Case Reports in Psychiatry最新文献

Background: Neuropsychiatric sequelae of COVID-19 have been documented, including delusions, hallucinations, agitation, and disorganized behavior. Although the mechanisms for these symptoms remain unclear, there has been an increasing body of literature suggesting a correlation between COVID-19 infection and psychosis. Here, we illustrate the case of a 34-year-old female with no previous psychiatric history who contracted COVID-19 and subsequently developed severe symptoms of psychosis. After presenting to the emergency department with one month of worsening mood, auditory hallucinations, intrusive thoughts, and hyperreligiosity, she was admitted to the inpatient psychiatric unit. The patient was treated with multiple antipsychotic medications and was discharged in stable condition with resolution of her auditory hallucinations; however, her delusions, hyperreligiosity, and negative psychotic symptoms persisted, resulting in a second inpatient psychiatric admission eight days after discharge, during which she again did not reach full remission.

Objectives: With this information, we hope to increase awareness of COVID-induced psychosis and further discuss the relationship between COVID-19 infection and neuropsychiatric symptoms.

Conclusions: Although there has been increasing research about the COVID-19 pandemic, there is much to be elucidated regarding the neuropsychiatric symptoms related to these infections. Similar to previous studies, our case describes a patient with no previous psychiatric history who developed severe psychotic symptoms after COVID-19 infection and was admitted to the inpatient psychiatric unit. These symptoms resulting from infection can be severe or debilitating for the patient. Therefore, physicians should be aware of these potential neuropsychiatric sequelae when treating patients with active COVID-19 infections, and treatment with antipsychotics or acute inpatient psychiatric admission should be considered.

Introduction: Leigh syndrome (LS) is a mitochondrial disease characterized by subacute necrotizing encephalomyelopathy with an estimated incidence of 1:40,000 births. The comorbidity of psychotic symptoms noted in mitochondrial and psychiatric diseases has spurred interest in the effects of DNA mutations and psychiatric disorders. Case presentation. We report the case of a Tunisian 28-year-old male diagnosed with maternally inherited Leigh syndrome. He presented anxiety and auditory hallucinations, and he reported a vague, unsystematized delusion evolving since 6 months. Significant remission was observed at risperidone 3 mg/day. Discussion. The normality of explorations in our case raised the issue of the link between the two diseases, supporting the hypothesis that mitochondrial dysfunction maybe the primary origin of psychotic disorders.

Conclusion: The aim of our work is to study the relations between mitochondrial dysfunction and psychiatric symptoms. Further study of mitochondrial dysfunction in psychiatric disorders is expected to be useful for the development of cellular disease markers and new psychotropics.

Psychosis is an abnormal state of mind that leads to losing touch with reality. Symptoms may include delusions and hallucinations, amongst other features. Psychosis is known to increase the risk of other health conditions and may have serious adverse outcomes. This is a case report of a 26-year-old woman with no previous psychiatric history who presented with symptoms and signs suggestive of acute psychosis shortly after starting a postprocedural combination of antimicrobials. The patient's family decided to stop the antimicrobials as they observed an escalation of the psychotic symptoms with the ongoing use of antibiotics. The patient was subsequently brought to the emergency service (EMS) department, and she was admitted to the behavioral health unit. The treatment team managed to stabilize the patient with several interventions, including the administration of antianxiety and antipsychotic medications along with psychosocial intervention. The symptoms of psychosis resolved within 3-4 days, and she was discharged home. Even though transient psychotic episodes have been reported previously with antibiotics, this case emphasizes the increased need for vigilance and reporting in patients receiving antimicrobials.

According to the International Statistical Classification of Diseases and Related Health Problems 11th Revision (ICD-11) definition, "Charles Bonnet Syndrome" (CBS) refers to the experience of complex visual hallucinations in a person who has experienced a partial or complete loss of vision. Pituitary adenoma is a rare situation that may be associated with CBS. We report a case of CBS in a Tunisian 44-year-old female with pituitary macroadenoma. The patient reported visual hallucinations which persisted after transsphenoidal adenomectomy. She had no prior psychiatric history. She did not take any medication that could produce hallucinations. After Olanzapine initiation, hallucinations were completely resolved. It is the first Tunisian case of CBS reported in English language. This peculiar condition seems to be under-recognized in our country. Clinicians should be aware that visual hallucinations may concern patients without psychiatric disorders.

Background: Giant cell arteritis (GCA) is an autoimmune vasculitis affecting medium- and large-sized arteries. Vascular inflammation may lead to narrowing of the arterial lumen, and acute occlusion may result in vision loss and stroke. The classical symptoms include headache, fever, and jaw claudication. However, there is an increasing recognition of atypical presentations. Case Presentation. We report a case of a 70-year-old woman presenting with fluctuating manic symptoms and confusion, in addition to headache and musculoskeletal pain. After diagnosis of GCA, treatment with corticosteroids gradually improved the somatic symptoms.

Conclusion: Corticosteroids led to a temporary exacerbation of manic symptoms, which improved after 3 to 4 weeks of continuous treatment, indicating that the symptoms were most likely associated with GCA. The patient manifested with clinical features and a clinical course that has, to our knowledge, not been described or published before. Therefore, GCA may be an underdiagnosed disease in psychiatric populations and should be considered in case of atypical, new-onset psychiatric disorders in the elderly.

The post-COVID-19 era has introduced novel cases of psychiatric complications that are either organic or purely psychological in nature due to social isolation. This report details a case of new-onset obsessive-compulsive disorder (OCD) and schizophrenia following the COVID-19 pandemic. The novelty of this case lies in the onset of the patient's symptoms in the context of the COVID-19 pandemic, without prior predisposing risks in the environmental, social, or biological aspects. We provided therapeutic treatment to the patient in an inpatient setting, while examining the patient to decipher the root cause of his symptoms. While there is substantial data suggesting exacerbations of OCD during the COVID-19 pandemic in the general population and a new onset of schizophrenia due to the virus itself, very little is known about the prevalence of either OCD or schizophrenia after the pandemic. With this in mind, we hope to provide more information regarding new-onset psychosis and OCD within the adolescent population. A considerable amount of studies and data are needed in this subset of the population.

A 20-year-old male was referred by a psychiatrist to the clinic for treatment. He was diagnosed with social anxiety disorder (SAD), depression, and substances abuse. He complained of depressive mood and severe anxiety symptoms. These symptoms are triggered in social situations, as well as when talking to others, being in public areas, and going to malls or any crowded places. Because of his symptoms, he avoided getting into the situation, which affected his daily life. The patient was diagnosed with SAD, major depression, and substance abuse and underwent 20 separate sessions of cognitive behavioral therapy (CBT). The application of CBT led to a decrease in the number of anxiety attacks and angry outbursts that the patient suffers from. It also helped him learn some techniques to use in his interactions within the society, as well as other techniques, such as cognitive reorganization of dysfunctional thoughts, and gradually exposed him to the social situations. He also learned to practice some relaxation techniques, to teach him integration in social situations and confrontation instead of avoidance.

Lithium has proven its efficacy in treating bipolar disorder. Severe side effects caused by lithium, including renal and endocrine outcomes, have already been amply documented. The impact of lithium on sexual function, however, is less well known. A 33-year-old man, with no past medical history, diagnosed with bipolar disorder, developed premature ejaculation after short-term use of lithium. The dose of lithium was reduced, leading to a rapid clinical resolution. Retrospectively, lithium-induced premature ejaculation was deemed the most likely diagnosis. Premature ejaculation is a rare side effect of lithium. Changing the time of medication administration and lowering dose could be considered as alternatives. Given lithium's pharmacological profile, it is likely that the pathophysiologic mechanism behind premature ejaculation is altered levels or altered serotonin receptor sensitivity in the ejaculatory modulating centers of the central nervous system. Given the reluctance to spontaneously report sexual adverse effects, clinicians should be aware of this possible side effect.

Background: Catatonia is a neuropsychiatric syndrome, which typically occurs in the context of another psychiatric or medical condition, with a significant morbidity and mortality risk. Significant medical conditions resulting from catatonia include nutritional deficiencies, skin ulcerations, electrolyte disturbances, aspiration pneumonia, and venous thromboembolism. As a result, prompt treatment is required. Gold standard treatment consists of benzodiazepines, followed by electroconvulsive therapy (ECT) if pharmacotherapy alone is ineffective. With pregnancy and catatonia, there is a high risk of adverse maternal/fetal outcomes, and the risks/benefits of treatment must be carefully considered.

Case: Here, we present a case of a young pregnant woman with schizoaffective disorder whose catatonic state was not successfully resolved with lorazepam, therefore requiring ECT. Patient presented to the emergency department at 20 weeks of pregnancy, displaying symptoms of catatonia and psychosis. She was admitted to the inpatient behavioral health unit, where she was treated with lorazepam for catatonia. Treatment occurred in close collaboration with the obstetrics team. While initially, the patient appeared to have a positive response to lorazepam, she became increasingly catatonic with minimal oral intake, mutism, and urinary retention. As a result, she was transferred to the medical floor, where ECT was initiated due to the ineffectiveness of lorazepam. Her catatonia was successfully resolved with 12 total treatments of ECT; there were no adverse effects to the fetus. Patient delivered her baby at 39 weeks with no complications. She continued to receive inpatient psychiatric care until she was stable for discharge to an extended acute care unit.

Objectives: In this report, we will review relevant literature on catatonia in pregnancy, with focus on treatment with ECT.

Conclusions: Though the literature on these topics is limited and typically presented in case reports format, there appears to be a favorable view toward the use of ECT for pregnant catatonic patients. This case could be considered a vital contribution to the literature, as it provides a successful example of treating catatonia in pregnancy with no known adverse effects to the mother or child.

Using electroconvulsive treatment and lithium together to treat acute manic episodes is common, but the effects of combining these therapies vary according to the literature. Some studies have found severe adverse side effects, while others have found the combination of both medications safe and helpful. To investigate potential adverse side effects, this study reports on two cases where bipolar affective disorder patients developed delirium after receiving electroconvulsive therapy and lithium concurrently. The delirium was attributed only to the combined administration of these medicines after ruling out other potential causes. Additionally, alterations in blood-brain barrier permeability, such as those caused by electroconvulsive therapy and age, increased the likelihood of delirium. As a result, caution should be taken when using this combination of medicines, especially in those predisposed to delirium. This study established links between these medications and adverse effects, such as delirium. Further research is necessary to determine the efficacy and risks of combining these medications, establish causality, and develop prevention strategies.