{"title":"False-Positive Phencyclidine (PCP) Result on 11-Panel Urine Drug Screen (UDS) in a 17-Year-Old Adolescent with Long-Term Venlafaxine Use.","authors":"Hyun Sue Kim, Aakash Jain, Anita S Kablinger","doi":"10.1155/2023/6666197","DOIUrl":"https://doi.org/10.1155/2023/6666197","url":null,"abstract":"<p><p>Venlafaxine is an antidepressant belonging to the class of serotonin-norepinephrine reuptake inhibitors that are US Food and Drug Administration-approved to treat and manage symptoms of depression, anxiety, and other mood disorders in adults. We describe an adolescent patient who likely had a false-positive phencyclidine result detected with an 11-panel urine drug screen in an outpatient setting of long-term use of therapeutic venlafaxine extended release for the treatment of recurrent major depressive disorder and generalized anxiety disorder. We believe that this may be the first published case report to characterize this phenomenon in a young patient in the absence of an acute overdose.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"6666197"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9805404","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}
Joana Regala, João Lourenço, Francisco Moniz-Pereira, António Bento
{"title":"Postictal Psychosis: Case Report and Literature Review.","authors":"Joana Regala, João Lourenço, Francisco Moniz-Pereira, António Bento","doi":"10.1155/2023/7960227","DOIUrl":"https://doi.org/10.1155/2023/7960227","url":null,"abstract":"<p><p>Postictal psychosis (PIP) is one of the most common types of psychosis in epileptic patients. By virtue of the paucity of research on PIP, its pathophysiology remains not completely understood. Our case report describes a clinical picture of PIP, characterized by pleomorphic features, with neither Schneider's first<i>-</i>rank symptoms nor negative symptoms of schizophrenia, in a longstanding epileptic female patient with a history of nonadherence to antiepileptic treatment and poorly controlled seizures. Additionally, she had previous cognitive impairment and encephalomalacia in the right parietooccipital region as a sequela of a moderate-to-severe traumatic brain injury known to precede the emergence of the epilepsy. In light of our findings, we critically reviewed the current literature on postictal psychoses providing insight into its neurobiological underpinnings.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"7960227"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9545560","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}
Liliana Dell'Osso, Primo Lorenzi, Benedetta Nardi, Barbara Carpita, Francesca Benedetti, Ivan Mirko Cremone
{"title":"Occurrence of Terrifying Nightmares after Few Days of Mirtazapine Use in Elderly Patients.","authors":"Liliana Dell'Osso, Primo Lorenzi, Benedetta Nardi, Barbara Carpita, Francesca Benedetti, Ivan Mirko Cremone","doi":"10.1155/2023/8843206","DOIUrl":"https://doi.org/10.1155/2023/8843206","url":null,"abstract":"<p><p><i>Introduction</i>. Sleep disturbance and insomnia are some of the most frequent complaints in patients suffering from depression. Some common antidepressant with excitatory effects may worsen sleep qualities, whereas others (like mirtazapine), thanks to their antihistaminergic action, are associated with sedative properties and can quickly improve sleep quality. In the case of mirtazapine, even if its mechanisms of action on sleep remain controversial, beneficial changes in sleep pattern may be observable since the first dose and are associated with a faster onset of the antidepressive action. <i>Case Presentation</i>. Despite these documented beneficial effects, we reported five cases of elderly patients (age ranging from 69 to 79) with various diagnoses and comorbidities (severe or recurrent depression, general anxiety disorder, borderline personality disorder, and Parkinson's disease) assessed during clinical daily routine for whom the use of mirtazapine was linked to the onset of nightmares so impressive and dramatic that made it necessary to interrupt the treatment. <i>Discussion</i>. This peculiar side effect is still scarcely documented, and the literature on this topic remains conflicting; however, considering that the cases were collected in a short range of time, the exacerbation of nightmares caused by mirtazapine may be more frequent than previously believed. Furthermore, some common features shared by all the cases reported have been highlighted such as the onset of the nightmares being chronologically associated with the initiation of the therapy with mirtazapine, the disappearance with the interruption, the similar age range of all, and the occurrence of the episodes described during fall season.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"8843206"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10089773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9305495","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":"Loxapine in the Treatment of Manic and Psychotic Symptoms in an Individual Intolerant to Multiple Mood-Stabilizing and Antipsychotic Medications.","authors":"David S Im, Marina Capitanov, Amy M VandenBerg","doi":"10.1155/2023/8887553","DOIUrl":"https://doi.org/10.1155/2023/8887553","url":null,"abstract":"<p><p>First-line treatments for schizophrenia and schizoaffective disorder include antipsychotics and mood stabilizers, but their use may at times be limited due to severe adverse events. This case describes a 41-year-old male with a history of schizoaffective disorder and polysubstance use who was admitted to an inpatient psychiatry unit for acute manic and psychotic symptoms in the setting of absconding from his residential home and noncompliance with prescribed psychiatric medications. During his inpatient psychiatric hospitalization, he experienced DRESS (drug reaction with eosinophilia and systemic symptoms) with valproate, nephrogenic diabetes insipidus with lithium, potential neuroleptic malignant syndrome with risperidone, and orthostasis/tachycardia with clozapine. He ultimately achieved stabilization of manic and psychotic symptoms with loxapine without experiencing adverse events. This report highlights the potential utility of loxapine in individuals with schizoaffective disorder intolerant to standard mood-stabilizing and antipsychotic medications.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"8887553"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10018420","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":"Misdiagnosis of Psychosis and Obsessive-Compulsive Disorder in a Young Patient with Autism Spectrum Disorder.","authors":"Jiangbo Ying, Melvyn Weibin Zhang, Sreedharan Geetha Sajith, Giles Ming-Yee Tan, Ker-Chiah Wei","doi":"10.1155/2023/7705913","DOIUrl":"https://doi.org/10.1155/2023/7705913","url":null,"abstract":"<p><p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction and the presence of restricted and repetitive patterns of behavior. Making a first diagnosis of ASD in adults has certain difficulties, including inaccurate recall of developmental history and overlapping behaviors with other psychiatric conditions. This case study presents a young man who was assessed to have no major mental illness during his first visit to emergency services in a psychiatric hospital. During his second visit, he was initially assessed to have first episode psychosis, due to his possible delusional beliefs related to the insurance payout, social withdrawal, and strange behaviors, and then later he was assessed to have obsessive-compulsive disorder (OCD) instead of psychosis, because of his recurrent and intrusive thoughts. Eventually, his diagnosis was revised to ASD during outpatient follow-up after more comprehensive assessment. It is not easy to differentiate ASD from psychosis among some adult patients, even for expert psychiatrists. Cognitive rigidity in ASD may be similar to delusions in psychosis. Unusual behaviors in ASD can be confused with disorganized behaviors in psychosis. Differentiating ASD from OCD can be a complicated task as well, due to similarities between ASD and OCD. Restricted interests and repetitive behaviors in ASD may be perceived as obsessions and compulsions in OCD. Overall, diagnosis of ASD in adults requires comprehensive evaluation. Distinguishing symptoms of OCD and psychosis from autistic traits is critical for accurate diagnosis and optimal treatment. Although research in adult ASD has expanded alongside increased prevalence statistics over the past few years, more efforts to enhance the diagnostic processes in adult ASD are needed to reduce the challenges in this field.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"7705913"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9943599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10769507","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 Use of Lisdexamfetamine to Treat ADHD in a Patient with Stimulant (Methamphetamine) Use Disorder.","authors":"J Levine, H Swanson","doi":"10.1155/2023/5574677","DOIUrl":"https://doi.org/10.1155/2023/5574677","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment of attention deficit hyperactivity disorder (ADHD) with stimulants among patients with stimulant use disorder carries concern for efficacy and exacerbation of addictive behaviors. Lisdexamfetamine is a unique stimulant used to treat ADHD with a lower abuse potential compared to other stimulants, as the medication is the only prodrug in its class. To our knowledge, there are no reports in the literature of the use of lisdexamfetamine to treat ADHD in patients with stimulant use disorder.</p><p><strong>Methods: </strong>We present a 33-year-old male with a history of stimulant (methamphetamine) use disorder, who was found to have long-standing ADHD. The patient was treated with lisdexamfetamine 30 mg, which was increased and sustained at 40 mg.</p><p><strong>Results: </strong>The patient reported significant improvement in focus, concentration, calmness, organization of thoughts, and less of a tendency to procrastinate. Additionally, he denied exacerbation of anxiety or sleep disturbances. He reported his cravings for stimulants were significantly decreased. After 2 months of treatment, he had moved out from his sober living facility, started a new job, and gained a promotion. He had no use of illicit substances, which was proven by routine urine drug screens.</p><p><strong>Conclusion: </strong>Our patient's ADHD was successfully treated with lisdexamfetamine. Not only did the patient's ADHD symptoms improve, but his cravings for stimulants were relieved. ADHD is common among patients with stimulant use disorder. Patients with ADHD and stimulant use disorder should not necessarily forgo pharmacologic treatment with stimulants for concerns of abuse. Due to its unique pharmacokinetic profile, lisdexamfetamine is a feasible treatment for patients with ADHD and a history of stimulant use disorder.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"5574677"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10414377","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}
James McKowen, Amy Berger, Joshua Towbin, Amy M Yule, Diana Woodward, Lisa Nowinski, Gina Forchelli, Robert J Meyers, Gagan Joshi, Timothy E Wilens
{"title":"A Manualized Behavioral Therapy Intervention for Youth with Autism Spectrum Disorder and Substance Use Disorder.","authors":"James McKowen, Amy Berger, Joshua Towbin, Amy M Yule, Diana Woodward, Lisa Nowinski, Gina Forchelli, Robert J Meyers, Gagan Joshi, Timothy E Wilens","doi":"10.1155/2023/8998160","DOIUrl":"https://doi.org/10.1155/2023/8998160","url":null,"abstract":"<p><p>Research highlights the increasing overlap of autism spectrum disorder and substance use disorders in young people. However, no behavioral treatments exist addressing this comorbidity despite great need. A team of clinicians developed an integrated behavioral protocol addressing substance use in youth with autism spectrum disorder. The multidisciplinary team developed 12 youth, 7 parent, and 3 joint modules based on established evidence-based therapies shown to have effectiveness separately addressing autism spectrum and substance use. Two cases are discussed to illuminate this integrated intervention. Adaptations to the protocol were made during feedback from patients and their parents. Further research is needed to determine the effectiveness of this preliminary protocol.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"8998160"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10082677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9284180","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}
Sahar Ashrafzadeh, Maria Theresa Mariano, Saba Syed
{"title":"Cushing's Disease Presenting with Functional Neurological (Conversion) Disorder.","authors":"Sahar Ashrafzadeh, Maria Theresa Mariano, Saba Syed","doi":"10.1155/2023/1662271","DOIUrl":"https://doi.org/10.1155/2023/1662271","url":null,"abstract":"<p><p>While psychiatric manifestations are common in patients with Cushing's syndrome (CS), to our knowledge, there are no reported cases of CS presenting with functional neurological disorder (FND), a neuropsychiatric condition in which patients experience neurological symptoms, such as motor dysfunctions, sensory symptoms, speech disorders, or nonepileptic seizures, in the absence of neurological disease. Here, we report a case of a complex patient with Cushing's disease who presented with multiple FND symptoms including nonepileptic seizures, bilateral lower extremity paralysis, decreased finger flexion resulting in limited hand function, and stuttering. This case illustrates a rare psychiatric manifestation of CS presenting as multiple neurological complaints. Furthermore, we elucidate how a multidisciplinary treatment approach improved our patient's FND symptoms.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"1662271"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10017209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9146770","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}
Soumitra Das, Pablo Melgar, Aniqa Abdul Rasool, Adarsha Adhikari, Rudresh Patel, Lorenzo Abednego B Adre, Marylaine J Lopez
{"title":"Delirium in a Relatively Young Person due to COVID-19 Infection.","authors":"Soumitra Das, Pablo Melgar, Aniqa Abdul Rasool, Adarsha Adhikari, Rudresh Patel, Lorenzo Abednego B Adre, Marylaine J Lopez","doi":"10.1155/2023/6215386","DOIUrl":"https://doi.org/10.1155/2023/6215386","url":null,"abstract":"<p><p>The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2 virus), has significantly impacted global health. It can present a range of complications, from asymptomatic to severe respiratory distress syndrome. It has also been linked to complications in multiple organ systems, including neurological symptoms such as headaches and encephalopathy. Delirium, characterized by acute confusion, is common in older adults and associated with prolonged hospital stays and elevated mortality rates. We present a case study of a young mother with a prior medical history of mild to moderate depression who experienced an episode of delirium consequent to a COVID-19 infection. The initial manifestation of her illness was mild diarrhea, but as her condition worsened, she began exhibiting symptoms of delirium. These symptoms include confusion, agitation, sleep disturbance, and disordered behavior. The delirious episode was brief and effectively managed with small doses of psychotropic medications to control aggressive behavior. Upon resolution, no additional treatment was deemed necessary. This case underscores the wide-ranging effects of COVID-19 on physical and psychological well-being and highlights the importance of considering symptoms beyond those associated with respiratory distress.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"6215386"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10063355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9240355","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":"Ribavirin Treatment for Severe Schizophrenia with Anti-Borna Disease Virus 1 Antibodies 30 Years after Onset.","authors":"Hidenori Matsunaga, Akio Fukumori, Kohji Mori, Takashi Morihara, Shunsuke Sato, Kyoko Kitauchi, Kanta Yanagida, Kazumi Taguchi, Tomoyuki Honda, Keizo Tomonaga","doi":"10.1155/2023/4899364","DOIUrl":"https://doi.org/10.1155/2023/4899364","url":null,"abstract":"<p><strong>Objective: </strong>Borna disease virus 1 (BoDV-1) was proven to cause fatal encephalitis in humans in 2018. However, the effects of persistent infections remain unclear. Here, we present the case of a 50-year-old woman with a 30-year history of severe schizophrenia, who was exposed to fleas from stray cats prior to disease onset, suggesting the possibility of zoonosis including BoDV-1 infection. The patient had experienced significant social impairment, thought deterioration, delusions, and hallucinations for more than 20 years.</p><p><strong>Method: </strong>A radioligand assay was used to test the patient for IgG and IgM antibodies against BoDV-1 nucleoprotein (N) and phosphoprotein (P). Based on the protocol for hepatitis C, we treated the patient with 400 mg/day ribavirin, which was later increased to 600 mg/day.</p><p><strong>Results: </strong>The serological examination revealed anti-BoDV-1 N IgG. Although only subtle changes were observed over the 24 weeks of treatment, the family noticed that the patient's Cotard delusions had disappeared 7 months after completing the treatment, accompanied by some improvements in the relationship with the family.</p><p><strong>Conclusion: </strong>Though definite proof was not obtained, this presumed suppression of BoDV-1 by ribavirin leading to improvements in Cotard syndrome-like symptoms suggests that intractable schizophrenia might be one of the BoDV-1 infection phenotypes. Further studies are needed to clarify the effect of persistent BoDV-1 infections in humans.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2023 ","pages":"4899364"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9137271","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}