Up to 23.5&#x0025; of patients with schizophrenia have onset of illness after the age of 40. We report a case of a 57-year-old lady who had been sitting continuously on the toilet for 2.5 years because of persecutory delusions and somatic passivity symptoms. She was diagnosed with late-onset schizophrenia and her symptoms improved with risperidone. In this case report, we describe the phenomenology of her psychotic symptoms and explore the socio-cultural factors behind the long duration of untreated psychosis (DUP). We conclude that more can be done to improve mental health awareness and reduce the social stigma associated with mental illness.

Ho Teck Tan

Manu Lal

Socio-Cultural Factors Delaying Treatment in a Patient with Late-Onset Schizophrenia

Introduction. Autoimmune encephalitis is caused by antineuronal immune mechanisms. Its clinical presentation is heterogeneous and in many cases onset with psychiatric symptoms. Paraclinical criteria guide the approach; however, the challenge occurs when there are no detectable autoantibodies in serum or cerebrospinal fluid (CSF). Methodology. We report one case that highlights the variability of clinical manifestations, which in the absence of antibodies was treated with immunotherapy with good response. Conclusion. In places where there is no antibody measurement, or when its measurement is negative, the clinical suspicion supported by CSF studies, magnetic resonance imaging, and electroencephalographic recording, should guide us to start immunotherapeutic treatment early. The early initiation of treatment ensures the reversibility of the neurological disorder in the vast majority of patients.

Miguel Soto Ontoso

Ruben A. Piernas Gonz&#x00E1;lez

Isabel Ram&#x00ED;rez Mart&#x00ED;nez

Jos&#x00E9; Miguel Meca Garc&#x00ED;a

Clinical Diagnosis of an Autoimmune Encephalitis Presented as a Manic Episode with Psychotic Symptoms: A Case Report

The combination of sleep deprivation, sleep phase advance, and bright light is termed triple chronotherapy (TCT). TCT is a promising treatment for depression, but it is not clear how effective it is for depression resistant to conventional treatments such as medications. Here, we report a case of triple chronotherapy effectively treating depression resistant to both medication and an extended course of bilateral electroconvulsive therapy. Triple chronotherapy may be a useful method to consider in cases of severe, treatment-resistant depression.

Jadon Webb

ECT-Resistant Bipolar Depression Treated with a Single Course of Triple Chronotherapy

Auditory verbal hallucination is one of the core symptoms of schizophrenia, same as delusions, and also occurs in many other psychiatric disorders. Significant numbers of people with congenital deafness experience auditory verbal hallucinations; however, there are only a few reports regarding the course of psychosis in people with congenital deafness. Herein, we report the case of a patient with congenital deafness and auditory verbal hallucinations whose diagnosis was changed from psychotic major depression to schizophrenia 7 years after the onset of the disease. His psychotic symptoms decreased when his primary medication was changed from an antidepressant to antipsychotic drugs, based on the change of diagnosis. In the treatment of congenitally deaf patients with auditory verbal hallucinations, the inability to communicate through spoken language may interfere with proper diagnosis and treatment. The ability to collect detailed information in ways other than through verbal language is imperative for psychiatrists to determine the appropriate diagnosis and treatment for these patients during the longitudinal course of illness.

Yoshihiro Matsumoto

Nobutaka Ayani

Yurinosuke Kitabayashi

Jin Narumoto

Longitudinal Course of Illness in Congenitally Deaf Patient with Auditory Verbal Hallucination

Background. Posttraumatic stress disorder (PTSD) is a debilitating mental disorder that develops in the aftermath of traumatic life experiences, especially those that occurred in childhood. PTSD is associated with intrusive memories, distressing dreams, dissociative reactions, avoidance of trauma-related stimuli, negative mood and sense of well-being, increased arousal and irritability, and clinically significant distress and impaired functioning. Case Presentation. The following case report presents a 42-year-old male displaying symptoms of PTSD, alexithymia, and depression. Conclusion. Untreated alexithymia may aggravate the trauma and cause the development of PTSD and depression.

Ewa A. Og&#x0142;odek

Alexithymia and Emotional Deficits Related to Posttraumatic Stress Disorder: An Investigation of Content and Process Disturbances

Introduction. While clonidine is used clinically for the treatment of nightmares in posttraumatic stress disorder (PTSD), few case reports demonstrating this indication exist, and there have been few studies investigating clonidine&#x2019;s mechanism of action for controlling nightmare symptoms. Case Report. In order to further characterize clonidine&#x2019;s role in treating nightmare symptoms in PTSD, we offer this case report describing one United States veteran who presented to an inpatient psychiatric unit after a suicide attempt. At that time, she described a remote history of PTSD symptoms, including nightmares, flashbacks, hyperarousal, and avoidance behaviors which had been well controlled on sertraline and clonidine. Upon her admission, her home sertraline and alprazolam were continued but her home clonidine was not continued. On day two of her hospital stay, she stated that her nightmares had returned. Her home clonidine was restarted on day two. On day three and thereafter, the patient no longer complained of nightmares. Conclusion. Our patient&#x2019;s nightmare symptoms had been controlled for years after beginning clonidine as an outpatient, but off clonidine, she had a return of her nightmare symptoms. Her nightmares again resolved once clonidine was resumed. Given this pattern in the patient&#x2019;s response to clonidine, this case may serve as additional evidence in the literature that clonidine has a role in treating nightmares in PTSD. Current proposed mechanisms of action for clonidine&#x2019;s ability to control nightmare symptoms in PTSD include that clonidine may alter the proportions of REM and non-REM sleep in a dose-dependent manner or that clonidine may play a role in memory consolidation. Further formal medication trials are the ideal future direction for establishing this role for clonidine.

Jill S. Bange

Kelly E. Melvin

Clonidine Use for the Treatment of Nightmares in Posttraumatic Stress Disorder

There are currently no licensed pharmacological treatments for Emotionally Unstable Personality Disorder. This case report describes a 50-year-old male who two years previously had been brought to the attention of psychiatric services following an overdose with intention to end his life. He was subsequently diagnosed with Emotionally Unstable Personality Disorder (EUPD) and, following further suicide attempts and trials of mainstream pharmacological treatments, responded to flupenthixol IM 20&#x2009;mg fortnightly, experiencing complete remission from his suicidal ideation. Clinicians should be aware of EUPD presenting in later life and should consider the role of typical antipsychotics, including flupenthixol, in the treatment of suicidal ideation in patients with EUPD. Age-specific guidance on EUPD management would be of use to clinicians, especially in the management of older patients, as current guidance is based on findings within a narrow age group.

Daniel J. Chivers

Mohammed Shaffiullah

Remission of Suicidal Ideation in Emotionally Unstable Personality Disorder with Flupenthixol

Alcohol use disorder (AUD) is a chronic relapsing and remitting psychiatric condition associated with adverse health outcomes. Although common, AUD is underdiagnosed, and treatment is often overlooked. At times of increased risk, such as the postoperative period, it is imperative to screen for and treat AUD to improve patient outcomes. Psychiatrists can play an important role in addressing AUD in this patient population through addiction psychiatry consultation services. We present the case of a patient with occult alcohol use disorder (AUD) leading to hospitalization in the setting of depressive mood symptoms and personality changes after a repeat pituitary macroadenoma resection and radiation five months earlier. AUD was noted months prior to hospitalization but was not addressed despite regular interactions with the healthcare system. Evaluation by addiction psychiatry specialists during hospitalization prompted recognition and treatment of AUD, resulting in cessation of alcohol use and resolution of mood symptoms and personality changes. The patient was discharged 3 days after admission and maintained abstinence from alcohol at two months postdischarge without recurrence of psychiatric symptoms.

Mckenzie P. Rowe

Al&#x00EB;na A. Balasanova

Occult Untreated Alcohol Use Disorder in a Patient with Recurrent Pituitary Macroadenoma

The COVID-19 pandemic has significantly impacted people around the world, with asymptomatic infection to severe diseases and death. There is an increasing incidence of mental health problems in patients diagnosed with COVID-19. There are some studies that discuss possible mechanisms responsible for psychotic disorders due to coronavirus as well as risk factors for developing psychosis in patients infected with the virus. We report the case and a review of the literature in a 29-year-old female with no past psychiatric history who was diagnosed with a brief psychotic disorder following infection with COVID-19.

Sulaimon Bakre

Kritika Chugh

Oluwaseun Oke

Anita Kablinger

COVID-19 Induced Brief Psychotic Disorder: A Case Report and Review of Literature

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Case Reports in Psychiatry publishes case reports and case series in all areas of psychiatry.

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Case Reports in Psychiatry - Table of contents 2022

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Case Reports in Psychiatry publishes case reports and case series in all areas of psychiatry.

Case Reports in Psychiatry