Case Reports in Psychiatry最新文献

This case report documents a rare presentation of obsessive-compulsive-like symptoms co-occurring with Capgras syndrome following surgical resection of a right-sided frontal lobe pleomorphic xanthoastrocytoma in a 13-year-old girl. The patient initially presented with headache and intractable vomiting, leading to the discovery of a right-sided frontal lobe tumor. Postoperatively, the patient exhibited cognitive and behavioral changes manifesting as misidentification beliefs regarding the identities of loved ones and associated distressing thoughts. Comprehensive psychiatric evaluation using validated assessment tools confirmed these presentations. This report contributes to understanding the complex interplay between neurological, psychiatric, and cognitive factors in the development of these rare postsurgical neuropsychiatric complications following frontal lobe tumor resection.

Objective: In the wider context of palliative care, problems faced by young people today, such as depression, mental illness, and suicide; are considered terminal problems, so they must be treated immediately and given appropriate intervention. Caution is needed in providing appropriate interventions for them, of course, interventions that are by their characteristics. Based on their character, they are a generation that is quite fragile and easily discouraged; on the other hand, they are a generation that is dynamic and passionate about creativity. There needs to be a match between what they need and what the intervention provides. One type of intervention in palliative care that has recently been offered is "rapid tele-psychotherapy" with single-session music therapy (RTP-SSMT), which is considered quite appropriate in responding to these challenges.

Method: I report the case of a 22-year-old broken-hearted girl with hopelessness, depression, and suicidal ideation.

Results: I describe the effectiveness of the implementation of RTP-SSMT in reducing the scales of hopelessness, depression, and suicidal ideation.

Significance of results: It can be concluded that the implementation of the RTP-SSMT for a broken-hearted girl with conditions of hopelessness, depression, and suicidal ideation who can be at risk for suicide can be said to be effective in alleviating these negative feelings. Aside from that, through this study, the biggest implication is that the RTP-SSMT intervention theory can be a choice for mental health workers who want to process assistance to patients/clients who experience hopelessness, depression, and suicidal ideation in someone who has experienced a breakup.

Background: Delusional infestation (DI), or delusional disorder, somatic type, is a rare psychiatric condition characterized by a fixed false belief of infestation despite lack of medical evidence. Patients frequently resist psychiatric care due to poor insight and somatic preoccupation, increasing the risk of delayed diagnosis and serious self-harm.

Case presentation: We report the case of a 60-year-old woman with no prior psychiatric history who presented with 11.5% total body surface area (TBSA) second- and third-degree self-inflicted burns resulting from attempts to eradicate perceived skin parasites. She reported a 2-year history of pruritus attributed to "shiny fiberglass bacteria," with associated tactile hallucinations. Extensive medical workup excluded underlying anatomic, inflammatory, or infectious etiologies. The psychiatry consultant diagnosed her with delusional disorder, somatic type. Treatment with low-dose risperidone and doxepin was initiated following empathic, nonconfrontational engagement. Her distress improved, and she demonstrated early signs of insight by the time of hospital discharge.

Conclusion: This case highlights the risk of severe self-injury in DI and underscores the need for timely psychiatric evaluation and a compassionate, collaborative approach. Reframing treatment goals to prioritize symptom relief over delusional challenge may enhance engagement and facilitate recovery.

Metachromatic leukodystrophy (MLD) is a rare, autosomal recessive disorder of lipid metabolism characterized by deficiency of arylsulfatase A (ARSA), which leads to an accumulation of sulfatides in central and peripheral nerve system and eventually to progressive demyelination. The adult form of MLD may be misinterpreted as a psychiatric disease, since behavioral signs may precede intellectual decline. Here we report the case of a 53-year-old woman initially admitted to a psychiatric ward with symptoms of depression. The behavioral changes were initially attributed to psychosocial stressors within the family, particularly long-term emotional abuse by the patient's former partner. However, detailed anamnesis with the patient's mother revealed progressive behavioral and cognitive decline, urinary and fecal incontinence, that is, features suggestive of an underlying neurological disorder. Notably, laboratory investigations recommended 6 years earlier had not been performed. Neurological examination revealed signs of a frontal syndrome, bilateral pyramidal tract involvement, and mild polyneuropathy. Magnetic resonance imaging (MRI) demonstrated abnormal white matter signal alterations. Further diagnostic investigations showed reduced serum ARSA activity, elevated urinary sulfatides, and a homozygous pathogenic variant in the ARSA gene, confirming the diagnosis of adult-onset MLD. The homozygous mutation indicated parental consanguinity, suggesting early trauma embedded within the family. This case underscores the complexity of diagnosing MLD and emphasizes the importance of integrating psychiatric, neurological, and systemic family perspectives in the diagnostic process of rare and slowly progressing illnesses.

Quetiapine, an atypical antipsychotic, is widely prescribed for psychiatric disorders, particularly schizophrenia, bipolar disorder, and depressive disorders with or without psychotic symptoms. While edema is more commonly associated with olanzapine and clozapine amongst second general antipsychotics, reports involving quetiapine-particularly the extended-release (XR) formulation-are rare. We describe the case of a 52-year-old woman with severe major depressive episode with psychotic features who was initiated on escitalopram and quetiapine immediate-release (IR) 100 mg/day, later switched to quetiapine XR 100 mg/day to improve adherence and reduce sedation. Ten days after the switch, she developed symmetrical bilateral lower limb pitting edema without systemic symptoms. Comprehensive cardiac, renal, hepatic, thyroid, and immunologic evaluations were unremarkable, and venous Doppler ruled out deep vein thrombosis. The edema resolved within 10 days of discontinuing quetiapine XR and recurred upon rechallenge. The Naranjo Adverse Drug Reaction Probability Score was 9, indicating a probable to definite association. Possible mechanisms include α1-adrenergic blockade, 5-HT2 receptor antagonism, and pharmacokinetic differences in XR formulations leading to sustained peripheral receptor occupancy. Literature review reveals few comparable reports, most involving higher doses or polypharmacy. This case highlights the importance of clinician awareness of quetiapine XR-associated edema, even at low doses, and supports dechallenge-rechallenge as a useful diagnostic approach to improve patient safety and adherence.

Background: Challenging behaviours (CBs) are common in patients with intellectual disabilities (IDs) and diagnosing an underlying primary psychiatric disorder is often difficult. Even though many respond to non-pharmacological or pharmacological interventions persistent aggressive and self-injurious behaviour occur and no treatment-resistant guideline exists. We aim to present clinical scenarios regarding patients with ID and persistent CB with or without a primary psychiatric disorder where clozapine could be considered.

Case presentation: We present five patients with ID with persistent CB with or without a primary psychiatric disorder treated with clozapine. Four of the five patients responded well to clozapine treatment with markedly decreased CB, and two patients had reduced psychotic- or affective symptoms. Side-effects were mild and manageable. Haematological monitoring was performed with a point-of-care (POC) test device.

Conclusions: We show that clozapine can be efficacious in persistent CB and/or treatment-resistant psychiatric symptoms in patients with ID. Monitoring and managing side-effects were possible.

Impact and implications: We suggest that clozapine should be considered in patients with ID regardless of a primary psychiatric disorder when CB does not respond to non-pharmacological and first line pharmacological treatment. It is possible to monitor and manage side-effects with a systematic approach including the use of POC testing.

Deliberate self-harm (DSH) is defined as the intentional infliction of physical injury on oneself without the intent to end one's life. Common behaviors associated with DSH include cutting with a knife or razor, scratching or hitting oneself, and intentional drug overdose. Additionally, these behaviors may encompass restricting food intake and engaging in other risk-taking activities, such as driving at high speeds and participating in unprotected sexual activities. DSH is a strong indicator of suicide risk, particularly in individuals with schizophrenia. The death of Vincent Van Gogh on July 29, 1890, at the age of 37, following a firearm-related suicide attempt, is a compelling example. This occurred a year after his infamous act of self-inflicted ear mutilation, underscoring the increased suicide risk among individuals with a history of significant self-mutilation. We report a similar case of a patient who presented with superficial new cuts on a broken index finger of the left upper limb. Further assessment revealed schizoaffective disorder, which required close monitoring and management. There is a need to enhance the knowledge of identifying those at an elevated risk of self-harm and, whenever feasible, to implement appropriate harm-reduction strategies.

Background: Catatonia is a multifaceted disorder marked by diminished motor activity and communication, and often accompanied by heightened agitation and cognitive confusion. While historically associated with schizophrenia, recent revisions in the DSM-5 have broadened its connections to various mental and physical health disorders. The lorazepam challenge test (LCT) is used to diagnose and treat catatonia. This case challenges the traditional manifestation of catatonia and the timeline of the LCT. Case: The case discussed involves a young man whose primary manifestation was cognitive impairment, ultimately diagnosed as catatonia through a traditional 2 mg LCT. Although his initial response to the LCT was negative, a marked reduction of symptoms was observed hours later. Discussion: Timely diagnosis of catatonia led to symptom improvement and reduced hospitalization. This case challenges the conventional assessment timeline and highlights the need for further understanding of catatonia's pathophysiology and treatment response. It underscores the diagnostic challenges posed by catatonia's cognitive and ambiguous presentation. Conclusion: The response to lorazepam, its dosage, and timing remain enigmatic, accentuating the knowledge gap in catatonia research. Further investigations are required to unravel the intricacies of catatonia's manifestation, diagnosis, and treatment response.

Managing aggressive behaviors in patients with substance use disorders (SUDs), particularly when accompanied by comorbid psychiatric disorders, presents considerable challenges. Clozapine is an atypical antipsychotic known for its effectiveness in treatment-resistant schizophrenia with evidence in support of its ability to reduce violent and aggressive behaviors. This case report describes two patients who were treated with clozapine and showed reduction in violent behaviors, as well as improvement in addiction issues during their stay in a secure rehabilitation center. This observation suggests that clozapine may offer considerable benefits in managing aggression in SUD patients with co-occurring psychiatric illness and highlights the need for further research to assess its broader applicability in complex cases beyond treatment resistant schizophrenia.

Catatonia is a complex psychomotor syndrome associated with several psychiatric disorders, including schizophrenia and autism. It is also associated with neurologic conditions such as encephalitis and epilepsy. Catatonia has also been described in genetic syndromes such as Down Syndrome. Catatonia presents with two main subtypes. Retarded catatonia is characterized by stupor, immobility, mutism, rigidity, and withdrawal, as well as negativism, posturing, and echolalia/echopraxia. Excited catatonia is primarily characterized by psychomotor agitation and occasionally self-injurious behaviors. Though the pathophysiology of catatonia remains poorly understood, treatment with benzodiazepines is effective in many cases, with electroconvulsive therapy indicated in cases of poor response. Rett syndrome is an X-linked neurodevelopmental disease associated with mutations in methyl-CpG-binding protein 2 and is characterized by regression of spoken language and purposeful hand skills, gait abnormalities, and stereotyped hand movements. Herein we describe a case of catatonia associated with Rett syndrome in a 17-year-old female. Her presentation was notable for hyperactivity, impulsive behaviors, agitation, self-injurious behaviors, and aggression. The patient had limited response to multiple medication trials. Initially she had a positive response to treatment with lorazepam, with later waning efficacy despite dose escalation. The patient was admitted to the inpatient psychiatry and completed an index course of 13 ECT treatments followed by maintenance ECT, completing 30 treatments in total. Treatment resulted in significant improvements in self-injurious behaviors, agitation, and overall engagement. In conclusion, catatonia should be considered in individuals with Rett syndrome who present with agitation and self-injury to aid in overall symptom improvement and outcome.