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Cureus Dec 2023Acute colonic pseudo-obstruction or Ogilvie's syndrome is a disorder causing massive colonic dilation with no evidence of mechanical obstruction. The actual incidence of...
Acute colonic pseudo-obstruction or Ogilvie's syndrome is a disorder causing massive colonic dilation with no evidence of mechanical obstruction. The actual incidence of acute colonic pseudo-obstruction is unclear; However, electrolyte imbalance, psychiatric disorders, the use of medications such as anticholinergics or antipsychotics, and recent abdominal surgery are the most common predisposing factors associated with this syndrome. Ogilvie's syndrome is most likely caused due to impairment of the gut's motor system and an imbalance of the autonomic nervous system including a reduction in the activity of stimulatory neurotransmitters. The predisposition to psychotic disorders could be, in some instances, due to neurodevelopmental abnormalities of the brain and the gut's autonomic nervous system. The symptoms of Ogilvie's syndrome are similar to mechanical obstruction of the colon but no physical cause of obstruction is usually present. Ogilvie's syndrome can be managed conservatively; however, if left untreated, Ogilvie's syndrome can lead to bowel perforation, which is associated with a high mortality risk. Antipsychotics have been considered the cornerstone treatment for psychiatric disorders including schizophrenia. Even though they are highly effective in treating psychiatric illnesses, their usage carries multiple risks. Overall, constipation is a common side effect of antipsychotic medications with some classes posing more risk than others. Constipation can be severe and may lead to serious complications such as paralytic ileus, bowel ischemia, and death. We present here a case of delusional disorder managed with risperidone and complicated by intestinal pseudo-obstruction. This case reiterates the need to consider all complications of antipsychotic medications, even rare ones, and include them in the discussion with patients and their caregivers before commencement.
PubMed: 38292959
DOI: 10.7759/cureus.51389 -
European Child & Adolescent Psychiatry Mar 2024The present study aimed to examine the association between the presence, number, and type of positive psychotic symptoms (PPS) and clinical severity in adolescent...
The present study aimed to examine the association between the presence, number, and type of positive psychotic symptoms (PPS) and clinical severity in adolescent patients. Five hundred-six patients aged 11-17 years were assigned to either the noPPS (n = 341), the delusional beliefs only (del; n = 32), the hallucinations only (hall; n = 80), or the delusional beliefs and hallucinations (del&hall; n = 53) group. Generalized Structural Equation Modeling was applied to identify the best-fitting model representing clinical severity indicated by psychiatric diagnoses, depressivity, personality pathology, non-suicidal self-injury, suicide attempts, perceived stress, and psychosocial impairments, assessed by interviews and questionnaires. The groups were compared concerning the final model's factors. The final model consisted of three factors representing psychopathology and functional impairments, self-harming behavior, and perceived stress (BIC difference to reference model: 103.99). Participants with any PPS scored higher on all factors than the noPPS group (differences in SD: 0.49-1.48). Additionally, the del&hall group scored 1.31 SD higher on psychopathology and functional impairments than the hall group, and 1.16 SD higher on self-harming behavior compared to the del group. Finally, the hall group scored 0.84 SD higher on self-harming behavior than the del group, with no group differences in the other factors. In adolescent patients, the presence of PPS may represent a marker for a more severe form of mental disorder, with hallucinations being indicative of self-harming behavior. Early transdiagnostic assessment of PPS seems indicated as it may inform treatment in the context of clinical staging.
PubMed: 38553647
DOI: 10.1007/s00787-024-02417-7 -
Cureus Apr 2024Semaglutide (Ozempic), a GLP-1 receptor agonist effective in weight management, and ziprasidone (Geodon), an antipsychotic with a lower risk of metabolic side effects,...
Semaglutide (Ozempic), a GLP-1 receptor agonist effective in weight management, and ziprasidone (Geodon), an antipsychotic with a lower risk of metabolic side effects, are well-established in treating type 2 diabetes and schizophrenia, respectively. However, their interactions and effects on psychiatric symptoms are less understood. In this study, we report a case of a 43-year-old male with schizophrenia and diabetes with exacerbated paranoid delusions upon semaglutide administration for weight loss; symptoms peaked at higher doses and subsided after dose reduction. Concurrently, serum ziprasidone levels were significantly elevated at the dose reduction, suggesting a pharmacokinetic interaction likely due to semaglutide-induced slowed gastric emptying affecting ziprasidone's absorption and metabolism. This study illustrates the need for careful monitoring of psychiatric symptoms and drug levels when these medications are used together. Additionally, further research into their interactions to optimize treatment for patients with coexisting metabolic and psychiatric conditions is warranted.
PubMed: 38817502
DOI: 10.7759/cureus.59319 -
Cureus Mar 2024Weight loss is not uncommon in the field of psychiatry; however, when severe cases arise, it necessitates attention and thorough evaluation for accurate diagnosis and...
Weight loss is not uncommon in the field of psychiatry; however, when severe cases arise, it necessitates attention and thorough evaluation for accurate diagnosis and appropriate treatment. This report highlights the case of a 32-year-old man referred to psychiatry due to significant weight loss. The patient mentioned consuming small food portions, attributing it to an undetected stomach illness despite repeated investigations by previous treating doctors. His current weight stood at 31 kg, with a body mass index (BMI) of 10.2 kg/m². Physical examinations and laboratory investigations were otherwise within normal parameters. A somatic delusion was confirmed, and the patient has been diagnosed with a delusional disorder after excluding other possibilities. This report highlights the importance of considering delusional disorder (somatic type) as a potential diagnosis for substantial weight loss, and it records an unexpected degree of physical well-being despite a notably low BMI.
PubMed: 38618312
DOI: 10.7759/cureus.56217 -
Cureus Apr 2024Drug-induced lung injury (DILI) occurs when exposure to a drug leads to inflammation and, eventually, fibrosis of the lung interstitium. While DILI is a rare side effect...
Drug-induced lung injury (DILI) occurs when exposure to a drug leads to inflammation and, eventually, fibrosis of the lung interstitium. While DILI is a rare side effect of antipsychotic medication, once it manifests, it requires detailed investigation and prompt treatment. Diagnosing DILI can be challenging at times due to its similarity to conditions such as infectious diseases or interstitial pneumonia induced by other causes. We hereby report a fatal case of suspected DILI associated with olanzapine. A 61-year-old female with a history of delusional disorder was admitted to our hospital due to worsened psychiatric symptoms. Ten milligrams of olanzapine had been initiated a week prior to admission by a psychiatrist at the local clinic to control these symptoms. After admission, although the patient claimed no respiratory symptoms, she developed a slight fever and deterioration of chest radiologic findings. Bronchoalveolar lavage revealed a progressively bloody return of fluid, suggesting pulmonary alveolar hemorrhage. Since no respiratory disorders have been noted, and considering the exclusion of other potential diagnoses, DILI was strongly suspected. Although olanzapine was promptly discontinued, the patient's condition rapidly deteriorated. Despite high-dose steroid therapy, the patient's response to treatment was inadequate, and she finally succumbed to the illness. This case highlights that olanzapine may induce lung injury similar to other psychiatric drugs. Furthermore, early diagnosis and treatment are essential for patients with psychiatric disorders who may sometimes present with fewer symptoms.
PubMed: 38707165
DOI: 10.7759/cureus.57571 -
Postepy Psychiatrii Neurologii Sep 2023Lurasidon is a relatively new, second-generation antipsychotic drug with an interesting receptor profile. It is considered to be safe and has a low risk of side effects....
PURPOSE
Lurasidon is a relatively new, second-generation antipsychotic drug with an interesting receptor profile. It is considered to be safe and has a low risk of side effects. It is a substance with a multi-receptor mechanism of action: it mainly blocks dopaminergic D2 and serotonergic 5-HT2A receptors. According to the Summary of Product Characteristics, the adverse reaction of neutropenia was too rare to enable the estimation of its frequency.
CASE DESCRIPTION
A case of 39-year-old patient is presented in the article, diagnosed with paranoid schizophrenia, who developed neutropenia as a result of treatment with lurasidone. After the discontinuation of lurasidone and recommended supplementation, the blood test results gradually improved and finally reached the normal range.
COMMENT
This case report shows the need for regular monitoring of blood cell parameters in patients treated with second-generation antipsychotics, as there is a risk of neutrocytopenia or even agranulocitosis.
PubMed: 38034503
DOI: 10.5114/ppn.2023.132474 -
BMC Psychiatry Mar 2024Although the impact of internet usage on mental health is extensively documented, there is a notable scarcity of reports in the literature concerning internet-induced...
BACKGROUND
Although the impact of internet usage on mental health is extensively documented, there is a notable scarcity of reports in the literature concerning internet-induced erotomania. Erotomania is a rare and likely underdiagnosed delusional disorder. It is characterized by an irrational belief held by the affected persons that someone of higher socioeconomic status harbor romantic feelings toward them. Here, we describe the psychopathology of erotomanic delusion induced by online romantic fraud in a female patient. Employing this case as a focal point, we illuminate novel aspects of erotomania that warrant attention and examination.
CASE PRESENTATION
We present a compelling case involving a 70-year-old married Caucasian woman diagnosed with medically controlled persistent depressive disorder for several years. The intricacies of her condition became evident as she became deeply engrossed in online profiles featuring the image of a renowned musician, inadvertently falling victim to an online romantic fraud. Subsequently, this distressing experience triggered the emergence of erotomanic delusions and a suicide attempt. The patient's history reveals an array of medical conditions and stressful life events, contributing to her vulnerability. The diagnosis of erotomanic delusional disorder, dysthymia, and mild cognitive impairment with cerebral vascular background was established. Treatment involved her previous antidepressant with low-dose risperidone, alongside supportive individual and group therapy. Her delusion showed remission four weeks later, prompting her discharge for outpatient follow-up. Although she retained some false beliefs, the intensity of the symptoms had notably diminished and her functionality improved.
CONCLUSION
This case underscores the complex interplay between mental health, online activities, and the consequences of delusions, including suicidal thoughts, shedding light on the need for a comprehensive approach in addressing such challenging psychiatric scenarios.
Topics: Humans; Female; Aged; Delusions; Depressive Disorder; Emotions; Cognitive Dysfunction; Suicide, Attempted
PubMed: 38509502
DOI: 10.1186/s12888-024-05667-6 -
The Journal of International Medical... Mar 2024Shared psychotic disorder characterized by Capgras syndrome is an extremely rare condition. To our knowledge, there are only a few published papers on this condition....
Shared psychotic disorder characterized by Capgras syndrome is an extremely rare condition. To our knowledge, there are only a few published papers on this condition. This paper presents a case of shared Capgras syndrome in two sisters. The inducer was a younger sister with schizophrenia, who passed on her Capgras delusion to her older sister after the death of their father. After committing a violent offense caused by Capgras delusion, a court ordered the sisters' involuntary admission to a psychiatric hospital. After being separated and receiving antipsychotic treatment, the sisters showed substantial improvement. However, shortly after hospital discharge, they stopped taking their medication and disappeared. After 15 years, their mother died and shortly afterwards, the sisters were re-admitted for forensic psychiatric evaluation after another violent crime caused by Capgras delusion. Timely recognition, adequate treatment and maintaining a therapeutic alliance could contribute to a better clinical course and outcome of this disorder, and reduce the risk of violent behavior.
Topics: Humans; Female; Capgras Syndrome; Shared Paranoid Disorder; Antipsychotic Agents; Mothers; Violence
PubMed: 38477256
DOI: 10.1177/03000605241233526 -
Cureus Feb 2024Capgras syndrome is a psychotic illness characterized by an unshaken false belief in having a close family member replaced by an imposter when there is no evidence of...
Capgras syndrome is a psychotic illness characterized by an unshaken false belief in having a close family member replaced by an imposter when there is no evidence of such. The patient described in this case report is a 68-year-old Caucasian female who presented with Capgras syndrome in the context of chronic progressive multiple sclerosis (MS) following an acute COVID-19 illness. She was treated with quetiapine with full resolution of symptoms.
PubMed: 38465171
DOI: 10.7759/cureus.53924 -
Clinical Case Reports May 2024Clonazepam has some evidence in the treatment of tardive dyskinesia. It can be used as an alternative treatment option in situations where vesicular monoamine...
Clonazepam has some evidence in the treatment of tardive dyskinesia. It can be used as an alternative treatment option in situations where vesicular monoamine transporter 2 inhibitors are not available or when it is not feasible to use them.
PubMed: 38745734
DOI: 10.1002/ccr3.8951