge following CAM. It is the first published case report to use the rechallenge protocol recently published by Qubad et al. (2024), thereby contributing to the development of standardized protocols for the safe and successful clozapine rechallenge following CAM.

Background: Individuals with schizophrenia appear to experience differences in dreaming compared to control populations-the small amounts of research that does exist demonstrates abnormalities such as simpler dreams that are more bizarre and with greater negative content than those of controls. Dream-related psychopathology remains insufficiently described however-particularly experiences in which patients believe their dreams are externally generated or controlled. Such phenomena extend classically described first rank symptoms-such as thought insertion and passivity phenomena-into the domain of sleep mentation. This case presents a patient who describes a delusional belief that an external agent can directly infiltrate his nocturnal state to insert dreams themselves.

Case presentation: A 34-year-old male patient with schizophrenia was admitted to the inpatient unit for commencement of clozapine following poor response to multiple antipsychotic agents. While admitted, he described a new delusional belief that a Central Intelligence Agency (CIA) agent was infiltrating his dreams at night and inserting externally created dreams. This symptom did not respond to ongoing clozapine uptitration and community follow-up suggests an ongoing limited response.

Conclusions: This patient describes a novel symptom not previously described in the literature to the best of the authors knowledge and neither appears consistent with other commonly described sleep related phenomenon nor first rank symptoms. As such, we use the term "dream insertion" to describe the phenomenon noted in the case report and suggest an expanded inquiry into the oneiric effects of schizophrenia to enhance understanding and management of such symptoms.