Case Reports in Psychiatry最新文献

Background: Catatonia is regarded as a diverse type of motor dysregulation syndrome that includes mutism, immobility, catalepsy, negativism, stereotypies, and echo phenomena. Catatonia is known to coexist with a wide range of physical and mental health conditions, including mood disorders, schizophrenia, autoimmune disorders, and metabolic abnormalities. Albeit, the association between obsessive-compulsive disorder (OCD) and catatonia is underreported, and mechanisms are not well elucidated. Study. In this study, we present a case of a 36-year-old woman who developed episodes of catatonia during the course of her obsessive-compulsive disorder (OCD). Success rates have been recorded with both benzodiazepines and electroconvulsive therapy (ECT). Gauging the severity of her symptoms and poor drug compliance, the patient was opted for and successfully treated with ECT. She was also educated about OCD through a series of therapy sessions and exposure and response prevention (ERP) principles. She was maintained on ERP and adjunctive clonazepam upon discharge. On subsequent follow-ups, the patient seemed to be doing well and was eager to begin her job again.

Conclusion: Our study shows a possible link between OCD and catatonia. Additionally, robust studies are needed in order to determine the pathophysiology of catatonia and the mechanism of ECT so that more beneficial therapeutics can be developed. A combination of ECT and antidepressants with ERP therapy for recurrent catatonia with OCD could be effective as a therapeutic modality.

Introduction: Major depressive disorder (MDD) and obstructive sleep apnoea (OSA) are prevalent in the general population. Moreover, early studies found that the two conditions are associated bidirectionally and lead to poor health outcomes. The prevalence of comorbid MDD in OSA patients could be as high as two-thirds. A sedentary lifestyle and psychological stress in the globalisation age may increase the risk of MDD and OSA.

Method: We reported a case of an MDD patient with OSA as well as discussed the assessment method and also reviewed the treatment of both conditions. We aimed to raise awareness for psychiatrists to differentiate other medical conditions when the symptomatology of MDD is atypical and unresponsive to standard psychiatric treatment.

Conclusion: Early detection and effective treatment for MDD and OSA are essential to achieve patient outcomes. Furthermore, it can reduce complications from both conditions. Therefore, a comprehensive evaluation should be made to determine the diagnoses when physicians suspect overlapping MDD and OSA.

Triple-negative breast cancer is a unique subtype among breast cancers. Management includes a neoadjuvant chemotherapy regimen. Psychiatric complications of the regimen have not been reported before. We present a case of acute psychosis after the second cycle of chemotherapy in a 42-year-old woman with triple-negative breast cancer. The patient presented with sudden irritability, agitation, disorganization in speech and behavior, and paranoia involving her coworkers conspiring against her and causing her trouble with the law for 4 days. She was in her usual state of health until after her second cycle of chemotherapy. This was the first presentation of psychotic symptoms in her life. She was conscious and oriented. There were no neurologic deficits. She denied any change in her mood and any features of hallucinations. She was uncooperative, restless, had flight of ideas, and persecutory delusions. The remainder of the examination was normal. An autoimmune process, nervous system infection, or psychosis secondary to the chemotherapy were suspected. Serum electrolytes and other biochemical parameters were normal. Imaging of the brain showed no signs of acute brain insults or intracranial metastasis. Cerebrospinal fluid analysis and culture showed no abnormality or growth. The work-up revealed that neurologic, infectious, or autoimmune causes of her psychotic symptoms were less likely. Thus, a diagnosis of psychosis secondary to chemotherapy was considered. Treatment was with paliperidone, risperidone, clonazepam, and sertraline. Over the course of treatment, she showed substantial improvement and completed all of the chemotherapy sessions without adverse effects. In summary, we report a case of a patient whose initial chemotherapy course was complicated by psychosis. Since the neurotoxic and psychiatric effects of chemotherapeutics are not yet sufficiently elucidated, our case emphasizes that early signs of behavioral changes in patients receiving chemotherapy should trigger comprehensive psychiatric evaluation and monitoring of the patient's mental state.

Meditation is gaining a lot of popularity nowadays because of the associated benefits on both mental and physical health. There is ample literature available on the benefits of meditation. However, there are cases of psychosis reported sporadically in individuals who indulge in excessive unguided meditation. Herein, we report a patient who presented with schizophrenia after doing excessive meditation.

This case study draws attention to the hazards of physicians with a history of alcohol addiction and a particular psychopathology framework in the context of occupational health surveillance, particularly during the challenging working conditions brought about by the COVID-19 pandemic. The case involves a hospital resident in her thirties, with a previous history of addiction and attempts at suicide, who was assigned to a COVID-19 unit of an Italian hospital. In this case study, we discuss the preventive intervention put in place in order to protect physicians' health and work. What emerges is the key role that rapid substantive communications between specialists play in formulating an effective strategy for dealing with these conditions. We believe this case is noteworthy for the lessons that can be learned for tailoring prevention and treatment pathways for health care workers with addiction.

We report the case of a 32-year-old male with autism spectrum disorder (ASD) suffering from severe misophonia. After titrating risperidone to 2 mg twice a day, the patient reported a significant reduction in his symptoms and his Amsterdam misophonia scale-revised (AMISOS-R) score dropped by from 31 to 5. Upon discharge, the patient was noted to have decreased irritability and overall improved behavior and effect. This significant symptomatic improvement was likely not explained by inpatient admission alone or other simultaneous pharmacologic treatments, as the effect was seen during an isolated titration of risperidone with other treatments remaining constant. Although, unfortunately, follow-up findings indicated that the treatment was not curative for the patient, risperidone's potential for treating misophonia may warrant systematic investigation.

Serotonin syndrome is characterized by symptoms of neuromuscular and autonomic excitation and altered mental status. It is most often drug induced with antidepressants being the main precipitants. However, other classes have been implicated as well including antipsychotics, antiemetic and pain medications, and lithium. The syndrome is typically induced by the combination of two or more serotonergic agents; however, there have been instances of serotonin syndrome occurring while a patient is on a single medication. The literature is limited regarding the study of risk factors associated with the production of serotonin syndrome while on only monotherapy or otherwise atypically causative agents. One such risk factor may be underlying neuromuscular pathology. This study is the first case series to our knowledge reporting two separate cases of serotonin syndrome being induced in patients with cerebral palsy as an underlying common factor.

Bereavement-related major depressive disorder (MDD) is a common disorder with both mental and physical effects. Specific psychotherapies for bereavement-related MDD remain unavailable in Japan despite its relatively high prevalence. Interpersonal psychotherapy (IPT) is a treatment with established efficacy for MDD, including bereavement-related MDD. There are, however, few studies of IPT for MDD and none at all for bereavement-related MDD in Japan. The efficacy of IPT for bereavement-related MDD needs confirmation in Japanese culture because the expression of emotions during the grieving and mourning process varies across cultures, and the Japanese-specific cultural custom exists of maintaining a relationship with the deceased in the afterlife mainly via a Buddhist memorial tablet, altar, and grave. We present a case study describing the therapist's adaptation of IPT to Japanese culture to treat bereavement-related MDD in a Japanese man with insufficient response to pharmacotherapy who had suddenly lost his mother to heart disease. His mother's death and a dispute with his father both appeared to have contributed to his sustained bereavement-related MDD. The 16-session treatment course for depressive symptoms was monitored using the Beck Depression Inventory-II. Treatment was scheduled weekly, but some sessions unavoidably took place fortnightly because they were conducted in person during the COVID-19 pandemic. The patient's MDD severity continually decreased, functional disability gradually recovered from the beginning until the 3-month follow-up, and the interpersonal relationships with his deceased mother, his wife, colleague, and father changed after IPT. Case studies are inherently limited, but IPT, in consideration of Japanese cultural characteristics for bereavement-related MDD, can be potentially effective in Japan.

We report the case of an 8-year-old child with a complex neurodevelopmental disorder, including severe developmental coordination disorder with dysgraphia, anxiety and depression, mild social functioning impairments, headache and chronic musculoskeletal pain, secondary to Ehlers-Danlos syndrome (EDS) hypermobility type. We explored whether wearing whole-body compressive garments (CGs) could improve his motor skills assessed through standardized and experimental procedures. In addition to the effectiveness of CGs on pain, we found partial improvements in his motor skills, specifically postural control, hand movements, and body schema representation, after wearing CGs for 15 days. During an experimental motor imitation task with a virtual tightrope walker, we found improvements in interpersonal synchronization with performances closer to those of typical developing (TD) controls. We conclude that CGs appear to be an innovative and interesting adjuvant treatment for motor skill impairments in children with multidimensional impairments involving EDS. These promising results require confirmation by further evidence-based research.

The rarity and close resemblance to other mental health conditions of dissociative fugue make it difficult to diagnose. Akin to a culture-bound syndrome, most African countries have their local explanation for this unique presentation and therefore people may not seek evidence-based health care but rather may resort to faith-based-treatment which may not give the best results. This is the case of a 39-year-old man who has experienced about five episodes of dissociative fugue over nine years. This case points out the comorbidities associated with the condition. We report this case to increase awareness of the condition and to bring to the fore the need for further studies into psychopathology and the treatment modalities.