Case Reports in Psychiatry The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Deletion Involving the 7q31-32 Band at the CADPS2 Gene Locus in a Patient with Autism Spectrum Disorder and Recurrent Psychotic Syndrome Triggered by Stress Thu, 19 Oct 2017 00:00:00 +0000 Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by impairments in social functioning, language, communication, and behavior. Recent genome-wide association studies show some microdeletions on the 7q31-32 region, including the CADPS2 locus in autistic patients. This paper reports the case of a patient with ASD and recurrent psychotic syndrome, in which a deletion on the 7q31-32 band at the CADPS2 gene locus was evidenced, as well as a brief review of the literature on the CADPS2 gene and its association with ASD. Paulo André Pera Grabowski, Alexandre Ferreira Bello, Diogo Lima Rodrigues, Murilo José Forbeci, Vinicius Motter, and Salmo Raskin Copyright © 2017 Paulo André Pera Grabowski et al. All rights reserved. Electroconvulsive Therapy in Functional Hallucination: Scope and Challenges Tue, 17 Oct 2017 00:00:00 +0000 Functional hallucinations are hallucinations triggered by a stimulus in the same modality and cooccur with it. They are rare in occurrence; however, their rarity has no significance as psychopathology till date. Also, very little is known about the treatment of such hallucinations. Electroconvulsive therapy (ECT) has been tested for several psychiatric illnesses and has a few relative contraindications; however, it has not previously been used in treating functional hallucinations. We report on a female patient with paranoid schizophrenia who experienced functional hallucinations continuously despite the use of adequate risperidone, which controlled other symptoms. She was treated with ECT which resolved the functional hallucinations. The case highlights the need to ponder on the significance of the phenomenon as well as treatment of this psychopathology by ECT. It also underscores ECT as a treatment option for this kind of hallucination. Sulochana Joshi and Rabi Shakya Copyright © 2017 Sulochana Joshi and Rabi Shakya. All rights reserved. A Case of Probable Amisulpride Induced Mania after Eight Months of Therapy Mon, 09 Oct 2017 00:00:00 +0000 Development of manic symptoms during treatment with atypical antipsychotics can be a troublesome side effect that has been described with most atypical antipsychotics. However, reports of amisulpride induced mania have been rare. Here, we report the case of an 18-year-old male patient diagnosed with schizophrenia, who developed manic symptoms while on treatment with amisulpride. While previous reports have described occurrence of mania within days to three months of treatment with amisulpride, we report a case where manic symptoms occurred after around eight months of therapy. We have also attempted to describe the possible risk factors based on the available case studies. Prakash Thapa and Rajasee Sharma Copyright © 2017 Prakash Thapa and Rajasee Sharma. All rights reserved. Obsessive-Compulsive Disorder with Suicide Obsessions in a First Responder without Previous Diagnosis of OCD or History of Suicide Attempts Mon, 02 Oct 2017 00:00:00 +0000 Obsessive-compulsive disorder (OCD) is a distressing and often debilitating disorder characterized by obsessions, compulsions, or both that are time-consuming and cause impairment in social, occupational, or other areas of functioning. There are many published studies reporting higher risk of suicidality in OCD patients, as well as studies describing increased risk of suicidality in OCD patients with other comorbid psychiatric conditions such as major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Existing case reports on OCD with suicide as the obsessive component describe patients with long standing diagnosis of OCD with suicidal ideations or previous suicide attempts. This report describes the case of a 28-year-old male, who works as a first responder, who presented with new onset symptoms characteristic of MDD and PTSD, with no past history of OCD or suicidality who developed OCD with suicidal obsessions. Differentiating between suicidal ideation in the context of other psychiatric illnesses and suicidal obsessions in OCD is critical to ensuring accurate diagnosis and timely provision of most appropriate treatment. The combination of exposure and response prevention therapy and pharmacotherapy with sertraline and olanzapine was effective in helping the patient manage the anxiety and distress stemming from the patient’s OCD with suicidal obsession. Vivekananda Rachamallu, Michael M. Song, Haiying Liu, Charles L. Giles, and Terry McMahon Copyright © 2017 Vivekananda Rachamallu et al. All rights reserved. Adapting Lymphedema Treatment in Patients with a Mental Disability Mon, 11 Sep 2017 08:18:38 +0000 Background and Purpose. Mental disability is often characterized by significant limitations in adaptive skills. When this condition is associated with lymphedema, treatment requires greater commitment of the care team. The objective of this study is to report the treatment of lymphedema using only one therapeutic technique, a low-stretch grosgrain stocking. Case Report. We report the case of a 14-year-old mentally challenged female patient with lymphedema of the left leg, motor difficulties, and impaired speech and sight. According to the caregiver, lymphedema was present at birth; however, the patient had not been submitted to specific treatment. Thus, only one technique, an adapted low-stretch grosgrain compression stocking, was proposed as it could be used during daily life activities. The adaptation involved the grosgrain stocking, fastened using eyelets and cord up to the thigh, being sewn onto a pair of cotton shorts. The result was a clinical improvement with reductions in the perimeter and volume due to the compliance of the patient and the family to treatment. Conclusion. The use of a single treatment strategy in the form of a low-stretch stocking in such cases together with the involvement of a multidisciplinary team can lead to good treatment outcomes for chronic lymphedema. Maria de Fátima Guerreiro Godoy, Lívia Maria Pereira de Godoy, Rodrigo Ocampos Troitino, and José Maria Pereira de Godoy Copyright © 2017 Maria de Fátima Guerreiro Godoy et al. All rights reserved. Trichloroacetic Acid Ingestion: Self-Harm Attempt Sun, 10 Sep 2017 08:46:32 +0000 Objective. Trichloroacetic acid (TCAA), or trichloroethanoic acid, is a chemical analogue of acetic acid where three methyl group hydrogen atoms are replaced by chlorine. TCAAs are also abbreviated and referred to as TCAs, causing confusion with the psychiatric antidepressant drug class, especially among patients. TCAAs exist in dermatological treatments such as chemical peels or wart chemoablation medication. TCAA ingestion or overdose can cause gastric irritation symptoms including vomiting, diarrhea, or lassitude. This symptomatology is less severe than TCA overdose, where symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. Owing to the vast difference in symptoms, the need for clinical intervention differs greatly. While overdose of either in a self-harm attempt can warrant psychiatric hospital admission, the risk of death in TCAA ingestion is far less. Case Report. A patient ingested TCAA in the form of a commercially available dermatological chemical peel as a self-harm attempt, thinking that it was a more injurious TCA. Conclusion. Awareness among physicians, particularly psychiatrists, regarding this relatively obscure chemical compound (TCAA) and its use by suicidal patients mistakenly believing it to be a substance that can be significantly more lethal (TCA), is imperative. E. R. Black Copyright © 2017 E. R. Black. All rights reserved. Jitteriness/Anxiety Syndrome Developing Immediately following Initiation of Oral Administration of Sertraline Tue, 22 Aug 2017 00:00:00 +0000 Here, we report our experience with patients in whom jitteriness/anxiety syndrome developed immediately following the start of oral sertraline administration. Administration was discontinued in these patients on day 2, and the jitteriness/anxiety syndrome improved the following day. Jitteriness/anxiety syndrome may develop immediately following oral administration of even low doses of sertraline, and improvement can be expected if sertraline is promptly discontinued. Toshinori Nakamura, Nobuhiro Sugiyama, Daimei Sasayama, Tetsuya Hagiwara, and Shinsuke Washizuka Copyright © 2017 Toshinori Nakamura et al. All rights reserved. Coprophagia and Entomophagia in a Patient with Alcohol Related Dementia Mon, 21 Aug 2017 07:42:43 +0000 Coprophagia and entomophagia are two phenomena not commonly reported in the medical literature and their occurrence is usually associated with mental disorders. We present the case of a 59-year-old man with a history of alcohol abuse who was evaluated due to cognitive deterioration and disturbed eating habits including feces and living insects. Organic causes were ruled out and an important cognitive impairment became evident on neuropsychological formal test. The behavior remitted after antipsychotic pharmacologic therapy and alcohol detoxification, leaving the diagnostic impression of alcohol related dementia. This report shows a rare association of these two conditions in a patient with dementia. João B. Fonseca and Pedro Morgado Copyright © 2017 João B. Fonseca and Pedro Morgado. All rights reserved. Clozapine-Induced Microseizures, Orofacial Dyskinesia, and Speech Dysfluency in an Adolescent with Treatment Resistant Early Onset Schizophrenia on Concurrent Lithium Therapy Tue, 01 Aug 2017 00:00:00 +0000 Clozapine is an atypical antipsychotic used in the treatment of refractory schizophrenia. It has a well-known side effect profile, including agranulocytosis, decreased seizure threshold, and tardive dyskinesia. In addition, numerous case reports have described clozapine-induced stuttering in adults. However, there has been only one previous case report describing it in the adolescent population. In addition, concurrent lithium therapy has been shown to enhance the neurotoxic effects of antipsychotics and lower the seizure threshold. Here, we report on the development of clozapine-induced microseizures, orofacial dyskinesia, and stuttering in a 17-year-old adolescent male with treatment of refractory early onset schizophrenia on clozapine and concurrent lithium therapy. The patient’s symptoms of schizophrenia responded well to the clozapine regimen. However, with the escalating dose of clozapine, the patient developed speech dysfluency in the form of stuttering and perioral twitching. An electroencephalogram confirmed seizure activity. Due to similarities with tardive dyskinesia, symptoms of microseizures induced by atypical antipsychotics may not be accurately diagnosed. A multidisciplinary treatment of speech dysfluency is of particular importance in the adolescent schizophrenic patients, who are expected to have longer duration of lifetime exposure to antipsychotics and in whom peer group interaction is crucial for normal personal and social development. Vivekananda Rachamallu, Ayman Haq, Michael M. Song, and Manish Aligeti Copyright © 2017 Vivekananda Rachamallu et al. All rights reserved. Autoscopic Hallucination in Alcohol Dependence Syndrome: A Rare or Missed Phenomenon? Mon, 24 Jul 2017 08:57:51 +0000 Autoscopic phenomenon, a psychic illusionary duplication of one’s own self, has been the subject of interest in the literature and science for years. It has been reported in various diseases of the central nervous system but with an unknown mechanism. Hallucinations are a common presentation in alcohol dependence syndrome during delirium tremens and as induced disorder. However, autoscopic hallucination has been rarely reported in the cases of alcohol dependence. We present a case of a 40-year-old man who experienced autoscopic hallucination during the withdrawal state of alcohol. He was successfully treated with detoxification and an antipsychotic medication and was doing well. The case highlights the need for strong suspicion and exploration of the autoscopic hallucination and autoscopic phenomenon in general in cases of alcohol dependence syndrome. Sulochana Joshi, Binita Thapa, and Rabi Shakya Copyright © 2017 Sulochana Joshi et al. All rights reserved. Misdiagnoses of Epilepsy as Ekbom Syndrome, Mood Instability, and Nocturnal Visual Hallucinations Thu, 13 Jul 2017 00:00:00 +0000 Epileptic seizures may be misdiagnosed if they manifest as psychiatric symptoms. We report three female patients with no preexisting history of epilepsy that were unsuccessfully treated as primary psychiatric disorder: one patient was initially diagnosed with somatization and Ekbom syndrome; the second was referred to psychiatrist due to mood instability and visual hallucinations; and the third one was referred for anxiety and hallucinations related to sleep. A carefully taken medical history clarified diagnoses of epilepsy. None of the patients responded to medications aimed at treating psychiatric symptoms, and all the patients had favorable response to antiepileptic treatment. These cases illustrate that epileptic patients may experience nonconvulsive seizures that might be misdiagnosed as primary psychiatric disorder. M. Duarte Mangas, Y. Martins, L. Bravo, and A. Matos Pires Copyright © 2017 M. Duarte Mangas et al. All rights reserved. Distressing Visual Hallucinations after Treatment with Trazodone Sun, 18 Jun 2017 08:46:16 +0000 Trazodone, a second-generation atypical antidepressant, is increasingly being used off-label, in the treatment of insomnia. Although generally well tolerated, trazodone treatment can be associated with some complications. We describe a case of a 60-year-old man who received trazodone for primary insomnia. He returned, to the emergency department, two days later with distressing visual hallucinations, which prompted inpatient treatment. Trazodone was discontinued, leading to a complete resolution of his visual hallucinations, and he was treated with mirtazapine for 6 months. There has been no relapse in a follow-up period of two years. Patients presenting with visual hallucinations without significant psychiatry history can be a challenging situation. We highlight the importance of careful anamnesis with an accurate medication history. Given the widespread use of trazodone, clinicians should be aware of this possible side effect. Gustavo Santos and Ana Maria Moreira Copyright © 2017 Gustavo Santos and Ana Maria Moreira. All rights reserved. A Case Report of Mania and Psychosis Five Months after Traumatic Brain Injury Successfully Treated Using Olanzapine Mon, 12 Jun 2017 06:49:51 +0000 Background. There are few published pharmacologic trials for the treatment of acute mania following traumatic brain injury (TBI). To our knowledge, we present the first case report of an individual being treated and stabilized with olanzapine monotherapy for this condition. Case Presentation. We describe the case of a 53-year-old African American male admitted to an inpatient psychiatric hospital with one month of behavioral changes including irritability, decreased need for sleep, hyperverbal speech, hypergraphia, and paranoia five months after TBI. Using Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria, he was diagnosed with bipolar disorder due to traumatic brain injury, with manic features. He was serially evaluated with clinical rating scales to measure symptom severity. The Young Mania Rating Scale (YMRS) score upon admission was 31, and the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) score was initially 9. After eight days of milieu treatment and gradual titration of olanzapine to 15 mg nightly, his symptoms completely abated, with YMRS and CRDPSS scores at zero on the day of discharge. Conclusion. Olanzapine was effective and well tolerated for the treatment of mania following TBI. Giordano F. Cittolin-Santos, Jesse C. Fredeen, and Robert O. Cotes Copyright © 2017 Giordano F. Cittolin-Santos et al. All rights reserved. Adult ADHD: Questioning Diagnosis and Treatment in a Patient with Multiple Psychiatric Comorbidities Sun, 11 Jun 2017 06:58:10 +0000 Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is a contentious diagnostic issue, which has been increasing in prevalence in recent years, and is often comorbid with other psychiatric disorders. This report presents a detailed account of a clinical case involving a middle-aged man with a history of recurrent depressive episodes and an unsubstantiated diagnosis of ADHD, treated with stimulants. There is persistent debate around the use of psychostimulants both in adult ADHD and in the treatment of depression. Despite promising activating properties, psychostimulants carry significant risks of misuse and substance use disorder. In this report, we consider the potential benefits and adverse effects of stimulants in the treatment of adult ADHD and mood disorders and review the learning points of this complicated, but not uncommon, clinical case. Robert Karoly Chu, Tea Rosic, and Zainab Samaan Copyright © 2017 Robert Karoly Chu et al. All rights reserved. Psychosis Crisis Associated with Thyrotoxicosis due to Graves’ Disease Sun, 11 Jun 2017 06:50:17 +0000 We present the case of a patient with previous psychiatric illness, acutely exacerbated by thyroid storm due to Graves’ disease, in whom treatment with antipsychotics induced catatonia. These associations are extremely rare and may be confused with Hashimoto’s encephalopathy, especially in the presence of anti-thyroid antibodies in cerebrospinal fluid. The treatment consists in the control of the triggering disease (in this case the resolution of the thyrotoxicosis) and the use of benzodiazepines. However, in some cases, the resolution of psychiatric symptoms is partial and may require the use of electroconvulsive therapy. Lilibet Urias-Uribe, Emmanuel Valdez-Solis, Claudia González-Milán, Claudia Ramírez-Rentería, and Aldo Ferreira-Hermosillo Copyright © 2017 Lilibet Urias-Uribe et al. All rights reserved. Obsessive-Compulsive Disorder Associated with Posterior Cranial Fossa Meningioma Thu, 01 Jun 2017 07:51:38 +0000 We report here a patient in whom the effects of a cerebellum mass may have led to development of obsessive-compulsive disorder (OCD). A 33-year-old woman showed symptoms of OCD, including obsessive worry about infection from tainted blood and repetitive confirmation, which worsened during pregnancy. She had comprehension in regard to her illness and no evidence of cognitive dysfunction and did not meet other DSM-5 criteria such as depression. One month after giving childbirth, the symptoms worsened, while headache and dizziness also developed. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score was 34. The patient was examined for a headache and a posterior cranial fossa meningioma was found. Following resection of the meningioma, the OCD symptoms were remarkably reduced (Y-BOCS score 10). There is only one previous report of pure OCD associated with a cerebellar mass and the present findings should help to elucidate the mechanism. Nobuyuki Takeuchi, Etushi Kato, and Kousuke Kanemoto Copyright © 2017 Nobuyuki Takeuchi et al. All rights reserved. Treatment of Hypochondriasis in Two Schizophrenia Patients Using Clozapine Wed, 31 May 2017 08:06:38 +0000 Hypochondriasis (HYPO), an obsessive-compulsive spectrum disorder, is frequent in patients with schizophrenia (SCH) (20%), especially among those treated with clozapine (36.7%). Treatment options for OCS/OCD in patients under clozapine (CLZ) include combining clozapine with amisulpride/aripiprazole or a mood stabilizer, augmenting clozapine with a serotoninergic reuptake inhibitor, adding cognitive behavioural therapy, and gradually reducing dosage. No treatments have been proposed for HYPO in patients using clozapine so we examine these options in 2 cases and report the results. Among treatments delivered, only dosage reduction adequately worked. We recommend caution when thinking about escalating treatment and suggest trying it only when alternative interventions were not successful and weighing risk and benefits of this therapeutic strategy. Further research is needed to confirm the hypothesis that CLZ treatment induces hypochondriac symptoms, to investigate the prevalence of the phenomenon, and, mostly, to identify possible treatment strategies. Antonio Tundo, Luca Proietti, and Rocco de Filippis Copyright © 2017 Antonio Tundo et al. All rights reserved. Home-Based Telepsychiatry in US Urban Area Mon, 29 May 2017 07:46:25 +0000 Telepsychiatry expands access to psychiatric care. However, telepsychiatry for elderly adults is only reimbursed in the US if the patient is assessed while in a clinical setting. This case study presents a homebound older woman previously hospitalized for schizophrenia who had not seen a psychiatrist in over 20 years. Care was provided with hybrid telepsychiatry (team-based practice with social worker traveling to the home with electronic tablet for connection with psychiatrist). The intervention resulted in detecting unrecognized depression and complex trauma. The treatment plan included adding an antidepressant and therapy plan, eliminating one psychiatric medication, and reducing dosage of pain medication. The outcomes were improved function and quality of life. The patient and caregiver were both highly satisfied with the services. This hybrid telepsychiatry is a reasonable option for homebound elderly patients living in urban areas and less expensive than nursing home admission. Alireza Amirsadri, Jaclynne Burns, Albert Pizzuti, and Cynthia L. Arfken Copyright © 2017 Alireza Amirsadri et al. All rights reserved. Management of Severe Developmental Regression in an Autistic Child with a 1q21.3 Microdeletion and Self-Injurious Blindness Thu, 25 May 2017 00:00:00 +0000 We report the case of a young boy with nonverbal autism and intellectual disability, with a rare de novo 1q21.3 microdeletion. The patient had early and extreme self-injurious behaviours that led to blindness, complicated by severe developmental regression. A significant reduction in the self-injurious behaviours and the recovery of developmental dynamics were attained in a multidisciplinary neurodevelopmental inpatient unit. Improvement was obtained after managing all causes of somatic pains, using opiate blockers and stabilizing the patient’s mood. We offered both sensorimotor developmental approach with therapeutic body wrap and specific psychoeducation adapted to his blindness condition for improving his communication abilities. Cora Cravero, Vincent Guinchat, Jean Xavier, Camille Meunier, Lautaro Diaz, Cyril Mignot, Diane Doummar, Sandra Chantot-Bastaraud, Angèle Consoli, and David Cohen Copyright © 2017 Cora Cravero et al. All rights reserved. Pseudologia Fantastica in the Emergency Department: A Case Report and Review of the Literature Wed, 10 May 2017 00:00:00 +0000 Psychiatrists commonly encounter deception in the emergency department. This article presents the case of a patient who presents to the emergency department with an unusual and elaborate web of deceptions along multiple themes including feigning medical illness, multiple losses, and grandiose academic and athletic achievements. We review the clinical characteristics of pseudologia fantastica and discuss how this patient’s constellation of malingering, factitious disorder, and personality disorder suggests this diagnosis. Robyn Thom, Polina Teslyar, and Rohn Friedman Copyright © 2017 Robyn Thom et al. All rights reserved. Neuropsychiatric Manifestations in a Patient with Panhypopituitarism Mon, 08 May 2017 00:00:00 +0000 We present a case of an incidental diagnosis of panhypopituitarism in a 68-year-old African American man admitted to our psychiatric inpatient unit with symptoms suggestive of schizophrenia. The case was unusual as a first-episode psychosis given the patient’s age. In the course of his admission, the patient’s clinical condition deteriorated culminating in a sudden altered mental status which prompted a transfer to the medical floors and further investigations. A head CT scan and a pituitary MRI revealed a near total resection of the pituitary while laboratory investigations revealed hyponatremia and a grossly low hormone profile. The progression of these events casts doubts on our admitting diagnosis as the primary cause of the patient’s symptoms. The patient’s clinical condition improved only when his endocrinopathy was treated with hormone replacement, fluids, and electrolyte correction in addition to antipsychotics. An inability to verify the patient’s psychiatric history and a remote history of pituitary resection several decades earlier, unknown to the treating team, added to the diagnostic conundrum. We revised the diagnosis to neuropsychiatric manifestations secondary to an organic brain syndrome due to a partial pituitary resection. The patient was discharged with no symptoms of psychosis, good insight, judgment, and good reality testing. Oluwole Jegede, Ajouka Jeyakumar, Thyarapan Balakumar, Alyssa Raghu, Katherine I. Chang, Katarina Soewono, Mario Gustave, and Ayodeji Jolayemi Copyright © 2017 Oluwole Jegede et al. All rights reserved. A Case of Sporadic Creutzfeldt-Jakob Disease Presenting as Conversion Disorder Wed, 03 May 2017 06:46:42 +0000 Background. Creutzfeldt-Jakob disease is a rare disorder of the central nervous system. Its initial diagnosis may be obscured by its variable presentation. This case report illustrates the complexity of diagnosing this disease early in the clinical course, especially when the initial symptoms may be psychiatric. It offers a brief review of the literature and reinforces a role for consultation psychiatry services. Methods. PUBMED/MEDLINE was searched using the terms “Creutzfeldt-Jakob disease”, “psychiatric symptoms”, “conversion disorder”, “somatic symptom disorder”, “functional movement disorder”, and “functional neurologic disorder”. Case. The patient was a 64-year-old woman with no prior psychiatric history who was initially diagnosed with conversion disorder and unspecified anxiety disorder but soon thereafter was discovered to have Creutzfeldt-Jakob disease. Discussion. This case highlights the central role of psychiatric symptoms in early presentations of Creutzfeldt-Jakob disease. Still, few other cases in the literature report functional neurological symptoms as an initial sign. The consultation psychiatrist must remain alert to changing clinical symptoms, especially with uncharacteristic disease presentations. Nikhil Yegya-Raman, Rehan Aziz, Daniel Schneider, Anthony Tobia, Megan Leitch, and Onyi Nwobi Copyright © 2017 Nikhil Yegya-Raman et al. All rights reserved. Catatonia Secondary to Sudden Clozapine Withdrawal: A Case with Three Repeated Episodes and a Literature Review Wed, 15 Mar 2017 00:00:00 +0000 A literature search identified 9 previously published cases that were considered as possible cases of catatonia secondary to sudden clozapine withdrawal. Two of these 9 cases did not provide enough information to make a diagnosis of catatonia according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5). The Liverpool Adverse Drug Reaction (ADR) Causality Scale was modified to assess ADRs secondary to drug withdrawal. From the 7 published cases which met DSM-5 catatonia criteria, using the modified scale, we established that 3 were definitive and 4 were probable cases of catatonia secondary to clozapine withdrawal. A new definitive case is described with three catatonic episodes which (1) occurred after sudden discontinuation of clozapine in the context of decades of follow-up, (2) had ≥3 of 12 DSM-5 catatonic symptoms and serum creatinine kinase elevation, and (3) required medical hospitalization and intravenous fluids. Clozapine may be a gamma-aminobutyric acid (GABA) receptor agonist; sudden clozapine withdrawal may explain a sudden decrease in GABA activity that may contribute to the development of catatonic symptoms in vulnerable patients. Based on the limited information from these cases, the pharmacological treatment for catatonia secondary to sudden clozapine withdrawal can include benzodiazepines and/or restarting clozapine. John Bilbily, Betsy McCollum, and Jose de Leon Copyright © 2017 John Bilbily et al. All rights reserved. Gland New Psychosis: New Onset Adult Psychosis with Suicidal Ideation and Attempt in the Setting of Thyroid Storm Tue, 07 Mar 2017 09:16:10 +0000 We present a case of new onset psychosis in the setting of thyroid storm in a woman with no previous psychiatric history. The patient presented with ongoing suicidal ideation, a suicide attempt that was interrupted by her husband, and audio and visual hallucinations. The patient was placed on a psychiatric hold and treated for thyrotoxicosis as well as psychosis. Treatment of the thyroid hormone overload resulted in a rapid resolution of her symptoms; she was discharged in excellent condition, and she has had no repeat hallucinations or self-injury ideation or attempts since. Although rare, thyrotoxicosis is a potentially life-threatening cause of psychiatric illness and should always be kept on the differential diagnosis for a patient with a first episode of psychosis. This case highlights how thyroid storm physiology, beyond its well-studied hemodynamic and metabolic instability, can be potentially fatal due to psychiatric sequelae. It also highlights the crucial role of a thorough history and physical exam in all patients. Esteban Cota and Jacob Lentz Copyright © 2017 Esteban Cota and Jacob Lentz. All rights reserved. Delusional Disorder, Erotomanic Type, Exacerbated by Social Media Use Tue, 07 Mar 2017 00:00:00 +0000 Erotomania is an uncommon form of delusional disorder in which an individual has an unfounded belief that another is in love with him. Previous case reports have shown that social media networks may play a role in worsening delusional beliefs. We report the case of a 24-year-old male college student that utilized social media to stalk a female college student, resulting in his suspension from school and hospitalization. The student was diagnosed with delusional disorder, erotomanic type, and started on risperidone. He showed little improvement and was transferred to another facility. This is the first identified case of social media triggering or exacerbating delusional disorder. We recommend increasing education on the ramifications of sharing personal information on social media. Justin Faden, Jonathan Levin, Ronak Mistry, and Jessica Wang Copyright © 2017 Justin Faden et al. All rights reserved. A Case of Persistent Generalized Retrograde Autobiographical Amnesia Subsequent to the Great East Japan Earthquake in 2011 Wed, 01 Mar 2017 09:32:20 +0000 Functional retrograde autobiographical amnesia is often associated with physical and/or psychological trauma. On 11 March 2011, the largest earthquake on record in Japan took place, and subsequent huge tsunami devastated the Pacific coast of northern Japan. This case report describes a patient suffering from retrograde episodic-autobiographical amnesia for whole life, persisting for even more than five years after the disaster. A Japanese man, presumably in his 40s, got police protection in April 2016 but was unable to respond to question about his own name. He lost all information about his personal identity, and his memory was wholly lost until the disaster on 11 March 2011. He was able to recall his life after the disaster, and semantic memories and social abilities were largely preserved. A medical examination performed on 1 November 2016 verified that he was awake, alert, and oriented to time, place, and person (except for himself). General physical and neurological examinations revealed no pathological findings. He also experienced some symptoms associated with posttraumatic stress disorder (PTSD), such as intrusive thoughts, flashbacks, and nightmares. No abnormalities were detected by biochemical test and brain magnetic resonance imaging (MRI). Physicians and other professionals who take care of victims of disaster should be aware of dissociative spectrum disorders, such as psychogenic amnesia. Yuji Odagaki Copyright © 2017 Yuji Odagaki. All rights reserved. Course of Neuropsychiatric Symptoms during Flares of Systemic Lupus Erythematosus (SLE) Thu, 23 Feb 2017 07:19:12 +0000 We present the case of a seventeen-year-old girl who presents with an interesting course of neuropsychiatric symptoms during several flares of SLE. The patient was diagnosed at the age of thirteen and has had four flares in total. The latter two flares included cutaneous and neuropsychiatric symptoms. The most recent flare occurred when she was aged seventeen. She had cutaneous symptoms which coincided with an episode of hypomania. Her mental state further deteriorated following steroid treatment. She exhibited affective and psychotic symptoms. Treatment with cyclophosphamide and olanzapine was associated with an improvement in both cutaneous and neuropsychiatric symptoms. Previously aged sixteen the patient had presented with cutaneous symptoms and a moderate depressive episode which was also exacerbated by steroid treatment. The patient’s mood improved when the dose of oral steroids was reduced to a daily dose of 15–20 mg prednisolone. Gareth Garrett, Nicola Ambrose, Zaib Davids, and Dorothea Bindman Copyright © 2017 Gareth Garrett et al. All rights reserved. Psychosis in a 15-Year-Old Female with Herpes Simplex Encephalitis in a Background of Mannose-Binding Lecithin Deficiency Sun, 05 Feb 2017 10:37:08 +0000 Historically, psychotic disorder has been associated with viral infection. Herpes simplex infections and Epstein-Barr virus (EBV) among other viral infections have been implicated in psychotic disorder. Of note in this case report is psychotic disorder that occurred following reactivation of herpes simplex infection in a background of mannose-binding lecithin (MBL) deficiency, childhood EBV infection, and severe psychosocial stress. Herpes simplex encephalitis (HSE) remains a significant cause of morbidity and mortality despite advancement in its treatment with intravenous acyclovir. Many studies have reported psychiatric and neurological manifestation of herpes simplex infection following primary or reactivated infection, while others suggest milder clinical course of herpes simplex encephalitis in a background of immunosuppression. Another contributory factor to psychotic disorder in this case is childhood EBV exposure which has been reported to increase the risk of psychosis in adolescence and adulthood. This case report describes a 15-year-old female with MBL deficiency who presented with psychosis caused by reactivated herpes simplex infection and had good clinical recovery. Based on childhood Epstein-Barr virus exposure and psychosis in adolescence (current case), she is at increased risk of psychotic disorder in adulthood, which underscores the importance of long-term monitoring. Kenneth Asogwa, Kwame Buabeng, and Amarjit Kaur Copyright © 2017 Kenneth Asogwa et al. All rights reserved. “Being with a Buddha”: A Case Report of Methoxetamine Use in a United States Veteran with PTSD Sun, 29 Jan 2017 09:15:33 +0000 Methoxetamine (MXE) is a ketamine analogue with a high affinity for the N-methyl-D-aspartate (NMDA) receptor. MXE is a newly emerging designer drug of abuse and is widely available through on-line sources and is not detected by routine urine drug screens. In this report, we describe a United States (US) veteran with posttraumatic stress disorder (PTSD) and heavy polysubstance use, who injected high dose MXE for its calming effect. Given MXE’s structural similarities to ketamine and recent work showing that ketamine reduces PTSD symptoms, we hypothesize that MXE alleviated this veteran’s PTSD symptoms through action at the NMDA receptor and via influences on brain-derived neurotrophic factor (BDNF). To our knowledge, this is the first case report of self-reported use of MXE in the US veteran population. More awareness of designer drugs, such as MXE, is an important first step in engaging patients in the treatment of designer drug addiction in both military/veteran settings and civilian settings. Joan M. Striebel, Emily E. Nelson, and Raj K. Kalapatapu Copyright © 2017 Joan M. Striebel et al. All rights reserved. Psychopathology Related to Energy Drinks: A Psychosis Case Report Mon, 02 Jan 2017 10:25:06 +0000 Energy drinks (ED) are nonalcoholic beverages that have caffeine as their most common active substance. The rapid expansion of ED consumption has created concern in the scientific community as well as in the public opinion. We report a psychotic episode probably triggered by ED abuse in a young adult without previous psychotic disorders. We have reviewed the literature regarding the relationship between caffeine, energy drinks, and psychopathology. Few articles have been published about mental health effects of energy drinks and caffeine abuse. Nevertheless, this relationship has been suggested, specifically with anxiety disorders, manic episodes, suicide attempts, psychotic decompensation, and substance use disorder. ED consumption could represent a global public health problem because of the potential severe adverse effects in mental and physical health. To our knowledge, this article is probably the first case of psychosis related to ED abuse in an individual without previous psychotic disorders. Daniel Hernandez-Huerta, Maria Martin-Larregola, Jorge Gomez-Arnau, Javier Correas-Lauffer, and Helen Dolengevich-Segal Copyright © 2017 Daniel Hernandez-Huerta et al. All rights reserved.