Clinical Reasoning and Challenges Faced With Onset Psychotic Symptoms in a Case of Combined Huntington's Disease and Gayet-Wernicke Encephalopathy.

Physicians are occasionally confronted with patients presenting psychotic symptoms of organic origin. Therefore, precision in diagnosing the organic basis is pivotal for targeted treatment, addressing the underlying etiology. This case study delineates the nuanced phases of clinical reasoning employed to ascertain a diagnosis of Huntington's disease (HD), notably amidst concurrent alcohol dependence. A comprehensive clinical examination and meticulous review of the patient's medical history served as linchpins in guiding subsequent investigations toward identifying the etiological underpinnings of the psychotic symptomatology. Furthermore, this case sheds light on the uncommon overlap of HD and Wernicke's encephalopathy, compounding diagnostic complexities, especially given the polymorphic nature of HD. The diagnostic intricacies needed precise analysis of the clinical picture and a deep understanding of potential interactions between neurological pathologies and the deleterious effects of alcoholism on the nervous system.

Myxedema Psychosis: Diagnostic Challenges and Management Strategies in Hypothyroidism-Induced Psychosis.

Myxedema psychosis (MP), a rare psychiatric manifestation of hypothyroidism, presents significant diagnostic and therapeutic challenges. This case report details the presentation, diagnosis, and successful management of a 60-year-old woman with MP, who was initially admitted to the psychiatric department for new-onset psychosis following the cessation of hormone replacement therapy after a subtotal thyroidectomy performed 20 years prior. Despite the rarity of psychosis as an initial presentation of hypothyroidism, this case underscores the critical importance of considering endocrine disorders in the differential diagnosis of unexplained psychotic symptoms. The clinical findings included a polymorphic delusional system and auditory hallucinations, without significant abnormalities on magnetic resonance imaging. Elevated thyroid-stimulating hormone (TSH) levels confirmed hypothyroidism, leading to the diagnosis of MP. Treatment with l-thyroxine resulted in complete resolution of symptoms in three weeks, highlighting the efficacy of hormone replacement therapy. This case contributes to the limited literature on MP and echoes the need for awareness among clinicians to ensure timely and accurate diagnosis and treatment.