Case Reports in Psychiatry最新文献

Background: In psychiatry, anatomical abnormalities are sometimes forgotten, and this can mislead doctors into thinking that the diagnosis is purely psychiatric. A physical examination is important whenever it is possible. Even though cerebral arteriovenous malformations (cAVMs) are rare and can go unnoticed, in some cases they can cause clinical symptoms, which is a complication. Case Presentation. In this case, we describe a patient with no prior medical or psychiatric history having a cAVM diagnosed after showing psychotic symptoms (delusion and disorganized thoughts and behavior). The deep 4 × 5 cm cAVM was discovered after admitting the patient to psychiatric ward, the neurological cause has been considered after a recorded seizure, which brings the following question: Is the clinical presentation a direct result of the cAVM or is it postictal?

Conclusions: An abnormality leading to another, here is how we could describe our patient's psychopathology leading to psychotic symptoms. The two hypotheses explaining this case report have a low rate of occurring making this a rare case. Either way, neurological cause cannot be overlooked even if the clinical presentation is typical.

In this case report, we described a patient admitted with buprenorphine/naloxone (BN) misuse, accompanied by intermittent pregabalin misuse, to self-treat the opioid withdrawal symptoms. We treated the withdrawal symptoms after cessation of BN with guanfacine extended-release (XR). To our knowledge, it has been the first case report describing guanfacine-XR in the treatment of BN misuse. Notably, our patient responded to the treatment with a decrease in withdrawal symptoms without any significant side-effect. Although it is not possible to generalize our findings with a single case report, it might be useful to mark guanfacin-XR as a potential treatment agent for opioid use disorders, including patients with synthetic opioid misuse.

Misophonia and misokinesia are disorders characterized by intensely negative physical and emotional reactions to specific auditory and visual stimuli. The availability of effective treatments, especially pharmacological ones, is limited. This report presents a case of a 35-year-old male with severe misophonia and misokinesia who experienced nearly complete resolution of symptoms while undergoing high-dose steroid therapy for an unrelated muscular injury. Two days after starting a 20 mg oral prednisone taper pack (in which the steroid dose is reduced by 4 mg daily), his Amsterdam Misophonia Scale (A-Miso-S) score drastically reduced from a baseline of 23 (i.e., extreme symptoms) to 1, with symptom relief persisting for approximately 2 weeks after completing the taper. Months later, a daily dose of prednisone (4 mg) was reintroduced. This again resulted in a marked reduction in symptoms (A-Miso-S of 6), enabling him to resume working in an office setting despite his triggers. Symptom improvement remained stable over several months. This case raises the possibility of the steroid prednisone as a novel treatment for misophonia and misokinesia. However, further investigation is needed to determine the generalizability of this observation.

Pseudocyesis is a complex psychiatric manifestation of the physical symptoms of pregnancy. Although not pregnant, the pseudocyetic patient displays signs and symptoms consistent with pregnancy, such as abdominal distention, cramping, and/or sensations of fetal movement. Pseudocyesis is more common in developing countries than in the developed world, possibly due to the importance that traditional societies attach to childbearing and the low social status that these societies assign to women who are unable to produce children. Socioeconomically disadvantaged women in developed countries may also be at increased risk. Although the etiology, pathogenesis, diagnosis, and management of pseudocyesis are poorly understood, it manifests with real symptoms, which may complicate both the patient's perspective about her condition and the medical and psychiatric teams' approach to the patient. This case report is one of only a few in the literature to present an example of pseudocyesis developing in the context of acute mania. After describing the patient's clinical course, from her initial symptoms of pseudocyesis to their eventual resolution, this report will provide recommendations for the sensitive care of patients with this rare but significant condition.

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a clinical condition with abrupt onset of obsessive-compulsive symptoms and/or severe eating restrictions and at least two concomitant cognitive, behavioral, or neurological symptoms. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a subtype of PANS with a controversial diagnosis. A case of a 12-year-old girl with severe eating restriction, obsessive-compulsive symptoms, anxiety, and neurological symptoms who initially was diagnosed with obsessive-compulsive disorder is presented. Published reports were reviewed for the evidence of diagnosis and treatment options of PANS/PANDAS. Studies show controversy regarding diagnosis. Moreover, study reports showed limited evidence for the treatment options. Selective serotonin reuptake inhibitors and psychotherapy are considered the main treatment with prompt infection treatment in the case of PANDAS.

This paper reports the case of a 27-year-old man with paranoid schizophrenia who was finally stabilized on clozapine medication. After vaccination against severe acute respiratory syndrome coronavirus 2, serum levels of clozapine increased. It is well established that immune responses can trigger cytokine cascades affecting drug metabolism, which, in the case of clozapine treatment, can lead to severe intoxication.

Catatonia is a psychiatric emergency in schizophrenia that often leads to excessive activation of the sympathetic nervous system. Urinary retention in catatonia is often underestimated but has potentially detrimental consequences. Herein, we present the case of a woman in her 40s with schizophrenia treated for catatonia during a relapse. When treated as an inpatient, the patient suddenly complained of severe abdominal pain. Computed tomography revealed a spontaneous rupture of the posterior wall of the bladder, requiring emergency repair surgery in the urology department. The patient was readmitted to our hospital following surgery and ultimately discharged 1 month later. Bladder rupture is life-threatening, and delayed diagnosis and treatment can be fatal. This case report serves as a warning that psychiatrists should not overlook urinary retention in patients with catatonia and should consider bladder rupture in the differential diagnosis when these patients have abdominal pain.

Objective: Eating disorders (EDs) are often associated with prior histories of trauma, subsequent PTSD and related psychiatric comorbidities. There is a paucity of information about their relationship to somatic symptom disorders, specifically psychogenic nonepileptic seizures (PNES), a type of functional neurological symptom disorder or conversion disorder.

Methods: We report a case of a 39-year-old bisexual female with bulimia nervosa (BN), PTSD, recurrent major depressive disorder (MDD), cannabis use disorder, and PNES who responded to integrated trauma-focused treatment during residential ED treatment using cognitive processing therapy (CPT). Symptoms of ED, PTSD, major depression, and state-trait anxiety were measured using validated assessment instruments.

Results: During the course of CPT treatment, the patient's total scores on the PTSD Symptom Checklist for DSM-5 (PCL-5) went from 59 to 26, which is below the diagnostic threshold for PTSD. In addition, she demonstrated improvements in the Eating Disorder Examination Questionnaire (EDE-Q) Global Severity score, the Eating Disorder Inventory (EDI-2) total score, the Patient Health Questionnaire (PHQ-9) total score, the Spielberger State and Trait Anxiety Inventory scores, and the Eating Disorder Quality of Life (EDQOL) total score. Furthermore, her PNES also abated, and she remained seizure free for ∼1 year following discharge with the exception of one short seizure, per report of the patient.

Conclusion: The use of CPT as part of an integrated trauma-informed treatment approach during residential ED treatment was successful in a woman with PNES, BN, PTSD, MDD, and cannabis use disorder.

Delirious mania is an acute neurobehavioral syndrome which can have the features of mania, delirium, psychosis and catatonia. There are no diagnostic and treatment guidelines of delirious mania which can lead to delayed treatment, increasing morbidity and mortality. The primary goal of this report is to raise awareness among healthcare professionals and improve patient outcomes for this potentially life-threatening condition. In this case report, we present an octogenarian female, a case of bipolar disorder, current episode manic, who had impaired orientation, delusion of persecution, and altered sleep-wake cycle. She was treated with a combination of mood stabilizer and antipsychotic and discharged after 24 days of admission.