Case Reports in Psychiatry最新文献

{"title":"Neuropsychiatric Clues to Herpes Simplex Virus Encephalitis Presenting as Normal Pressure Hydrocephalus.","authors":"Christopher E Potts, Alana Kassis, Akbar Ali, James Issa, Usman Alizai, Dakota May","doi":"10.1155/crps/9748747","DOIUrl":"10.1155/crps/9748747","url":null,"abstract":"<p><p>Herpes simplex virus type 1 (HSV-1) encephalitis can mimic neurodegenerative or structural disorders, particularly in older adults presenting with cognitive or behavioral symptoms. We report the case of a 73-year-old woman with progressive gait instability, urinary incontinence, and cognitive decline, which was initially attributed to normal pressure hydrocephalus (NPH). Despite transient improvement after two lumbar punctures and neuroimaging suggestive of significant ventriculomegaly, the patient's symptoms progressed with increasing paranoia, hallucinations, and agitation. Psychiatric consultation worked up the NPH diagnosis and identified various behavioral abnormalities-such as fluctuating delirium and psychosis-inconsistent with classic NPH. After 20 days of admission, restructuring of the differential and extensive infectious and metabolic testing led to the identification of HSV-1 DNA in cerebrospinal fluid (CSF). The patient improved markedly with prompt acyclovir therapy. This case underscores the diagnostic overlap and mimicry between infectious and neurodegenerative processes and highlights the role of psychiatric input in reframing atypical neurocognitive presentations and expanding the differential of treatment-resistant NPH in the presence of inconsistent symptomatic progression.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"9748747"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197323","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":"Use of Testosterone-Lowering Medication in Patients With Intellectual Disabilities and Problematic Sexual Behaviour: A Case Series.","authors":"Jacob Rong Bentsen, Torbjørn Lien Kjær, Magnus Roland Balleby, Jimmi Nielsen","doi":"10.1155/crps/6191292","DOIUrl":"10.1155/crps/6191292","url":null,"abstract":"<p><strong>Background: </strong>Testosterone-lowering medication (TLM) is used in severe cases of paraphilic disorders and problematic sexual behaviour, but its use in patients with intellectual disability is not well characterised.</p><p><strong>Method: </strong>A nationwide survey identified five male patients with intellectual disability who had received TLM in specialised outpatient clinics.</p><p><strong>Results: </strong>Four patients showed reduced problematic sexual behaviour during treatment; three relapsed after discontinuation. Adverse effects included osteoporosis, hypertension, depression and suppressed sexual development. Monitoring and access varied regionally.</p><p><strong>Conclusions: </strong>TLM may be effective in selected patients with intellectual disability but requires careful monitoring and ethical oversight.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"6191292"},"PeriodicalIF":0.0,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197360","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 24-Year-Old Male Adult With a Severe Intellectual Developmental Disorder and Intractable Challenging Behaviors: A Case Report.","authors":"Edouard Guez, Nicolas Turin, Filippia Doulou, Yoann Beigheldrut, Pia El Kossaifi, Frank Ferrari, Michèle Levy-Soussan, David Cohen, Marianna Giannitelli","doi":"10.1155/crps/5963356","DOIUrl":"10.1155/crps/5963356","url":null,"abstract":"<p><strong>Background: </strong>This case highlights the clinical complexity of caring for individuals with autism spectrum disorder (ASD) and severe intellectual developmental disorder (IDD), particularly in the context of prolonged mechanical restraint, psychotropic polypharmacy, and life-threatening somatic complications. It illustrates how a multidisciplinary and individualized neurobehavioral approach can lead to major clinical improvement despite an initially poor prognosis and limitations regarding intensive care.</p><p><strong>Case presentation: </strong>Nathan is a 24-year-old man of Slavic origin with ASD and severe IDD who had been subjected to continuous mechanical restraint for 2 years and was receiving five concomitant antipsychotic medications. He presented with severe behavioral dysregulation in a context of chronic anxiety, marked communication limitations, recurrent aspiration pneumonia related to gastrostomy feeding, and adverse effects associated with antipsychotic treatment. He was referred to a specialized neurobehavioral unit, where a multidisciplinary team-including psychiatry, intensive care, palliative care, and ethics specialists-agreed on a conservative management plan. Antipsychotic treatment was streamlined to clozapine, fluoxetine was later introduced, and care combined nutritional rehabilitation, communication-focused support, and individualized psychoeducational, occupational, and psychomotor interventions in a highly structured environment. Oral feeding was gradually reintroduced, ultimately allowing gastrostomy removal, and restrictive measures were progressively discontinued. Overtime, his behavioral symptoms, emotional regulation, physical health, mobility, and overall quality of life improved markedly.</p><p><strong>Conclusions: </strong>This case underscores the importance of integrated multidisciplinary care in complex ASD/IDD presentations involving severe behavioral and somatic complications. Psychopharmacological simplification, environmental and communication adaptations, and individualized rehabilitation strategies were central to the improvement in both somatic outcomes and behavioral functioning. It also highlights the need to recognize prolonged mechanical restraint as a harmful and unsustainable management strategy in individuals with severe neurodevelopmental disorders.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"5963356"},"PeriodicalIF":0.0,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197328","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":"Twice Exceptional in Medicine: A Case Series of Neurodivergent Physicians.","authors":"Ashley Toussaint, Om Panda, Cheryl Graber","doi":"10.1155/crps/8705513","DOIUrl":"10.1155/crps/8705513","url":null,"abstract":"<p><p>The term twice-exceptional (2e) describes individuals who combine high intellectual potential with neurodevelopmental or psychiatric conditions that may impair performance in traditional environments. While this concept has been increasingly recognized in education, its relevance to medical training and practice has received little attention. This case series presents five physicians across different stages of training who exemplify twice-exceptionality, highlighting both their cognitive strengths and the barriers they faced in clinical environments. The first case involves a surgical resident with nonverbal learning disorder (NVLD), attention deficit hyperactivity disorder (ADHD), and type 1 diabetes whose superior intellect masked significant executive dysfunction until repeated crises prompted disclosure and pursuit of accommodations. The second case describes a resident with ADHD and perfectionism who, through structured coping strategies and mentorship, thrived in a supportive environment. A third case highlights a senior resident with anxiety and obsessive-compulsive disorder whose perfectionism and rumination undermined efficiency and self-confidence despite positive evaluations. The fourth case involves an attending physician with ADHD and obsessive traits who maintained professional success through compensatory overwork but experienced disorganization, fatigue, and burnout. The fifth case describes another attending physician with ADHD, anxiety, and depression whose intellectual giftedness coexisted with executive dysfunction and impaired self-care, leading to chronic struggles despite ongoing treatment. Across these cases, recurring themes emerge: masking of disability by high achievement, misattribution of neurodivergent struggles as professionalism deficits, and delayed or absent accommodations. While some physicians succeed in supportive environments, others experience isolation, burnout, or attrition when their needs remain unrecognized. These cases underscore the paradox of twice-exceptionality in medicine, where extraordinary potential and hidden vulnerabilities coexist. Greater recognition of this duality is essential to building neurodiversity-affirming environments that move beyond deficit-based models, reduce stigma, and foster structures in which talented but vulnerable physicians can thrive.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"8705513"},"PeriodicalIF":0.0,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013920","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":"Delusion of Jinn Possession in a Young Man With Schizophrenia: Case Report and Impact of Including a Religious Leader in Patient Care.","authors":"Aamna Asif, Nathan H Hwang, Rabia Asif, Fatima Asif, Ahmad El Gamal, Robert T Rubin","doi":"10.1155/crps/4021081","DOIUrl":"10.1155/crps/4021081","url":null,"abstract":"<p><p>Spiritual beliefs of many ethnic and religious groups can play a major role in the maintenance of physical and mental health. Integration of spiritual understanding into medical treatment can enhance patient outcomes in many specialties, especially psychiatry. As the Muslim population grows worldwide, the integration of spiritually and culturally sensitive mental healthcare with Islamic principles becomes increasingly important for optimum treatment outcomes. Herein, we discuss the inclusion of spiritual care in the treatment of a young Muslim man with schizophrenia who presented with the belief of being possessed by a jinn, a supernatural being capable of possessing or harming humans. In the context of a biopsychosocial-spiritual model of care, we focus on how Islamic principles augmented our patient's treatment through involvement of an Islamic religious leader (imam) to expertly address this patient's religious-based beliefs. Continuing to integrate spirituality broadly into mental health care should enrich our understanding of human nature and the patient experience and result in better outcomes through holistic medicine.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"4021081"},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866886","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":"When Delusion Becomes Reality: A Six-Year Diagnostic Odyssey and Ethical Crisis in a Case of Veridical Spousal Infidelity Belief.","authors":"Alireza Parsapoor, Mehdi Sayyah","doi":"10.1155/crps/3752206","DOIUrl":"10.1155/crps/3752206","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of delusional disorder, jealousy type, traditionally relies on the criterion of a \"false\" belief. This report describes a complex case in which a belief long considered delusional was ultimately verified, revealing limitations of rigid diagnostic frameworks and raising a profound ethical dilemma.</p><p><strong>Case presentation: </strong>Ms. A, a 42-year-old woman, presented with a fixed, 4-year belief in her husband's infidelity, accompanied by mild depressive symptoms but preserved global functioning. Over a 6-year period, she received treatment from multiple psychiatrists, including sequential trials of antipsychotics (risperidone, olanzapine, and aripiprazole) without benefit. Documented treatment resistance led to a trial of electroconvulsive therapy (ECT). Following the first ECT session, her husband confessed to long-term infidelity and a secret remarriage, while demanding that the clinician withhold this information from the patient.</p><p><strong>Discussion: </strong>This case challenges the diagnostic emphasis on belief falsity and illustrates how prolonged familial deception can sustain misdiagnosis. The protracted, multiprovider treatment history likely contributed to diagnostic entrenchment and therapeutic escalation. Ethically, maintaining secrecy after the confession constituted institutional gaslighting and epistemic injustice, violating core principles of nonmaleficence and autonomy. The clinician's primary duty to the patient must supersede spousal demands for confidentiality in cases of harmful deception.</p><p><strong>Conclusion: </strong>Veridical \"delusions\" require a paradigm shift toward dynamic diagnosis and patient-centered ethics. Clinicians must critically evaluate collateral information, remain alert to epistemic injustice, and prioritize patient welfare and truth disclosure over preservation of harmful familial secrets.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"3752206"},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763528","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":"Tianeptine Misuse, Dependence, and Clinical Management: Three Case Reports and Literature Review.","authors":"Valeria A Saldana, Paul H Earley, David S Silverstein, Yi-Lang Tang","doi":"10.1155/crps/2981699","DOIUrl":"10.1155/crps/2981699","url":null,"abstract":"<p><p>Tianeptine, an antidepressant approved only in Europe, Asia, and Latin America, is available without regulation in the United States through online vendors and various retail locations. The rise in its misuse has raised public concerns, marked by dramatic dose escalation, rapid tolerance, toxicity, and withdrawal symptoms. Substance use disorder due to another substance (tianeptine) commonly presents with symptoms similar to opioid use disorder. Symptoms of intoxication include euphoria, respiratory depression, and CNS sedation. Withdrawal symptoms may include anxiety, agitation, and gastrointestinal distress. Acute intoxication management may include the use of naloxone and supportive measures. Withdrawal management should consider the use of buprenorphine as a first-line treatment. Clonidine and other medications used for opioid withdrawal may also be beneficial. Cases with chronic use may require intensive interventions, including residential care, long-term follow-up, and close monitoring, as relapse rates are high. This report presents three cases of tianeptine misuse, detailing their presentation, withdrawal symptoms, and treatment, including pharmacological interventions and treatment setting. We further highlight the problems associated with misuse, the unique presentation of the disorder, treatment options for substance use disorder due to another substance (tianeptine), and the urgent need for regulatory oversight.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"2981699"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763503","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":"An Unusual Case of Multifactorial Catatonia Following Taxane-Based Chemotherapy Regimen.","authors":"Wei Siang Lee, Leslie Lim, Vincent Wong","doi":"10.1155/crps/5820055","DOIUrl":"10.1155/crps/5820055","url":null,"abstract":"<p><p>Catatonia is a neuropsychiatric syndrome characterised by motor and behavioural disturbances. While commonly associated with psychiatric conditions, a substantial proportion of cases have medical or drug-induced aetiologies. Chemotherapy can cause catatonia, and taxane-based chemotherapy is known to cause central neurotoxicity; however, taxane-related catatonia has not been reported before. We describe a 75-year-old woman with a schizophrenia in remission, who developed catatonia after docetaxel administration for breast cancer. Her catatonia fulfilled DSM-5-TR criteria and had an initial Bush-Francis catatonia rating scale (BFCRS) score of 23. A lorazepam challenge was positive, and treatment with oral lorazepam resulted in rapid resolution. Mild recurrence during follow-up was successfully managed with lorazepam titration. We discuss the possible link between taxanes, taxane-induced central neurotoxicity (TICN) and catatonia, with neuroscientific, clinical and radiological considerations. This case highlights the potential contribution of taxane chemotherapy to catatonia in a medically complex patient, and underscores the importance of early recognition and prompt treatment of catatonia.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"5820055"},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721757","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":"Alice in Wonderland and Ekbom Syndromes in a Bipolar I Manic Episode: A Case Report With Neuroimaging Findings.","authors":"Yuta Hori, Satoru Yanagaki, Masashi Nibuya, Seishu Nakagawa, Eiji Suzuki","doi":"10.1155/crps/1065938","DOIUrl":"10.1155/crps/1065938","url":null,"abstract":"<p><p>With recent advances in anatomical and functional brain mapping, Alice in Wonderland syndrome (AIWS), a perceptual distortion disorder, has received increased attention. We report the case of a 67-year-old man with bipolar I disorder (manic episode), AIWS, and delusional parasitosis (Ekbom syndrome). The patient exhibited diverse perceptual distortions across visual, auditory, and tactile modalities. In addition to derealization and depersonalization, he showed a distorted sense of time. Single-photon emission computed tomography (SPECT) revealed a transient but significant decrease in blood flow in the right posterior cingulate region, accompanied by relatively increased blood flow in the bilateral occipital regions during the episode.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"1065938"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638055","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":"Unveiling the Complex Interplay: Sudden Emergence of First-Rank Schneiderian Symptoms Following TMS in a Patient With Severe Depression and Complex Trauma.","authors":"Jaskaran Singh, Luba Leontieva, S D Sperry, Karan Sachdeva, Sanobar Jaka","doi":"10.1155/crps/5528976","DOIUrl":"10.1155/crps/5528976","url":null,"abstract":"<p><p>Schizophrenia-spectrum disorders are characterized by psychotic symptoms, including hallucinations, delusions, and disorganized thinking. Schneider's first-rank symptoms (FRS)-including thought broadcasting and experiences of external control-are clinically salient but not ergonomic and require careful differential diagnosis. The emergence of new-onset psychosis in midlife, particularly in individuals without prior psychotic history, warrants a broad biopsychosocial evaluation. We present the case of a 47-year-old male with chronic major depressive disorder and complex developmental trauma who developed abrupt FRS-like phenomena (prominently thought broadcasting) and auditory hallucinations following a period marked by (1) severe pneumonia with lung abscess, (2) escalating anxiety and depressive distress, (3) exposure to substances including reported synthetic cannabinoids (\"Spice\") with a urine toxicology positive for amphetamines, and (4) neuromodulation via 20 sessions of transcranial magnetic stimulation (TMS). Concurrently, the patient experienced a severe psychosocial/legal stressor (investigation related to child sexual exploitation material), associated with profound shame and fear. Rather than attributing symptoms to a single trigger, this case highlights a convergence model-medical inflammation, substance toxicity, trauma-related vulnerability, and acute legal stress-potentially disrupting cerebral homeostasis and precipitating psychosis and suicidality. Treatment included discontinuation of TMS, pharmacologic stabilization, and intensive psychotherapy, with partial remission of psychotic symptoms. There is a need for structured monitoring for emergent psychosis and multidimensional suicide risk in high-risk patients receiving neuromodulation.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2026 ","pages":"5528976"},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376127","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}