The clinical management of patients with treatment-resistant psychotic disorders is still challenging despite years of extensive research. If first-line antipsychotic treatment proves ineffective, clozapine is considered golden standard. Herein, we report on a patient with schizoaffective disorder that initially showed no response to treatment with clozapine and ECT and therefore reached a therapeutic dead end. After an unintentional exposure to supratherapeutic clozapine levels, related to a pneumonia, a significant and persistent reduction of psychotic symptoms occurred. The report suggests a careful reevaluation of the clozapine dose in cases of treatment-resistant psychotic disorders with failed trials of clozapine. Further increase of dose may prove efficacious, although side effects should be closely monitored. Research to determine the upper threshold of clozapine for antipsychotic efficacy is warranted.

Nina H. Grootendorst-van Mil

Anna R. M. Huiskens

Sieds Dieleman

Tom K. Birkenh&#xe4;ger

Response after Infection-Associated Rise in Clozapine Levels in Treatment-Resistant Schizoaffective Disorder

We present a case of rapid onset severe psychosis followed by suicide attempt in a United States Navy sailor. Investigation revealed a left temporal lobe brain mass suspicious for low-grade glioma. After hospitalization and medical management with olanzapine and lurasidone the patient&#x2019;s psychosis improved. The purpose of this paper is to add to the existing case reports that suggest a relationship between temporal lobe lesions and psychiatric illness, specifically psychosis. In addition, this case adds insight into the effectiveness of medical therapy for brain tumor patients that are not immediate candidates for neurosurgical intervention.

Richard Shehane

Steve Miller

Luke Suber

Miranda Chakos

Treatment of Acute Psychosis with Second-Generation Antipsychotics in a Patient with Left Temporal Lobe Lesion

Background. Proton pump inhibitors (PPIs) are frequently prescribed antiulcer agents in hospitals and are shown to be safer than H-2 blockers. We present a case report of PPI-induced delirium, regarding which not much has been written in the literature. Case Report. We present a case of a 93-year-old woman with no known past psychiatric history, who was hospitalized for syncope workup and who developed delirium after a double dose of pantoprazole. Discussion. Very few reports of PPI-induced delirium exist in the literature. In this case report, we attempt to highlight the mechanism of PPI induced delirium which in our case was most likely due to the primary effects of PPI and drug-drug interactions. Given the paucity of literature on this topic, we encourage further research into relationship between PPI and delirium and urge caution while using PPIs in geriatric population.

Anupriya Razdan

Ramaswamy Viswanathan

Alan Tusher

Pantoprazole-Induced Delirium: Review of a Case and Associated Literature

Gabapentin has become increasingly used in psychiatric practice specifically for anxiety disorders. Even though gabapentin is not approved by the US Food and Drug Administration to treat anxiety, physicians sometimes use it as an alternative to benzodiazepines in patients with a history of substance abuse. Gabapentin is also prescribed when individuals are at risk of thrombocytopenia which is not considered a side effect. Among patients at risk of thrombocytopenia are those positive for human immunodeficiency virus (HIV). Here we present a case of an HIV-positive man who presented for inpatient psychiatric care with severe anxiety and a history of alcohol and benzodiazepine abuse. In this patient, gabapentin worsened thrombocytopenia after repeated exposure to this medication. We suggest caution when considering gabapentin for patients with preexisting low platelet counts, as there seems to be a risk for worsening thrombocytopenia with this antiepileptic in the presence of HIV infection.

Mohammed Basith

Andrew Francis

Alfredo Bellon

Reversible Thrombocytopenia after Gabapentin in an HIV-Positive Patient

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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 2018

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

Case Reports in Psychiatry