Psychiatry research case reports最新文献

{"title":"Psychiatric comorbidities in treatment-resistant depression: Insights from a second-opinion consultation case series","authors":"Vitaliy L. Voytenko ,&nbsp;Patrick Street ,&nbsp;Brant T. VanOrman","doi":"10.1016/j.psycr.2024.100205","DOIUrl":"https://doi.org/10.1016/j.psycr.2024.100205","url":null,"abstract":"<div><p>Approximately one-third of patients with major depression do not improve sufficiently even after multiple trials of otherwise effective antidepressant treatments, meeting criteria for treatment-resistant depression (TRD). The phenomenon of TRD remains poorly understood, as it can be attributed to a myriad of diverse factors, including pharmacogenetic variations and underdiagnosed or untreated comorbid psychopathology. This series of six case reports from an innovative second-opinion consultation program brings into focus some of the most prevalent psychiatric comorbidities in TRD: anxiety disorders, “double depression” (a combination of dysthymia and major depressive disorder), and personality psychopathology and discusses implications for their assessment and treatment. It also highlights the benefits of incorporating psychological testing in second-opinion evaluations toward increased accuracy and reliability of assessment of co-occurring psychiatric disorders. This enhanced approach to re-evaluation of patients with TRD may lead to more highly personalized treatment recommendations and better treatment outcomes.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100205"},"PeriodicalIF":0.0,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021224000014/pdfft?md5=7b03bfe3121c5c65594ec26568ae2476&pid=1-s2.0-S2773021224000014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first reported case of new-onset mania and psychosis post heterologous bivalent mRNA COVID-19 booster vaccination","authors":"Darren Cheng Han Teo ,&nbsp;Xing Yan Choo ,&nbsp;Chao Tian Tang","doi":"10.1016/j.psycr.2023.100204","DOIUrl":"https://doi.org/10.1016/j.psycr.2023.100204","url":null,"abstract":"<div><p>We report the first case of new-onset mania and psychosis post heterologous bivalent booster vaccination (corresponding to the 4th mRNA vaccine) in Singapore, to our knowledge. The COVID-19 pandemic has significantly impacted mental health, and studies have shown that COVID-19 infections can be directly or indirectly associated with neuropsychiatric symptoms. While mRNA vaccines are highly effective in preventing severe illness and death from COVID-19, there are case reports describing associated neuropsychiatric manifestations following COVID-19 vaccination, but none reported post heterologous bivalent boosting yet. This report centers on an immunocompetent man in his 40s who developed manic and psychotic symptoms temporally after receiving his first Moderna/Spikevax bivalent COVID-19 vaccine, with a lack of other contributing biological and psychological factors. He previously received three doses of the Pfizer-BioNTech/Comirnaty vaccine with no significant side effects. The manic and psychotic symptoms included elevated mood, increased irritability, psychomotor agitation, increased energy, decreased need for sleep, increased distractibility, grandiosity, and paranoid delusions. Following the development of these symptoms, he was hospitalized and treated with Olanzapine, after which his symptoms resolved. He recovered well, with no relapse of symptoms after discontinuation of Olanzapine and after discharge from the hospital. While vaccination is generally considered safe, a small minority of individuals may experience significant psychiatric adverse reactions following COVID-19 booster vaccination, perhaps a higher immunogenic risk if one received heterologous bivalent boosting, a suspicion raised in this case report.  This warrants further systematic study as COVID-19 evolves from being a pandemic to an endemic infection internationally.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223001025/pdfft?md5=5436f72558ff5c8cdfcd2925b6a494ce&pid=1-s2.0-S2773021223001025-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138713179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidities and COVID-19—A case study of an adolescent's tumultuous journey through psychosis","authors":"L. Bond,&nbsp;D. Killeen,&nbsp;B. Hennessy,&nbsp;D. Wolde-Giorgis,&nbsp;I. Whyte,&nbsp;B. Doody,&nbsp;T. Rudd","doi":"10.1016/j.psycr.2023.100200","DOIUrl":"10.1016/j.psycr.2023.100200","url":null,"abstract":"<div><h3>Background</h3><p>Psychosis in children and adolescents is devastating to those affected. The addition of comorbid medical comorbidities can further complicate presentation and management. Additionally, there is growing literature about a possible link between psychosis and COVID-19.</p></div><div><h3>Case Presentation</h3><p>The authors present a case of a 16-year-old Irish/Nigerian male with first episode psychosis admitted to a child and adolescent psychiatric inpatient unit in Ireland. The patient had a complex medical history of glcose-6-phosphate dehydrogenase deficiency, narcolepsy, and co-infection of coronavirus disease 2019 (COVID-19). The presence of multiple co-morbidities made management challenging. Additionally, culturo-religious factors arose which arose as barriers to the therapeutic relationship between the patient and his family.</p></div><div><h3>Conclusions</h3><p>This case highlights the complexity of managing psychosis in an adolescent with multiple serious medical comorbidities. Further research exploring the relationship between medical comorbidities and psychosis is warranted to improve patient outcomes.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223000986/pdfft?md5=d377043242fa764234d672b3ce2be284&pid=1-s2.0-S2773021223000986-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139025097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of recurrent acute pancreatitis due to paliperidone palmitate long-acting injectables (LAI)","authors":"Aseel Al-Ibrahim,&nbsp;Konstantinos Francis","doi":"10.1016/j.psycr.2023.100203","DOIUrl":"10.1016/j.psycr.2023.100203","url":null,"abstract":"<div><p>Drug-induced pancreatitis is an uncommon but not usually life-threatening adverse reaction to various medications, including several antipsychotics. We are reporting here on the first such case due to a long-acting antipsychotic, paliperidone palmitate, in a patient with schizophrenia that had been stabilised using this medication for more than a year. A subsequent re-challenge led to a second episode of acute pancreatitis, making the aetiological correlation with paliperidone palmitate more definite. Both episodes were resolved with conservative treatment.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223001013/pdfft?md5=362d4c8363c632ad45c9439a809fa8a4&pid=1-s2.0-S2773021223001013-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138609353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic challenges in a patient presenting with postictal and interictal psychosis: A case report and review","authors":"Ayyub Imtiaz ,&nbsp;Samuel Duffy ,&nbsp;Benedicto Borja","doi":"10.1016/j.psycr.2023.100202","DOIUrl":"https://doi.org/10.1016/j.psycr.2023.100202","url":null,"abstract":"<div><h3>Background</h3><p>Epilepsy and psychotic disorders have a bidirectional correlation that is established in the literature. Psychosis of epilepsy (POE) describes a group of psychoses such as interictal and postictal psychosis. We present a case of overlapping symptoms of postictal and interictal psychosis making diagnostic clarification difficult.</p></div><div><h3>Case</h3><p>A 58-year-old female with a history of epilepsy since childhood, blunt traumatic brain injury, glioma status post right temporoparietal craniotomy and resection, HIV on HAART, depression, and alcohol use disorder, presented to the emergency room with hallucinations, paranoia, delusions, and agitated behavior after a seizure. The patient had an increase in seizure frequency over the past 9 months, now having one seizure a week. The disorientation, agitation, and hallucinations would resolve spontaneously in a short period of time but have persisted after recent seizures. Recent MRI revealed focal cortical and subcortical encephalomalacia with gliosis in the right superior temporal gyrus extending into the lingual gyrus and mesial temporal sclerosis. EEG showed multifocal 1 Hz sharp discharges in a ratio of 3:1 coming from the right temporal region, not correlated to any tonic-clonic events.</p></div><div><h3>Conclusion</h3><p>This case has risk factors and presenting features for both interictal and postictal psychosis making accurate diagnostic clarification difficult during their stay. Differentiating between various POE can prove challenging as the evidence-based management differs. When an antipsychotic needs to be provided, we recommend risperidone as a suitable option given its relative safety in both seizure disorders and traumatic brain injuries secondary to neurosurgery.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223001001/pdfft?md5=51a28ccb208114101c07c059cf249fc2&pid=1-s2.0-S2773021223001001-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138489570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human immunodeficiency virus-related neurocognitive disorder with hallucinations and delusions: A case report","authors":"Junpei Igata ,&nbsp;Naomichi Okamoto ,&nbsp;Hirofumi Tesen ,&nbsp;Maya Akiyama ,&nbsp;Satoru Ide ,&nbsp;Atsuko Ikenouchi ,&nbsp;Reiji Yoshimura","doi":"10.1016/j.psycr.2023.100201","DOIUrl":"https://doi.org/10.1016/j.psycr.2023.100201","url":null,"abstract":"<div><h3>Introduction</h3><p>In patients with human immunodeficiency virus (HIV) infection, HIV-associated neurocognitive disorder (HAND) manifests in 18–50% of cases. Symptoms, including memory impairment, impaired attention, concentration, executive dysfunction, slowed motor speed, apathy, personality changes, and abnormal behavior can vary. However, psychotic symptoms, such as hallucinations and delusions, are rare. We report a case of HAND with hallucinations, delusions, abnormal behavior, irritability, and decreased motor and attention-processing speeds that were successfully treated with risperidone and aripiprazole.</p></div><div><h3>Case presentation</h3><p>A 39-year-old Japanese man with a 6-year history of HIV infection presented to our hospital with delusions, hallucinations, and cognitive dysfunction. Five years ago, he was admitted to our department with abnormal behaviors, such as trespassing in a stranger's residence and immobility. He was diagnosed with HAND after ruling out opportunistic infections secondary to HIV infection and neurodegenerative diseases. He was initially admitted with auditory and visual hallucinations, which improved with risperidone 4 mg. However, 2 years ago, he discontinued risperidone and became irritable. He was admitted to our department in October of the same year with hallucinations, delusions, slow movement, and decreased spontaneity. Misperception, delusions, abnormal behavior, and prolonged response latency were observed at the time of admission. On the third day of admission, aripiprazole was administered, and the dose was titrated to 30 mg. His-hallucinations, delusions, abnormal behavior, and irritability disappeared. One year later, in March, a cognitive function test showed that his motor speed, attention-information processing speed, and activity had improved.</p></div><div><h3>Conclusion</h3><p>This patient presented with HAND symptoms, such as hallucinations, delusions, abnormal behavior, hyperirritability, and cognitive dysfunction. Risperidone and aripiprazole effectively alleviated these symptoms, and the cognitive dysfunction showed reversible improvement. Clinicians should be aware of the possibility of rare symptoms, such as hallucinations and delusions, while treating HAND. Additionally, they should consider the possibility of improved cognitive function and provide appropriate treatments.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223000998/pdfft?md5=71471f18dcc0f5eb41f373c5406d69f5&pid=1-s2.0-S2773021223000998-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138475018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steroid-Responsive Encephalopathy associated with Autoimmune Thyroiditis (SREAT) presenting as malignant excited catatonia: A novel clinical presentation","authors":"Alicia R. Khan ,&nbsp;Jacob Carolan ,&nbsp;Mario J. Rullo ,&nbsp;Kelly L. Hamilton ,&nbsp;Tamara Movsesova ,&nbsp;Barsegh A. Barseghian ,&nbsp;Pauline Tsai ,&nbsp;Jennifer F. Schreiber","doi":"10.1016/j.psycr.2023.100198","DOIUrl":"https://doi.org/10.1016/j.psycr.2023.100198","url":null,"abstract":"<div><h3>Background</h3><p>Hashimoto Encephalopathy, more accurately known as Steroid Responsive Encephalopathy associated with Autoimmune Thyroiditis (SREAT), is an exceedingly rare and often controversial diagnosis that, when present, manifests as encephalopathy with a variety of other potential symptoms in the setting of elevated antithyroid peroxidase antibody and/or antithyroglobulin antibody. Its manifestations can include encephalopathy, seizures, myoclonus, hallucinations, stroke-like findings, and more.</p></div><div><h3>Patient case</h3><p>We present the case of a 39-year-old transgender man with autistic spectrum disorder and depression, initially presumed to be in acute psychiatric decompensation, later found to have elevated levels of anti-thyroid peroxidase antibodies, who responded well to plasma exchange (PLEX) and rituximab. On initial psychiatric admission, the patient had symptoms of suicidal ideation, confusion, and agitation. He showed little improvement on medications such as quetiapine, olanzapine, valproate, and bupropion. Due to worsening agitation and cognitive impairment, he required further medical and neurological evaluation. He later had an episode deemed to be a likely seizure. This workup included electroencephalogram (EEG), MRI Brain, and lumbar puncture, yet all were unremarkable. Laboratory values were notable for elevated serum anti-thyroid peroxidase (TPO) antibodies of 661 U/mL. The patient received intravenous high-dose steroids with transient improvement. He eventually responded dramatically to plasmapheresis and rituximab. At his post-discharge follow up, he had returned to his cognitive baseline. He successfully resumed his job and has since remained at his functional baseline.</p></div><div><h3>Conclusion</h3><p>This case is the first to our knowledge to characterize a novel presentation of SREAT mimicking malignant excited catatonia. In such cases, if initial response to glucocorticoid treatment is equivocal, plasma exchange may be an effective treatment option.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223000962/pdfft?md5=cdc8a3c10578a58e5aaea2427b16d459&pid=1-s2.0-S2773021223000962-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138549377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pica and coprophagia in schizophrenia: A case report","authors":"Juliana L. Vanderburg,&nbsp;Alia R. Warner,&nbsp;Alexandra N. Duran,&nbsp;Lauren A. Mordukhaev","doi":"10.1016/j.psycr.2023.100199","DOIUrl":"https://doi.org/10.1016/j.psycr.2023.100199","url":null,"abstract":"<div><h3>Background</h3><p>Little research has addressed maladaptive eating behaviors among patients with schizophrenia. Pica, the eating of nonfood items, and coprophagia, the consumption of feces, occur at higher rates in the early stages of schizophrenia; however, etiology of pica is poorly understood. Understanding primary precipitants of pica among patients with schizophrenia is integral for providing effective treatment. We present a case study on an interprofessional collaboration to ascertain primary diagnosis of a patient exhibiting symptoms of psychosis and pica/coprophagia.</p></div><div><h3>Case presentation</h3><p>A 22-year-old Hispanic male involuntarily presented to an inpatient facility. His-family reported that for 6 months prior to admission, he did not attend to self-care tasks, began consuming nonfood items, and appeared internally preoccupied. While hospitalized, he maintained similar behavior. He frequently went to the bathroom to consume his feces and urine. If disrupted, he sometimes became physically aggressive and persisted in his behavior. He reported odd beliefs related to nutrition. At times, he rubbed hand sanitizer on his face and body. He was trialed on olanzapine, haloperidol, lorazepam, and paliperidone to address agitation and psychosis. Medical rule-outs for his behavior included cognitive impairment, seizure, central nervous system (CNS) lesion, and substance/alcohol use. He was referred to psychology for an evaluation to determine his primary diagnosis. Findings indicated absence of mood episodes and OCD. His history revealed several risk factors for schizophrenia, and progression of illness was typical of schizophrenia. His pica behaviors declined following implementation of a consistent regimen of paliperidone per court ordered medication petition.</p></div><div><h3>Conclusion</h3><p>This case report presents a patient with co-occurring pica, coprophagia, and first episode psychosis, a rare and understudied combination of symptoms. He evidenced delusional beliefs related to nutrition, which precipitated maladaptive eating behaviors. The case is relevant for providers observing maladaptive eating behaviors in patients with symptoms of psychosis, suggesting that treating pica with antipsychotic medications may be efficacious. The case study also illustrates the importance of accurate diagnostics and the power of interprofessional collaboration in providing psychiatric care.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223000974/pdfft?md5=0f7e23823e899b2684de76a70705875b&pid=1-s2.0-S2773021223000974-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138475017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘A course of electroconvulsive therapy in a geriatric patient with symptomatic degenerative cervical myelopathy before corrective surgery’","authors":"Amelia James,&nbsp;Emma Hack,&nbsp;Francine Moss","doi":"10.1016/j.psycr.2023.100195","DOIUrl":"https://doi.org/10.1016/j.psycr.2023.100195","url":null,"abstract":"<div><p>We report the case of a 70-year-old woman who received ECT for major depression with psychotic features. The patient was identified to have symptomatic severe cervical degenerative myelopathy during treatment and she received 21 sessions of right unilateral electroconvulsive therapy (ECT) without adverse neurological outcome. Precautions were undertaken to minimize risk of ECT-associated spinal cord injury. ECT was successfully recommenced without precautions following laminectomy.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223000937/pdfft?md5=59138dffdb6b5f1921f12c8f79bca0a9&pid=1-s2.0-S2773021223000937-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138430684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary hypoparathyroidism associated with catatonia in a patient with bipolar affective disorder: A case report","authors":"Tulasi Sindhuja ,&nbsp;Akash Kumar ,&nbsp;Gurveen Bhatia ,&nbsp;Snehil Gupta ,&nbsp;Ashok Kumar","doi":"10.1016/j.psycr.2023.100196","DOIUrl":"https://doi.org/10.1016/j.psycr.2023.100196","url":null,"abstract":"<div><p>Primary hypoparathyroidism is caused by parathyroid hormone (PTH) deficiency and characterized by hypocalcemia. Psychiatric manifestations such as mood disorders, however, are uncommon in primary hypoparathyroidism; therefore, neuro-psychiatric manifestations, including mood disorders, in the latter condition can pose a significant diagnostic challenge. Furthermore, co-morbid psychiatric disorders, metabolic conditions, and concurrent (psychotropic) medications can complicate the clinical picture of either of the conditions, including posing substantial diagnostic and management challenges. In this paper, we report a case of primary hypoparathyroidism with catatonia in a patient with a pre-existing bipolar affective disorder (BPAD) with poor response to mood stabilizers and antipsychotic medication for two years.</p><p>The girl, of age 18 years presented to the emergency department in a catatonic state characterized by mutism, posturing, stupor, negativism, waxy flexibility, and echolalia (Bush-Francis Catatonia Rating Scale (BFCRS) score was 16). Her symptoms responded poorly to psychotropic medications, moreover, she was overly sensitive to adverse effects of various medication (e.g., very prolonged QTc interval). Laboratory investigations showed that she had severe hypocalcemia, hypomagnesemia, hyperphosphatemia, and alkalosis. Her PTH levels were significantly low. Upon correction of dyselectrolytaemia (through calcium and magnesium supplements) and concurrent intake of tab. Olanzapine, a significant improvement in her symptoms was noticed. After excluding all causes of acquired hypoparathyroidism, we concluded it as primary hypoparathyroidism. The case highlights the importance of having a comprehensive and wider assessment of such atypical presentations of catatonia, especially if it responds poorly to conventional treatments.</p></div>","PeriodicalId":74594,"journal":{"name":"Psychiatry research case reports","volume":"3 1","pages":"Article 100196"},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773021223000949/pdfft?md5=c71394053e1ab1f547ed7be238134814&pid=1-s2.0-S2773021223000949-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138435649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}