scholarly journals Graves’ disease presenting with hypomania and paranoia to the acute psychiatry service

2021 ◽  
Vol 14 (2) ◽  
pp. e236089
Author(s):  
Benjamin Bennett ◽  
Ajay Mansingh ◽  
Cormac Fenton ◽  
Jonathan Katz
Keyword(s):  
Young Woman ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Psychiatric Symptoms ◽  
Graves Disease ◽  
Psychiatric History ◽  
Organic Disease ◽  
Acute Psychiatry ◽  
Psychiatric Conditions ◽  
Mood Lability

This manuscript describes the case of a young woman, with no prior psychiatric history, who developed hypomania and paranoia as the principal presenting features of Graves’ disease. After starting treatment with carbimazole and propranolol, symptoms resolved without the use of antipsychotic drugs. Close liaison between psychiatry and endocrinology services was essential. This demonstrates that treating underlying thyrotoxicosis in patients presenting with psychiatric symptoms may lead to recovery without the use of antipsychotic medication. While agitation, irritability and mood lability are well-recognised thyrotoxic symptoms, psychosis is a rare presenting feature of Graves’ disease. All patients with agitation, delirium or psychiatric symptoms should have thyroid function checked as part of initial tests screening for organic disease. In new or relapsing psychiatric conditions, it is important to ask patients, their carers or relatives about symptoms of hypothyroidism or thyrotoxicosis.

scholarly journals A Case of Violent Suicide Attempt in a Context of Myxedema Psychosis following Radioiodine Treatment in a Patient with Graves’ Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Louise Todorov ◽  
Amel Ait Boudaoud ◽  
Rachel Pascal de Raykeer ◽  
Alina Radu ◽  
Khadija Lahlou-Laforêt ◽  
...  
Keyword(s):  
Suicide Attempt ◽  
Suicide Attempts ◽  
Psychiatric Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Psychosocial Stressors ◽  
Antipsychotic Treatment ◽  
Graves Disease ◽  
Persecutory Delusions ◽  
Psychiatric Units ◽  
Command Hallucinations

Introduction. Hypothyroidism has been associated with mood disorders but some cases of acute psychosis have also been reported. However, less attention has been paid to suicidal behavior in these patients. Case Report. We report a case of suicide attempt by self-stabbing in a 43-year-old woman without past psychiatric history, four months after radioiodine therapy for Graves’ disease. On clinical examination remarkable signs of myxedema were found and blood investigations showed hypothyroidism with an extremely high thyroid stimulating hormone (TSH) level (152 mUI/L; reference range 0.20-5.10). The patient presented delirium symptoms at the time of self-stabbing, which was associated with persecutory delusions and auditory harm command hallucinations. A rapid physical and psychiatric improvement was observed after the initiation of an oral thyroid replacement therapy without relapse after early discontinuation of the antipsychotic treatment. Discussion. The most distinctive feature of our case is that the violent suicide attempt could be attributed to the myxedema psychosis. Suicide may result from several factors, including psychosocial stressors, psychiatric symptoms, and hormonal disturbance. This unique presentation should remind clinicians to systematically consider ordering additional tests in patients with atypical psychiatric presentation, even when serious behavioral disorders (such as violent suicide attempts) are present and may result in premature transfer to psychiatric units.

Psychiatry in gastrointestinal medicine

2018 ◽  
Author(s):  
Satish Keshav ◽  
Alexandra Kent
Keyword(s):  
Inflammatory Bowel Disease ◽  
Eating Disorders ◽  
Hepatic Encephalopathy ◽  
Side Effects ◽  
Bowel Disease ◽  
Psychiatric Symptoms ◽  
Acute Intermittent Porphyria ◽  
Gastrointestinal Medicine ◽  
Inflammatory Bowel ◽  
Psychiatric Conditions

This chapter discusses psychiatric conditions with gastrointestinal (GI) consequences (including eating disorders, depression, and side effects of psychiatric medications), and GI diseases with psychiatric symptoms (including hepatic encephalopathy, coeliac disease, Wilson’s disease, acute intermittent porphyria, functional GI disease, and inflammatory bowel disease).

scholarly journals Exophthalmos in a young woman with no Graves’ disease – a case report of IgG4-related orbitopathy

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Annamaria Erdei ◽  
Zita Steiber ◽  
Csaba Molnar ◽  
Ervin Berenyi ◽  
Endre V. Nagy
Keyword(s):  
Case Report ◽  
Young Woman ◽  
Graves Disease

Serum prolactin levels and sexual dysfunctions in antipsychotic medication, such as risperidone: a review

2000 ◽  
Vol 12 (1) ◽  
pp. 19-26 ◽  
Author(s):  
H. Knegtering ◽  
P.A. Lambers ◽  
G. Prakken ◽  
C. ten Brink
Keyword(s):  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
University Hospital ◽  
Serum Prolactin ◽  
Sexual Dysfunctions ◽  
Receptor Blockade ◽  
Naturalistic Study ◽  
Serotonergic Receptor ◽  
Male Patients ◽  
The University

SUMMARYClassical antipsychotic drugs increase the level of serum prolactin. The atypical antipsychotic clozapine barely increases prolactin levels. An open naturalistic study in the University Hospital of Groningen suggests that treatment with risperidone in comparison to classical antipsychotics seems to increase the risk of erectile and ejaculatory disorders in male patients and to menstrual disturbances in female patients. In the literature reviewed, risperidone is associated with higher prolactin levels in comparison to classical antipsychotics. It is still unclear which mechanism is responsible for the increase of serum prolactin levels and sexual dysfunctions in patients using risperidone. Dopaminergic and serotonergic receptor blockade seems to play an important role. Other mechanisms are discussed.

Graves’ Hyperthyroidism-Induced Psychosis Treated With Aripiprazole—A Case Report

2012 ◽  
Vol 26 (1) ◽  
pp. 59-61 ◽  
Author(s):  
Livia R. Macedo ◽  
Jehan Marino ◽  
Brady Bradshaw ◽  
Joseph Henry
Keyword(s):  
Atrial Fibrillation ◽  
Psychiatric Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Long Term Effects ◽  
Free T4 ◽  
History Of ◽  
Antithyroid Peroxidase Antibody ◽  
First Time

Graves’ disease is an autoimmune syndrome with symptoms such as tachycardia, atrial fibrillation, and psychiatric symptoms. Limited evidence exists for the treatment of Graves’ hyperthyroidism-induced psychosis with atypical antipsychotics. A 47-year-old female with a psychiatric history of bipolar disorder presented for the first time to the psychiatric hospital. She was agitated and grossly psychotic with delusions. Electrocardiogram showed atrial fibrillation and tachycardia. Drug screen urinalysis was negative. Endocrine workup resulted in a diagnosis of Graves’ disease (thyroid-stimulating hormone [TSH]: 0.005 μIU/mL, triiodothyronine [T3]: 537 ng/dL, thyroxine [T4]: 24 mcg/dL, free T4: 4.5 ng/dL, positive antithyroid peroxidase antibody, and antinuclear antibody). Aripiprazole 10 mg daily was initiated and titrated to 15 mg daily on day 4. On day 16, her suspicious behavior, judgment, and insight improved. Other medications given included aspirin 325 mg daily, metoprolol 25 mg twice daily, titrated to 12.5 mg twice daily, and methimazole 30 mg daily, titrated to 20 mg twice daily, and discontinued on day 29. The patient received radioiodine I-131 treatment 1 week later. We report the first known case on the use of aripriprazole to treat Graves’ hyperthyroidism-induced psychosis. Further studies examining the long-term effects and appropriate dose and duration of aripiprazole in this patient population are needed.

scholarly journals High-dose antipsychotic medication

1996 ◽  
Vol 20 (11) ◽  
pp. 676-680 ◽  
Author(s):  
Peter L. Cornwall ◽  
Fuad Hassanyeh ◽  
Caprice Horn
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Maximum Dose ◽  
High Dose ◽  
National Formulary ◽  
Physical Status ◽  
High Dose Treatment

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.

scholarly journals Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial

2011 ◽  
Vol 42 (5) ◽  
pp. 1049-1056 ◽  
Author(s):  
A. P. Morrison ◽  
P. Hutton ◽  
M. Wardle ◽  
H. Spencer ◽  
S. Barratt ◽  
...  
Keyword(s):  
Cognitive Therapy ◽  
Antipsychotic Medication ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Controlled Trial ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
End Of Treatment ◽  
Secondary Outcomes

BackgroundAlthough antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months.MethodTwenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning.ResultsT tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen's d effect sizes were moderate to large [for PANSS total, d=0.85, 95% confidence interval (CI) 0.32–1.35 at end of treatment; d=1.26, 95% CI 0.66–1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly.ConclusionsThis study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.

scholarly journals Psychosis Crisis Associated with Thyrotoxicosis due to Graves’ Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Lilibet Urias-Uribe ◽  
Emmanuel Valdez-Solis ◽  
Claudia González-Milán ◽  
Claudia Ramírez-Rentería ◽  
Aldo Ferreira-Hermosillo
Keyword(s):  
Cerebrospinal Fluid ◽  
Electroconvulsive Therapy ◽  
Psychiatric Illness ◽  
Psychiatric Symptoms ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Thyroid Antibodies ◽  
Hashimoto’S Encephalopathy

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.

Relationship between Narcissistic Tendencies and Psychiatric Conditions in Patients Undergoing Physical Rehabilitation

1996 ◽  
Vol 83 (2) ◽  
pp. 403-408 ◽  
Author(s):  
Isao Fukunishi ◽  
Takayuki Aoki
Keyword(s):  
Patient Group ◽  
Psychiatric Symptoms ◽  
Adjustment Disorder ◽  
Physical Rehabilitation ◽  
The Self ◽  
Control Group ◽  
Self Sufficiency ◽  
Significant Difference ◽  
Healthy Control ◽  
Psychiatric Conditions

This study examined the relationship between psychiatric conditions and narcissism in 78 patients with physical rehabilitation for illnesses such as cerebrovascular disease. The frequency of psychiatric disorders (Major Depression and Adjustment Disorder) was significantly higher for the patient group than for the healthy control group. The patients had significantly higher scores on measures of psychiatric symptoms including depression and lower scores on a narcissistic factor (Self-sufficiency) than the controls. In the patient group, the Self-sufficiency scores were significantly and positively correlated with Vigor scores In the patient and control groups, although the correlation coefficient was not high and no significant difference was noted, the Self-sufficiency scores were negatively correlated with the Depression scores. These findings suggest that, in patients undergoing physical rehabilitation, poor Self-sufficiency is related to a decrease in vigor as a depressive symptom, perhaps due to the loss of physical functioning.

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