Case Reports in Psychiatry最新文献

Background: Neuroleptic malignant syndrome (NMS) is an idiosyncratic and life-threatening side effect that usually occurs in response to dopamine receptor antagonist medications. Despite increased awareness, the diagnosis of NMS remains challenging due to its wide differential diagnoses, which can lead to delayed treatment and increased mortality or premature reinitiation of the causative agent, culminating in recurrent NMS, a phenomenon with limited reports. This case presents a patient who experienced three episodes of NMS within 1 year, all triggered by risperidone. Case Presentation: A 58-year-old male patient with schizophrenia presented to the emergency department of a university hospital in Northern Iran, due to decreased consciousness, fever, and rigidity. Initial laboratory results showed elevated creatine phosphokinase (CPK) at 14,949 U/L. He had two previous episodes of rhabdomyolysis and hospitalization in the past year. Review of prior hospital records indicated treatment for rhabdomyolysis with symptoms consistent with NMS, without making this diagnosis. Conclusion: In any patient treated with dopaminergic drugs who suffer from mental status changes, muscle stiffness, high fever, and dysautonomia, especially who have complications such as rhabdomyolysis, kidney failure, seizures, leukocytosis, and increased CPK and lactate dehydrogenase (LDH), the possibility of NMS should be considered.

Background: Othello syndrome (OS) is a rare psychiatric disorder characterized by delusional jealousy and unfounded suspicions of infidelity. It has been associated with neurological diseases such as Parkinson's disease (PD), particularly in patients receiving dopamine agonists (DAs). Case Presentation: A 69-year-old man with a longstanding diagnosis of PD developed OS after transitioning from levodopa/carbidopa to ropinirole due to intolerance. Six months after initiating ropinirole, the patient began experiencing intense, delusional beliefs regarding his wife's fidelity, despite no cognitive decline or psychiatric history. The delusional symptoms significantly strained his marital relationship. Clinical Findings and Diagnostic Assessment: Neurological examination remained consistent with PD, and no structural brain abnormalities were observed on magnetic resonance imaging (MRI). The temporal association between ropinirole use and symptom onset led to the diagnosis of ropinirole-induced OS. Ropinirole was gradually discontinued over 4 weeks, and quetiapine was introduced. The patient showed substantial improvement in psychiatric symptoms with resolution of delusional beliefs and restoration of spousal rapport. Conclusion: This case highlights the potential for DAs, including ropinirole, to induce OS in PD patients. Clinicians should remain vigilant for psychiatric side effects during PD treatment and consider timely intervention, including medication adjustment and antipsychotic therapy, to prevent severe psychosocial consequences.

Delayed posthypoxic leukoencephalopathy (DPHL) is a rare diagnosis that may present similarly to other more common neurological conditions, such as catatonia. While often seen with carbon-monoxide poisoning, it can also be due to anoxia due to other causes, such as drug overdose or cardiac arrest. Due to the delayed nature of its symptoms and overlap with other conditions, it can be initially misdiagnosed. We present a 50-year-old female patient with a history of depression who was found unresponsive, hypoxic, and febrile at her home for an unknown amount of time. The initial concern was for sepsis. Initial computed tomography (CT) of the head and magnetic resonance imaging (MRI) of the brain were normal. The patient had rhabdomyolysis with secondary renal failure, shock liver, and acute pancreatitis. Once medically stabilized, her cognition returned to a normal baseline. However, 10 days into her hospitalization, her mental state deteriorated, displaying symptoms of mutism, stupor, staring, decreased oral intake, and perseveration. Catatonia, secondary to a major depressive episode, was suspected. Lorazepam was titrated upward without result. Lack of response to lorazepam prompted a repeat brain MRI, revealing diffuse white matter changes in the frontal, temporal, parietal, and occipital lobes of both hemispheres. A diagnosis of DPHL was made. She was then started on carbidopa/levodopa 25/100 mg with improvement and was discharged to a rehabilitation facility.

Background: Body integrity dysphoria (BID) is a rare disorder, in which individuals experience a persistent desire to become physically disabled, often through limb amputation. It is now included within the International Classification of Diseases 11th Revision (ICD-11), and this is one of the first case reports to describe the application of these new diagnostic criteria. This also raises the question of treatment pathways for individuals with the disorder, with recognition bringing legitimacy to patients' experience, and responsibility to professionals. Case Presentation: We describe the experience of a 50-year-old man with a long standing desire for his leg to be amputated. He described frustration with the support available, and shame associated with accessing this. After discussions in an online forum he caused dry ice burns to his leg, which resulted in a below-knee amputation. The patient was satisfied with this outcome. All the essential features of ICD-11 diagnostic requirements for BID were met, as well as a number of additional clinical features. Conclusions: New diagnostic criteria appeared both accurate and acceptable to our patient. This formal recognition of the diagnosis presents a new challenge to services about how best to support individuals, and whether there needs to be development of clinical guidance to support clinicians.

Pica, the ingestion of nonnutritive substances, represents a complex and poorly understood phenomenon. Although it is inherently a psychiatric condition, it has an intricate relationship with other psychiatric, physiological, and pathological states, suggesting a highly multifactorial etiology. Recognizing and addressing pica in acute settings is crucial, as it poses significant health risks for patients, including the potential of toxic ingestion. Our presentation highlights the case of a 36-year-old woman with a complex psychiatric history who presented to the emergency department (ED) with severe symptomatic anemia. Her anemia was found to be macrocytic and a result of autoimmune-induced vitamin B12 deficiency. Further inquiry uncovered that, prior to admission, the patient exhibited a craving for smelling bleach powder that progressed to mouthing the toxic substance for more than a month. This is the first report of a case of bleach craving in a patient with vitamin B12 deficiency absent coexisting iron-deficiency. This unique presentation underscores the importance of psychiatric consultations as a part of comprehensive clinical assessments in emergency medical settings. We also suggest that pica presentations may be nuanced and thus it is critical to understand the biopsychosocial factors driving this behavior and target interventions in the appropriate medical domains.

Capgras syndrome (CS) presents a unique diagnostic and management challenge, particularly when associated with neurodegenerative conditions. This case report describes a 73-year-old female diagnosed with Lewy body dementia (LBD) who developed CS, manifesting as the delusional belief that her deceased husband had been replaced by an imposter. The clinical presentation was complex, including pronounced sleep disturbances, cognitive decline, behavioral anomalies, and visual hallucinations, necessitating a thorough differential diagnosis process. We detail the patient's history, clinical findings, and the investigations undertaken, including brain imaging and cognitive assessments. The management approach involved a personalized treatment plan integrating Lithium sulfate, Citalopram, and Lurasidone, alongside psychosocial interventions. While a partial improvement was observed, the case underscores the complexities of managing CS in the context of LBD, highlighting the need for tailored and multidisciplinary approaches to care. This case contributes to the limited literature on CS in LBD and provides practical insights for clinicians managing similar presentations.

Objectives: This case study examined the long-term course and treatment of posttraumatic stress disorder (PTSD) following the 2011 Great East Japan Earthquake (GEJE) and nuclear disaster. Specifically, this study investigated the role of early maladaptive schemas (EMSs) and coping modes in symptom persistence, the interplay between physical health issues and PTSD symptoms, and the efficacy of a staged treatment approach. Methods: We present a 12-year longitudinal case study of a woman with delayed-onset PTSD. The patient underwent a staged treatment comprising supportive therapy, schema therapy, and prolonged exposure (PE) therapy. Treatment progress and symptom manifestations were qualitatively analyzed, focusing on schema modifications, coping mode changes, and trauma processing. Results: The key findings were: (1) EMSs (e.g., enmeshment and subjugation) contributed to PTSD symptom maintenance and influenced postdisaster interpersonal patterns; (2) maladaptive coping modes played a role in symptom persistence and delayed disease onset; (3) the observed cyclical pattern of symptom exacerbation was particularly evident in the anniversary effect; (4) the staged treatment approach effectively addressed complex PTSD, with schema therapy facilitating subsequent trauma-focused interventions. Conclusion: This study highlights the potential of combining schema therapy and PE to treat complex delayed-onset PTSD following compound disasters. This underscores the importance of addressing the underlying cognitive structures and coping mechanisms alongside trauma-focused interventions. These findings have implications for postdisaster long-term mental healthcare planning and suggest directions for future research to optimize treatment approaches for persistent PTSD.

Objective: Drug-induced myoclonus is a rare adverse effect associated with several drug classes, including antipsychotics. This case report describes a patient who developed generalized myoclonic jerks while on long-term risperidone therapy, in the context of concomitant sertraline use, without fulfilling clinical criteria for serotonin syndrome. Case Presentation: We present a 73-year-old male patient with a history of cerebrovascular disease and behavioral symptoms treated with sertraline and risperidone. The patient developed sudden, generalized myoclonic movements. Neurological examination and imaging studies excluded acute structural pathology and metabolic or infectious causes. Serotonin syndrome was ruled out based on clinical findings. The myoclonus resolved rapidly after discontinuation of risperidone, without any specific symptomatic treatment, suggesting a potential drug-related mechanism. Conclusion: This case highlights the importance of recognizing antipsychotic-related myoclonus as a potentially reversible condition. Clinicians should consider drug-induced myoclonus in the differential diagnosis and pay special attention to the risks posed by polypharmacy involving psychotropic agents.

Background: Eating disorders and cannabinoid hyperemesis syndrome are increasingly common causes of nausea, vomiting, and weight loss in adolescent females. Acute intermittent porphyria (AIP) is rare but has considerable pathophysiological overlap with these conditions and requires a high index of suspicion. Purpose and Basic Procedures: We present the case of a 15-year-old girl who presented with nausea, vomiting, and decreased appetite in the context of cannabis use and disordered eating. She was initially discharged from the emergency department but returned the next day experiencing seizures and altered mental status. Medical workup revealed AIP, and she responded well to the appropriate treatment. Main Findings: To date, no literature exists about the overlap between cannabinoid hyperemesis syndrome and AIP, although they often present with similar features. There is scant information about the interplay between AIP and disordered eating. As our case report shows, an AIP diagnosis could be delayed by misattribution of presenting symptoms to cannabis use or disordered eating. Principal Conclusion: AIP is a rare but highly treatable cause of nausea, vomiting, and altered mental status in adolescents. Due to its symptomatologic overlap with more common conditions like cannabinoid hyperemesis syndrome and eating disorders, it is easily missed. Thus, a high index of suspicion is required to obtain an AIP diagnosis and initiate treatment.

Angioedema of the tongue, also known as angioneurotic, or Quinke edema is a swelling of the tongue due to plasma leaking from capillary and postcapillary venules into deep submucosal tissue. This condition can either be hereditary, or acquired, due to allergy induced reactions for example. With an acute onset, this phenomenon can potentially be life threatening due to sudden and complete upper airway obstruction. Our aim is to describe the case of a 54-year-old schizophrenic male patient who presented with an angioedema of the tongue occurring after oral administration of haloperidol, a first-generation antipsychotic. The patient was admitted for close respiratory monitoring. The established cause for this condition was an allergic reaction to haloperidol. The following course was a favorable outcome with complete resolution of the edema without respiratory distress. We aim to report our case and to delve into other existing similar cases reported thus far in literature.