Case Reports in Psychiatry最新文献

Introduction: COVID-19 has been a sudden public health crisis since January 2020, spreading from the city of Wuhan, China, to the whole country within a month and posing serious threats to lives. The pandemic has a profound effect on all aspects of society, including mental health and physical health. The actual effect of the virus on the brain and possible psychiatric manifestations is still an area of study and further investigation. There are also several case reports showing manic like symptoms after COVID-19 infection. We describe the case of a 55-year-old patient who presented with behavioral and mood symptoms after a COVID-19 infection. Case Presentation. The patient presented with behavioral disturbance after a diagnosis of COVID-19. He exhibited symptoms including irritability, verbal and physical aggressiveness, increased goal-directed activity, elated and expansive mood, increased energy, grandiosity and inflated self-esteem, and decreased need for sleep. Findings on psychiatric evaluation encompassing detailed history and mental state examination suggested bipolar disorder due to COVID-19 infections. For this, he was put on sodium valproate 1000 mg per day and later, and he was discharged after 21 days with improvement.

Conclusions: This case highlights the importance of paying attention to psychiatric symptoms in patients with COVID-19 and the early intervention and involvement of psychiatrists especially in critically ill patients. In the present scenario, we urge physicians to pay attention to those cases and be open-minded for such a possible new diagnosis. We also recommend performing antibody tests for CSF and RNA tests for patients with mental abnormalities following COVID-19. Further studies can be performed to identify the relationship between COVID-19 and bipolar disorders.

Posttraumatic stress disorder (PTSD) is a debilitating stress disorder occurring in the context of a traumatic event and is characterized by intrusive and avoidance symptoms, negative alterations in cognition and mood, and arousal and reactivity changes. Despite its representation throughout literature, the pathophysiology of PTSD remains incompletely understood, thus contributing to broad, variable, and at times, experimental treatment options. The authors present the first documented case of the rapid and successful management of PTSD using valproic acid and twice daily dosing of prazosin aimed at targeting symptoms of hyperarousal and both daily and nightly intrusive symptoms of flashbacks and nightmares, respectively. The authors also discuss postulations of the underlying mechanisms of action responsible for such symptom alleviation. Further investigation is needed to expand upon our knowledge of the use of such agents in the treatment of PTSD to improve upon existing clinical guidelines, especially in the acute setting, thus providing better overall prognosis.

We describe the case of a 5-year-old male who developed severe hyperactive delirium with aggressive violent behavior following the administration of IV levetiracetam for the treatment of status epilepticus on two occasions. The child's symptoms ranged from attacking his parents and the intensive care staff. Risperidone was given without any improvement in symptoms. A high-dose continuous infusion of IV dexmedetomidine was administered, and his violent behavior and delirium significantly improved. The two episodes of hyperactive delirium following IV levetiracetam administration occurred at ages 3 and 5, resulting in extensive work up including laboratory testing and cranial imaging, along with cerebral spinal fluid analysis and were normal. IV dexmedetomidine provided rapid symptom relief to prevent harm for the child, staff, and family on both occasions.

Evidence suggests that inhibition of protein kinase C (PKC) signalling may have a contributing role in the treatment of bipolar affective disorder (BPAD). Endoxifen, an active metabolite of tamoxifen, is a potent direct PKC inhibitor. This report presents a severe case of a BPAD patient with a baseline Young Mania Rating Scale (YMRS) score of 49, associated family history and addiction to psychostimulants, with no improvement by the first and second-generation antipsychotics. Treatment with endoxifen 8 mg once a day showed improvement in manic symptoms with a YMRS score of 4 and a reduction in the use of psychostimulants as well as other antipsychotic concomitant medications. No adverse effects were noted up to 8-month follow-up. Long-term treatment with endoxifen is safe and effective in severe BPAD.

Since glucocorticoids (GCs) were introduced for the treatment of various diseases, they have been linked with the development of psychiatric adverse effects such as mania, depression, and psychosis. These behavioral or psychiatric adverse events usually appear within a few days after commencing GCs and are possibly to reverse with drug withdrawal. We present a rare case of a 75-year-old woman who developed mania during treatment with GC eye drops following cataract surgery. Management consisted of discontinuing prednisolone and administering olanzapine, which resulted in full recovery in a week. Olanzapine was then discontinued, and a diagnosis of steroid-induced mania was concluded for this case.

A 36-year-old Hispanic female patient with gastrointestinal symptoms and weight loss was found to have a trichobezoar in her stomach requiring a surgical removal. Psychiatry team was consulted due to concerns for depression and trichotillomania. The psychiatric evaluation revealed that the patient was not ingesting her own hair - the most common instance in cases of trichotillomania and trichophagia, but her daughter's hair. The patient was doing this as an unconscious, spontaneous response to her daughter's manifest hair loss caused by daughter's malignancy and treatment thereof. The patient was given a diagnosis of Adjustment disorder and treated as such, as the patient's symptoms resolved with her daughter's remission. The patient's cultural background was taken into consideration and the team explored cultural factors that could have mediated such a response. The team also explored the psychodynamic aspects of this case in order to attain a more comprehensive understanding of this patient's unique presentation. To best describe this unusual behavior, we coined a term for such a phenomenon - allotrichophagia (Greek: eating others' hair).

Bipolar disorder is a mental health disorder where the patient experiences extreme shifts in mood marked by depression, mania, or hypomania. It affects their overall daily life activities and sleep patterns. This case report is of a 74-year-old female patient with bipolar disorder who experienced a manic episode after initiation of antibiotics to treat gallbladder perforation with abscess formation. The patient's past medical history included Parkinson's disease, diabetes mellitus, bipolar disorder, and acalculous cholecystitis. The patient required hospitalization for a cholecystostomy tube insertion for drainage. During hospitalization, the patient was started on empiric treatment with broad-spectrum antibiotics, including piperacillin/tazobactam and metronidazole. The patient remained stable during the inpatient stay and was discharged home one week later. She was prescribed cefuroxime and metronidazole to complete a 2-week duration of antibiotics. However, upon discharge, she developed manic symptoms, including lack of need to sleep, excessive talking, and severe agitation. Upon assessment, the psychiatric team decided to hold metronidazole as it has an adverse effect of mania as evidenced in drug information resources. The patient started to show immediate recovery from the symptoms with complete resolution of manic symptoms on the 3^rd day following the discontinuation of metronidazole. This case emphasizes the increased need for vigilance in bipolar patients upon prescribing metronidazole. Also, further research is needed to predict the time to onset of manic symptoms and improvement in patient symptoms upon drug discontinuation.