Case Reports in Psychiatry

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.

Research highlights the increasing overlap of autism spectrum disorder and substance use disorders in young people. However, no behavioral treatments exist addressing this comorbidity despite great need. A team of clinicians developed an integrated behavioral protocol addressing substance use in youth with autism spectrum disorder. The multidisciplinary team developed 12 youth, 7 parent, and 3 joint modules based on established evidence-based therapies shown to have effectiveness separately addressing autism spectrum and substance use. Two cases are discussed to illuminate this integrated intervention. Adaptations to the protocol were made during feedback from patients and their parents. Further research is needed to determine the effectiveness of this preliminary protocol.

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.

Introduction. Phantom limb pain is a pain sensation experienced in the area of the missing body part. The pain generally appears in the first few days after surgery. PLP could occur in teeth, tongue, breast, eyes, rectum, bladder, testicles, and penis. Phantom pain in the penis is not only felt as pain but sometimes as an erection or urination, even after the removal of the penis. Clinical Case. A 35-year-old man was referred to the psychiatrist due to phantom erection after undergoing reimplantation of the penis by the urologist. A few days before the referral, he was admitted to the emergency department after a penile amputation that his wife performed. During the recovery phase after the penile reimplantation procedure, the patient worried about his penis’ outcome and became depressed. The patient was in severe anxiety and moderate-to-severe depression status. Treatment. The patient was given nonpsychopharmacology such as supportive psychotherapy, family psychoeducation, relaxation and marital therapy, and psychopharmacology, such as amitriptyline 12.5 Mg PO two times a day and clobazam 10 Mg PO each day for 3 months. One and a half months later, his anxiety and depression were better. Conclusion. A psychiatric approach was needed in an amputated limb patient with psychopathologic symptoms. Nonpsychopharmacotherapy and psychopharmacotherapy were needed if the patient had symptoms. Further studies with a large number will be necessary to validate the psychiatric approach in amputated limb patients with psychopathologic symptoms cases.

Physical examination is a core component of any assessment done by a physician. Despite that, a physical examination is not always a top priority in many patients with psychiatric illnesses. We present the case of a woman with a prior diagnosis of a delusional disorder with overinvested religious beliefs. The patient had been stable on treatment for many years and only recently presented with a physical complaint, and manifestation assumed to be due to the nature of her psychiatric illness and, hence, overlooked by many physicians before being examined by her last psychiatrist. This resulted in a significant mobility problem for the patient. The patient showed partial insight, linking her pain to a “message from God.” Despite the delusional context, the psychiatrist was allowed to examine her feet and discovered significant neglect and poor foot hygiene. This case emphasizes the importance of conducting thorough physical examinations in psychiatric settings. Moreover, it presents an example of situations preventing psychiatric patients from being examined despite displaying obvious physical signs.

The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2 virus), has significantly impacted global health. It can present a range of complications, from asymptomatic to severe respiratory distress syndrome. It has also been linked to complications in multiple organ systems, including neurological symptoms such as headaches and encephalopathy. Delirium, characterized by acute confusion, is common in older adults and associated with prolonged hospital stays and elevated mortality rates. We present a case study of a young mother with a prior medical history of mild to moderate depression who experienced an episode of delirium consequent to a COVID-19 infection. The initial manifestation of her illness was mild diarrhea, but as her condition worsened, she began exhibiting symptoms of delirium. These symptoms include confusion, agitation, sleep disturbance, and disordered behavior. The delirious episode was brief and effectively managed with small doses of psychotropic medications to control aggressive behavior. Upon resolution, no additional treatment was deemed necessary. This case underscores the wide-ranging effects of COVID-19 on physical and psychological well-being and highlights the importance of considering symptoms beyond those associated with respiratory distress.