http://casereports.bmj.com This feed contains articles for BMJ Case Reports Subject Collection "Psychiatry" BMJ Case Reports http://casereports.bmj.com http://casereports.bmj.com/cgi/content/short/2013/may09_1/bcr2013009307?rss=1 A 22-year-old lady presented to the emergency department with dyspnoea and pleuritic chest pain. Life-threatening asthma, pulmonary embolus and pneumothorax were all excluded. However, investigations did show an unexplained hypophosphataemia and raised lactate, both of which were subsequently attributed to hyperventilation with a component of panic. Here we explore the mechanism of these findings and the management of hypophosphataemia. Suarez, N. Conway, N. Pickett, T. 2013-05-09 doi:10.1136/bcr-2013-009307 Panic-related hyperventilation resulting in hypophosphataemia and a high lactate BMJ Publishing Group Ltd MAY09_1 2013 201300930 2013-05-09 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr29_1/bcr2012008538?rss=1 Research suggests that a significant proportion of inpatients in general medical wards may lack capacity to make treatment decisions, a situation that often goes unrecognised by clinicians. We would like to briefly discuss two cases from a non-psychiatric setting, where a mental disorder served to inhibit the individual's ability to weigh-up associated risks when deciding to refuse potentially life-sustaining healthcare interventions. In both cases the history of mental disorder was well established yet, for markedly different reasons, the respective presentation was such that the influence of the disorder on decision-making was not evident to the treating teams. Linn, K. Sayer, C. O'Connor, G. Magee, T. 2013-04-29 doi:10.1136/bcr-2012-008538 Reflections on mental capacity assessments in general hospitals BMJ Publishing Group Ltd APR29_1 2013 201200853 2013-04-29 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr23_1/bcr2013008978?rss=1 This article reports on the case of a 63-year-old Jamaican man who presented with progressive dysphagia and dysphonia. CT was able to visualise several large anterior cervical osteophytes, which were protruding into soft tissue structures such as the pharynx and oesophagus. Surgical removal of C3-C6 was undertaken but severe damage to local structures had already occurred. The patient remained nil by mouth and had a percutaneous gastrostomy feeding tube for means of nutrition. Four months later, despite the removal of the osteophytes, videofluoroscopy demonstrated that the patients swallow remained unsafe. The patient suffered three episodes of aspiration pneumonia and although their speech improved, they remain nil by mouth at the time of going to publication. Fox, T. P. Desai, M. K. Cavenagh, T. Mew, E. 2013-04-23 doi:10.1136/bcr-2013-008978 Diffuse idiopathic skeletal hyperostosis: a rare cause of dysphagia and dysphonia BMJ Publishing Group Ltd APR23_1 2013 201300897 2013-04-23 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr18_1/bcr2013009101?rss=1 A 48-year-old man presented with long-standing symptoms of major depression in the absence of markedly abnormal neurological findings or structural brain alterations. Antidepressive treatment, including medication and psychotherapy, had not led to significant improvement. The EEG, cerebrospinal fluid (CSF) analysis, fluorodeoxyglucose-positron emission tomography and neuropsychological testing showed pathological findings. An epileptic state provided further evidence for an organic encephalopathy. Extensively elevated thyroid-antibodies in the serum and CSF, as well as the rapid and sustained recovery after intravenous treatment with prednisolone, pointed to the diagnosis of a primarily psychiatric manifestation of a steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT). Normann, C. Frase, L. Berger, M. Nissen, C. 2013-04-18 doi:10.1136/bcr-2013-009101 Steroid-responsive depression BMJ Publishing Group Ltd APR18_1 2013 201300910 2013-04-18 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr09_1/bcr2012008215?rss=1 Psychiatric symptoms are not always best explained in the context of psychological stress. The same mental, emotional and behavioural changes also arise from various medical conditions. For a clinician this dual origin of psychiatric symptoms creates an ongoing diagnostic challenge. Our patient is a 50-year-old gentleman who had been working in a company for around 33 years and always had good appraisals. He presented to mental health services with a 5-year history of persecutory beliefs, convinced that his employers were out to damage his reputation. Apart from a diagnosis of polycythaemia, a few months before the onset of abnormal beliefs, there is no personal or family history of psychiatric disorder or medical illness. His delusions did not respond to conventional treatment with psychotropic medication possibly due to non-adherence because of side effects. However, a series of venesections lead to an improvement in mental state. Rai, R. Pieters, T. 2013-04-09 doi:10.1136/bcr-2012-008215 An unusual psychiatric presentation of polycythaemia 'Difficulties lie in our habits of thought rather than in the nature of things' Andre Tardieu BMJ Publishing Group Ltd APR09_1 2013 201200821 2013-04-09 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr05_1/bcr2012008263?rss=1 Two patients without a history of diabetes mellitus but with a history of chronic alcohol abuse were referred to our foot clinic due to pain and deformity of the midfoot. On examination both of the feet of the first patient and the left foot of the second patient were swollen and warm but all the inflammatory markers were negative. Subsequent imaging revealed Charcot deformity and the patients were treated with casting and special shoes. The temperature and the swelling of the feet after the offloading improved. x-Rays which were performed 1 and 2 years after the diagnosis did not show any progression of the Charcot deformity. Arapostathi, C. Tentolouris, N. Jude, E. B. 2013-04-05 doi:10.1136/bcr-2012-008263 Charcot foot associated with chronic alcohol abuse BMJ Publishing Group Ltd APR05_1 2013 201200826 2013-04-05 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/mar25_1/bcr2012006604?rss=1 A 23-year-old woman with anorexia nervosa (AN) and a strong need for control was offered an integrative treatment, empowering the patient to be an active participant and advocating shared decision-making. To emphasise this, both the therapist and patient describe their views on the therapy. The integrative treatment resulted in more psychological flexibility and behavioural improvements, as is evident from an increased weight, a decreased dietary restriction and an increased valued action. The strength of this integrative treatment is based on accepting and encouraging patient's self-chosen treatment method, within healthy limits, and thereby creating a flexible, supportive and empowering therapeutic alliance. More research is needed to test the efficacy of combining complementary therapies within conventional treatments of AN. Hartogs, B. M. A. Eikmans, K. M. Bartels-Velthuis, A. A. 2013-03-25 doi:10.1136/bcr-2012-006604 Melting down the Ice Queen: an integrative treatment of anorexia nervosa BMJ Publishing Group Ltd MAR25_1 2013 201200660 2013-03-25 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/mar15_1/bcr2013008929?rss=1 Description A 50-year-old woman presented to the emergency department with history of lower retrosternal chest discomfort and acute dysphagia. Questioning revealed that she had consumed large pieces clay ([~]200 g) half an hour prior to the chest pain. She had made desperate attempts to relieve the dyspagia by drinking water which made her condition worse. She worked in a boutique and used these dry clay pieces as a cheap alternative to tailor's chalk'. On examination she was anxious, restless and saliva was drooling from her mouth. The hemodynamic parameters and bedside ECG were within normal limits. An upper gastrointestinal endoscopy (UGIE) demonstrated a big impacted lump of the clay causing complete obstruction of the lower esophagus (Ofigure 1). In addition, there were small bits and large pieces of unchewed clay and other detritus lying along the esophageal wall. The clay was removed pie ... Gupta, M. Sachdev, A. Lehl, S. S. Singh, K. 2013-03-15 doi:10.1136/bcr-2013-008929 Clay impaction causing acute dysphagia BMJ Publishing Group Ltd MAR15_1 2013 201300892 2013-03-15 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/feb20_1/bcr2012008314?rss=1 This case demonstrates an acute presentation of unwitnessed seizure causing typical injuries. Progress in hospital was complicated by worsening autonomic disturbance and agitation, typical for serotonin syndrome, suspected in light of recent selective serotonin reuptake inhibitor antidepressant initiation. Supportive care required treatment in the intensive care unit setting but full recovery ensued. This case not only reminds clinicians of the potential pitfalls in assessing postictal injured patients, but also that serotonin syndrome requires a high-index of diagnostic suspicion given the range of presenting features. Management ranges from simple withdrawal of the offending agent to specific therapies such as a cyproheptadine. Proudfoot, M. Gormley, J. 2013-02-20 doi:10.1136/bcr-2012-008314 Serotonin syndrome: pills, thrills and shoulder aches BMJ Publishing Group Ltd FEB20_1 2013 201200831 2013-02-20 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/feb15_1/bcr2012008286?rss=1 Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism. Its clinical diagnosis has considerably changed during recent times, with MRI of the brain paving way for in life diagnosis. We believe that physicians need to have a high index of suspicion, because acute onset MBD is not always fatal and complete recovery is possible, provided the diagnosis is made early and treated appropriately. We report a case of MBD who was diagnosed early in the disease course with subsequent clinical and radiological recovery on institution of appropriate treatment. Sehgal, V. Kesav, P. Modi, M. Ahuja, C. K. 2013-02-15 doi:10.1136/bcr-2012-008286 Acute Marchiafava-Bignami disease presenting as reversible dementia in a chronic alcoholic BMJ Publishing Group Ltd FEB15_1 2013 201200828 2013-02-15 CASE-REPORT