Myxedema Psychosis after Levothyroxine Withdrawal in Radioactive Iodine Treatment of Differentiated Thyroid Cancer: A Case Report

Neuropsychiatric symptoms, especially acute psychosis (often referred to as myxedema madness or psychosis), are rare but possible clinical presentations of patients with hypothyroidism. A 42-year-old woman with papillary thyroid carcinoma and recent total thyroidectomy had developed flat affect, paranoid delusion, and visual and auditory hallucination during inpatient admission for elective radioactive iodine treatment. On admission, her history and physical exam did not reveal symptoms and signs of significant hypothyroidism. Other medical causes of acute psychosis were excluded, and the patient was immediately treated with thyroid hormone replacement therapy. Subsequently, her thyroid function normalized, and her psychotic symptoms gradually improved. Although there is a lack of classic signs and symptoms of hypothyroidism, myxedema madness should be recognized as one of the potentially treatable causes of acute psychosis.

Remission of depression in patients with schizophrenia and comorbid major depressive disorder: results from the FACE-SZ cohort

BackgroundMajor depressive disorder (MDD) is underdiagnosed and undertreated in schizophrenia, and has been strongly associated with impaired quality of life.AimsTo determine the prevalence and associated factors of MDD and unremitted MDD in schizophrenia, to compare treated and non-treated MDD.MethodParticipants were included in the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment. MDD was defined by a Calgary score ≥6. Non-remitted MDD was defined by current antidepressant treatment (unchanged for >8 weeks) and current Calgary score ≥6.Results613 patients were included and 175 (28.5%) were identified with current MDD. MDD has been significantly associated with respectively paranoid delusion (odds ratio 1.8; P = 0.01), avolition (odds ratio 1.8; P = 0.02), blunted affect (odds ratio 1.7; P = 0.04) and benzodiazepine consumption (odds ratio 1.8; P = 0.02). Antidepressants were associated with lower depressive symptoms score (5.4 v. 9.5; P < 0.0001); however, 44.1% of treated patients remained in non-remittance MDD. Nonremitters were found to have more paranoid delusion (odds ratio 2.3; P = 0.009) and more current alcohol misuse disorder (odds ratio 4.8; P = 0.04). No antidepressant class or specific antipsychotic were associated with higher or lower response to antidepressant treatment. MDD was associated with Metabolic syndrome (31.4 v. 20.2%; P = 0.006) but not with increased C-reactive protein.ConclusionsAntidepressant administration is associated with lower depressive symptom level in patients with schizophrenia and MDD. Paranoid delusions and alcohol misuse disorder should be specifically explored and treated in cases of non-remission under treatment. MetS may play a role in MDD onset and/or maintenance in patients with schizophrenia.Declaration of interestNone.

Mood Disorder Masking Delusional Disorder

This is a case of a 44 years old lady, married and working as a maid. She presented with prominent depressed mood in addition to feeling worthless. She was unable to sleep and felt lethargic during the day. She also expressed death wishes without active suicidal plans. She was treated for Major Depressive Disorder initially. However, her symptoms of depression did not resolve with trial of various antidepressants of adequate dosage and duration. Further exploration and collateral history from family members revealed that her mood symptoms were stem from paranoid delusion towards her husband and his family. As a result of her delusion, she also faced with difficulties in interaction and intimacy with her husband and his family and thus affected her marriage. She was started on antipsychotic, in which, she responded well to it.

Freud's Fictions: Fixation, Femininity, Photography

This article takes off from Freud's literary use of the term ‘fixation’ to explore how female sexuality both establishes the universal foundations of Freud's metapsychology and is excluded from it via a reading of one Freud's strangest and most provocative case presentations. Like a primal word, fixation operates in contradictory fashion: it is associated both with regression and futurity, petrified immobility and contingency. Fixation is Freud's name both for the primal origin of sexuality and the very word for what shuts sexuality down. In ‘A Case of Paranoia Running Counter to the Disease’, the first case history devoted to a woman after Dora, Freud recounts his brief encounter with a woman who is brought to Freud because she is suffering from a (presumably) paranoid delusion that her would-be lover has arranged to have her photographed during their sexual engagements. On the basis of his fictionalized account of this fictive case (the woman never actually enters into treatment with him), Freud establishes a curiously suggestive link between fixation, femininity and photography, and introduces, for the first time, the notion of ‘primal phantasies’. By looking how femininity, fixation and photography come together, this article explores how and why Freud attributes quasi-photographic powers to female sexuality as a means of trying to produce a figure for unseen and un-seeable images that come from a primal and unrecoverable past.

Paramethoxymethamphetamine (Mitsubishi turbo) abuse: Case report and literature review

IntroductionParamethoxymethamphetamine and paramethoxyamphetamine (PMMA and PMA) are two so-called designer amphetamines, which appear from time to time on the illegal narcotics market in many countries. They are frequently sold as ecstasy or amphetamine, often mixed with amphetamine or methamphetamine [1, 2]. Paramethoxyamphetamine (PMA) is a hallucinogenic synthetic substituted amphetamine with capable of development of dependence [3]. The purpose of this report is to review the clinical evidence for the potential of abuse of paramethoxyamphetamine. We propouse a case report and literature review.MethodWe conducted a systematic review of the literature with the principal database (PubMed, Enbase, PsychInfo) and we present a case report.ResultsThe effects of paramethoxyamphetamine is characterized at the beginning with symptoms like euphoria, derealizzation, psychomotor activation, feeling in tune with surroundings and in love for friends, who come to visual and auditory illusions and hallucinations, paranoid delusion, and violent agitation.Discussion and conclusionThe use of these recreational drugs is especially common among young people participating in rave parties. Occasionally paramethoxymethamphetamine (PMMA) or paramethoxyamphetamine (PMA) are found in street drugs offered as ecstasy. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case report: Sanchís-Banús syndrome

IntroductionThere are few reported cases relating visual acuity and psychosis. The Spanish psychiatrist Sanchís-Banús focused on two patients who became blind and who, due to stress developed paranoid and jealousy delusional ideas. He called it “Sanchís-Banús syndrome” (SBS) that is mentioned in the psychiatry literature.MethodologyA case report. We present a case of “paranoid delusion of the blind” (SBS), quite similar in its clinical characteristics to those of the original patients of the valencian psychiatrist Sanchís-Banús. In our case, we met a 46-years-old woman, who worked as a lottery seller because she had a visual problem: retinitis pigmentosa. She had had her first psychotic decompensation when the blindness started. In spite of having achieved good social and work performance with quetiapine 400 mg/daily, laboral conflicts and stress caused her delusional ideas again. She began to think that her mother was not her real mother (Capgras syndrome) and that she was being persecuted. She also did not eat the meal and did not drink water because she thought that they were contaminated.ResultsWe started treatment with clozapine at doses of 300 mg every day (50-50-200) combined with aripiprazole15 mg/day tolerating the medication without notable effects. After this adjustment of medication, remission and good criticism of hallucinatory and delusional clinical course. The nosological, clinical, and prognostic features of SBS are discussed in light of the current literature.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Case Report on Management of Father Daughter Incest with Schizophrenia

Incest is a neglected and hidden public health problem. This case is about a patient who was victim of sexual abuse, suffered from schizophrenia and abused his biological daughter. He was physically and sexually abused by seniors and classmates, developed paranoid delusion and auditory hallucination. During the course of the illness, he was hospitalized several times as a case of schizophrenia and sexual dysfunction was his main concern. The patient’s illness followed a waxing and waning course. He took medication on on-and-off basis. He abused his biological daughter sexually at the later stage of the illness. Ultimately, the patient attempted suicide after an indecent sexual act with another relative and he was admitted to the hospital. He was treated with risperidone that was titrated to 10 mg per day. After continuing the medication for 2 years he regained a functioning life and remained stable with medication. This case shows the importance of exploring the sexual behavior of the patients and sharing the experience may help in the treatment of schizophrenia patients with incest.