Case Reports in Psychiatry最新文献

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with Lewy body dementia (LBD) who developed CS, manifesting as the delusional belief that her deceased husband had been replaced by an imposter.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.

Behavioral and psychological symptoms of dementia (BPSD) are very common, and their management remains challenging. In older people with dementia, equine-assisted therapy (EAT) may be a promising nonpharmacological intervention for the management of BPSD. Here, we present five cases of patients with agitation and aggression due to moderate-to-severe dementia. They had overall two to three sessions of EAT at a frequency of one session per week. We assessed the Neuropsychiatric Inventory Questionnaire (NPI-Q) score before and 1 day after the second EAT session. We observed a discrete reduction in the NPI-Q after the EAT sessions, although not all of the improvements experienced by patients, families, and carers were reflected in the NPI-Q. Future studies should be conducted to assess subjective lived experiences of EAT in patients with moderate-to-severe dementia.

Objective: Risk for mood and behavioral activation (MBA) due to selective serotonin reuptake inhibitors (SSRIs) is multiply determined in persons with Prader-Willi syndrome (PWS) due to underlying epigenetic and pharmacogenomic factors that affect medication response. Further, age and molecular subtype of PWS are predisposing factors, as there is a >60% risk for bipolar disorder onset prior to age 30 among those with maternal uniparental disomy (mUPD). This article presents two cases of MBA due to sertraline prescribed to treat anxiety in these adults with PWS (mUPD). Methods: Literature review, clinical experience, and data from group home behavior logs inform this case report. The assent of the patients and the consent of their parents (legal guardians) were obtained for this publication. Results: In these two cases, the gradual onset of MBA occurred over 1 year as the dose of sertraline was increased causing irritability, sleep disturbance, increased intensity of hyperphagia, and other phenotypic behaviors. These clinical signs were attributed to the stress of COVID-19 shutdown that resulted in loss of community activities for work, socialization, leisure, and exercise. But after sertraline was discontinued, activation resolved. Mood-stabilizing medication was required for a return to baseline, as sertraline may have unmasked or exacerbated an underlying bipolar diathesis. Conclusion: Sertraline and other SSRI medications can cause MBA in patients with PWS at typical starting doses, although risk for adverse effects increases with higher doses. Age is a contributing factor. Knowing the genetic subtype of PWS is essential for making clinical decisions about pharmacotherapy, and results of pharmacogenomic testing may inform the selection of medication, dose, and schedule of administration.

Delusional misidentification syndromes (DMSs) are a group of disorders, characterized by consistent misidentification of individuals, locations, objects, or events. Four primary subtypes are recognized within this classification: Capgras syndrome, Frégoli syndrome, intermetamorphosis syndrome, and the syndrome of subjective doubles. We report a case of a woman with schizophrenia who experienced a strange delusion that her parents were her babies. This delusion did not arise from visual hallucinations of infants or from prosopagnosia. Furthermore, she denied experiencing auditory hallucinations related to the infants, suggesting that this delusion was not secondary to auditory hallucinations. The delusion that she had her infant was the delusion of maternity, and it was a form of delusional procreational syndrome that consists of sequential delusions in every possible stage of procreation. We concluded the delusion of misidentification that her parents were her own babies exhibited in this case was a subtype of intermetamorphosis syndrome coexisted with delusional procreation syndrome and her coping mechanisms shaped by underlying fears and inner wishes.

Introduction: This case highlights the unique challenge of difficult-to-treat depression (DTD), a complex condition that distinguishes itself from treatment-resistant depression (TRD) due to its multifaceted nature. DTD is characterized by comorbidities, childhood trauma, symptomatic variability, personal history, substance use, and adherence issues, presenting a significant clinical challenge. Unlike TRD, typically defined by the failure of at least two adequate pharmacological treatments, DTD requires a more comprehensive approach. Recent literature supports a multidisciplinary treatment strategy as the most effective in managing DTD. The patient's main concerns and important clinical findings: We present the case of a 63-year-old female patient with a long-standing history of unresolved depressive disorder despite multiple pharmacological treatments. Her primary concerns included severe anhedonia, persistent suicidal ideation, and impaired personal and familial functioning. The patient's history included prior failed treatments, highlighting the complexity of her case. Primary diagnoses, interventions, and outcomes: The patient was diagnosed with DTD. A personalized treatment plan was implemented, integrating a clearly defined multidisciplinary approach: pharmacotherapy, psychotherapy (with a focus on grief and trauma processing), and psychosocial support, including active family involvement through psychoeducation sessions. Neurostimulation techniques were discussed as a potential alternative but were not applied in this case. Over time, the patient demonstrated significant improvement, with a reduction in depressive symptoms, resolution of suicidal ideation, and enhanced personal and familial functioning. Conclusion: This case underscores the need for a personalized treatment approach for DTD that goes beyond pharmacotherapy to include psychotherapy, psychosocial support, and alternative options, such as neurostimulation when indicated. Active involvement of patients and their families is crucial, as evidenced by improvements in clinical and functional scores. Continuous monitoring and treatment adjustments based on objective measures (e.g., HRS-D, GAF, DTDQ) further optimize outcomes. The case exemplifies how an integrated treatment strategy can address the complexities of DTD, leading to long-term recovery and improved quality of life. The key takeaway is that managing DTD requires a comprehensive and individualized approach.