Case Reports in Psychiatry最新文献

Background: Chromosome 4q deletion is a rare genetic disorder affecting an estimated 1 out of 100,000 people. It is characterized by microdeletions of the long arm of chromosome 4 with variable clinical presentations including heart defects, craniofacial and skeletal abnormalities, short stature, and developmental delays. While behavioral and psychiatric symptoms have been reported in a small number of patients with chromosome 4q deletions, none of these reports have described the hyperphagia or parasomnia symptoms that are presented in the current case. Case Presentation: A 7-year-old boy presented with a microdeletion of the long arm of chromosome 4 that resulted in psychiatric symptoms and neurodevelopmental delays. Notable manifestations included hyperphagia and parasomnias, in addition to aggression, functional encopresis, and speech delays. The boy's initial treatment was markedly delayed due to limited genetic testing at the age of 1 year, which led to a misdiagnosis of childhood aggression. This limited the care team involvement for neurologic evaluation and appropriate school interventions that would have otherwise been indicated. At inpatient admission, a multidisciplinary approach to diagnosis and treatment was adopted, encompassing pharmacological and behavioral interventions. The patient's attention-deficit/hyperactivity disorder (ADHD) was treated, and his individualized education plan included a functional behavioral assessment, as well as occupational therapy and speech and language services. Following a 4-day inpatient stay, the patient demonstrated a significant decrease in aggressive behaviors. Conclusion: Chromosome 4q deletion-related behaviors parallel those of children with autism spectrum disorder (ASD), and treatment is primarily focused on behavioral interventions. To successfully manage the psychiatric features of this complex condition, the involvement of a multidisciplinary team is recommended.

Obsessive-compulsive (OC) disorder (OCD) is a common and potentially disabling illness with a waxing and waning course. OCD significantly disrupts the quality of life. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacological treatments for OCD and benefit up to half of the patients. Augmentation with low-dose antipsychotics is an evidence-based second-line strategy. Psychotherapy, including cognitive behavior therapy (CBT), is used both as first and second-line treatment. A significant portion of patients, however, do not respond to conventional treatments. We present a case series on the use of Endoxifen as an augmenting agent in patients with OCD and multiple psychiatric comorbidities who did not respond well to conventional pharmacotherapy.

This case study investigates the complex interplay between autism spectrum disorder (ASD) and maladaptive daydreaming (MD), focusing on the misinterpretation of stereotypical movements. The case investigates Liam, a 23-year-old male diagnosed with ASD in childhood. He sought reassessment due to suspicions that his "stimming" behaviors might be linked to MD rather than autism. We analyze Liam's freely reported experiences, self-reported scale scores, and the outcome of clinician-administered diagnostic interviews scored independently by two clinicians. Findings reveal that social communication problems were not present, negating the diagnosis of ASD, and behaviors previously attributed to ASD could be better construed as kinesthetic components of MD episodes. This case highlights the potential for misidentification of MD as ASD, mainly when stereotypical movements are present. The case study underscores the significance of awareness to MD in research and clinical settings. It also illuminates the critical importance of differential diagnosis in cases of ASD, as similar behavioral manifestations may stem from distinct underlying conditions. This study contributes to the emerging body of literature on the relationship between ASD and MD and calls for increased awareness among clinicians about the potential overlap in symptoms between these conditions. We discuss future research directions and implications for clinical practice.

Background: Rastafarianism maintains that cannabis is a sacred element of the religious practice, and followers of the religion traditionally engage cautiously with western medicine. This case involves Mr. I, a 72-year-old Rastafari male with acute myelogenous leukemia (AML) and hepatic decompensation, who developed delirium with psychotic features which were initially managed with quetiapine. His family expressed concerns with psychotropic medications and requested using dronabinol, a synthetic cannabinoid, to manage his symptoms considering the spiritual significance of cannabinoids in the Rastafari culture. The psychiatry team's dissenting recommendations regarding dronabinol was met with resistance, and the family voiced that they felt their religious beliefs were not being respected and considered bringing in their own marijuana products. Following an ethics consultation, a compromise was reached to trial low-dose dronabinol. However, Mr. I's symptoms worsened, prompting discontinuation of dronabinol and management with olanzapine. Discussion: This case exemplifies the complexities of clinical care when religious beliefs conflict with medical necessity. We discuss the limited indications for dronabinol and potential adverse effects on delirium's behavioral symptoms. Concerns about fungal sensitization from cannabinoid products in the context of immunosuppressive chemotherapy and the effects of cannabinoids on hepatic dysfunction are also explored. Moreover, we emphasize the importance of cultural sensitivity for Rastafari individuals who view marijuana as sacred and therapeutic. Balancing cultural and religious sensitivity with ethical, evidence-based medicine through a thorough discussion of risks and benefits is essential for optimal decision-making in such ethical dilemmas.

A 57-year-old woman with bipolar disorder (BD) was started on combination therapy with aripiprazole and lithium. At the same time, a community pharmacist administered follow-up through 24-h telephone services for the early detection of adverse events. Four days after starting therapy, the patient called a community pharmacy after working hours and mentioned the occurrence of disabilities, possibly due to adverse effects, including extrapyramidal symptoms (EPSs), to the pharmacist who received the forwarded call. The community pharmacist immediately called the hospital to report the patient's problems and suggested a decrease in doses or withdrawal of the suspected medications to the prescribing doctor. After several hours, the hospital called and informed the pharmacist that the doctor had instructed the patient to discontinue aripiprazole. The pharmacist immediately called the patient, explained the doctor's instructions, and found that the EPS symptoms improved gradually, except for difficulty speaking smoothly. Ultimately, valproic acid was prescribed instead of lithium, resulting in a dramatic improvement in speech difficulties. These results indicate that community pharmacist-administered follow-up and intervention, especially through 24-h telephone services, is crucial for drug safety management, such as early detection of adverse events caused by combination therapy in patients with BD.

Aviophobia, that is, fear of flying, is a common type of anxiety disorder. Benzodiazepines are used in the treatment of anxiety. Liraglutide is a treatment for obesity or overweight in combination with weight-related comorbidity. We present the case of a 23-year-old woman with overweight and aviophobia, who used clonazepam as antianxious protection when flying. When taking liraglutide shortly before clonazepam the efficacy of clonazepam seemed absent as the patient experienced a panic attack at the airport. This finding suggests that liraglutide may interfere with clonazepam and reduce its effect. Further research is needed to establish this association.

Background: Schizophrenia is a chronic mental health disorder characterized by an array of symptoms, leading to impairment of functioning. Many patients with schizophrenia tend to have long-stay hospitalizations due to several factors, one of them being the repatriation process. Case Presentation: I report the case of a 29-year-old male foreign citizen who presented with auditory hallucinations, paranoid delusions, and aggressiveness. The patient had a history of multiple admissions due to poor drug adherence. After being admitted to the psychiatry ward, the patient was improved and ready for discharge after 4 weeks but struggled to remember his relatives' phone numbers. Due to financial constraints and poor support, the repatriation process was delayed for 160 days. Conclusion: The present case highlights the challenges in managing schizophrenia abroad, urging international protocols to streamline the repatriation process and address financial, logistical, and social barriers for improved outcomes.

Introduction: There has been a recent significant increase in medical cannabis prescribing in Australia despite weak evidence for its effectiveness in treating the most common indications. Concern has been raised about the potential harms of inappropriate prescription of cannabis; however, there have been no prior published cases of psychosis secondary to medicinal cannabis in Australia. Case Presentation: We present a case of a 21-year-old Indigenous male with psychosis following switching from illicitly obtained cannabis to prescription cannabis, which resulted in Othello delusions towards his partner, violence towards her and ultimately an attempt to end his life. Discussion: Cannabis use is linked to the development of a psychotic illness whether it is prescribed or obtained illicitly. People who are prescribed cannabis are also at an elevated risk of developing cannabis use disorder (CUD). Cannabis prescribers need to screen for risk factors of drug-induced psychosis such as a family member with a psychotic illness, review patients regularly and provide harm minimisation advice to prevent damage from their prescription. Conclusion: There are clear dangers to overprescribing medicinal cannabis and the care that needs to be taken by prescribers to avoid them. There is a need for a change in the regulation of cannabis prescribing in Australia. Further research is warranted on the effects of the increase in prevalence of cannabis prescribing.

Nightmares and flashbacks are common debilitating symptoms of posttraumatic stress disorder (PTSD) that can disrupt daily functioning. Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of these intrusion symptoms, although its short half-life makes it so that often multiple doses are needed. Doxazosin, another alpha-1 antagonist, is starting to be investigated in the treatment of PTSD-related nightmares due to its lesser side effect profile and longer half-life. In our case series, we present three cases of patients with PTSD-related nightmares who were successfully treated with doxazosin following a relapse of symptoms after discontinuation of prazosin for various reasons. The success of doxazosin immediate release for PTSD-related nightmares warrants further studies into its efficacy and use as an alternative treatment to prazosin.

Bupropion is an atypical antidepressant indicated for the treatment of major depressive disorder (MDD), seasonal affective disorder (SAD), and smoking cessation. It is also used off-label for attention deficit hyperactivity disorder (ADHD). Its mechanism of action includes the selective norepinephrine and dopamine reuptake inhibitor (NDRI). The drug is available in immediate-release (IR), sustained-release (SR), and extended-release (XL) formulations. Common side effects are typically mild and include anxiety, insomnia, headache, dizziness, constipation, and nausea. Rarely, cutaneous hypersensitivity reactions may occur. We describe a 23-year-old man who developed severe and diffuse urticaria and angioedema 4 weeks after initiation of bupropion XL for MDD and ADHD. The bupropion was stopped, and he was treated with levocetirizine, diphenhydramine (oral and topical), and methylprednisolone with complete resolution of his symptoms within 2 weeks. Due to a good initial therapeutic response to the medication, a trial of bupropion SR was initiated. The patient again had a favorable therapeutic response without any dermatologic side effects.