Psychosis, Treatment Emergent Extrapyramidal Events, and Subsequent Onset of Huntington's Disease: A Case Report and Review of the Literature.

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease characterized by a triad of progressive motor dysfunction, cognitive decline and psychiatric disturbances. The hallmark of HD is the distinctive choreiform movement disorder that typically has a subtle, insidious onset in the fourth to fifth decade of life and gradually worsens over 10 to 20 years until death. Notably, two-thirds of HD patients present with chorea and one third with mental changes. The prevalence of psychiatric symptoms is significantly higher than in the general population, and is estimated to be around 66-73%. Here, we report a unique case of subsequent onset of HD in a patient previously treated for schizophrenia and complicated by the extrapyramidal side effects to antipsychotics.

De Novo delayed onset hypothermia secondary to therapeutic doses of risperidone in bipolar affective disorder.

The commonly reported side effects related to risperidone include dizziness, nausea, weight gain, sleep disturbances, and sexual dysfunction. A rather rare and very much less documented side effect of risperidone is hypothermia: traditionally defined as a drop in core body temperature below 35°C (95°F). We report a case of a 75-year-old woman who had been treated for bipolar affective disorder for nearly 3 years with risperidone went on to develop hypothermia which was reversed with the withdrawal of the offending drug. This case is unique as it reported a rare but potentially serious side effect occurring after a prolonged administration of risperidone contrary to the previous reports in which hypothermia occurred only a few hours or days after the administration of risperidone and occurred in a patient who was diagnosed as having bipolar affective disorder as opposed to schizophrenia, the most common psychiatric disorder associated with previously reported hypothermia. The authors would like to emphasize the importance of this idiosyncratic potentially life-threatening adverse effect of risperidone-induced hypothermia to all clinicians, which occurs regardless of the duration of drug intake, in order to help them identify the condition early and treat it effectively.

Challenges in managing a mother with a dual diagnosis of peripartum cardiomyopathy and paranoid schizophrenia - a case report.

INTRODUCTION: Psychotic illness has a low incidence in the puerperal period. Peripartum cardiomyopathy as a complication of pregnancy is also rare. CLINICAL CASE: We report a case where the above two conditions occurred simultaneously in a patient and posed significant difficulties in the clinical management. She was diagnosed as having paranoid schizophrenia and peripartum cardiomyopathy. Many of the antipsychotics were contraindicated, and electroconvulsive therapy could not be administered due to the added risks involved with regard to anesthesia. She was therefore managed with clonazepam and olanzapine. DISCUSSION: This case highlights the challenges in a patient with a psychiatric illness presenting with comorbid physical illness.

Prolonged Delirium Secondary to Hypoxic-ischemic Encephalopathy Following Cardiac Arrest.

Hypoxic-ischemic brain injury encompasses a complex constellation of pathophysiological and cellular brain injury induced by hypoxia, ischemia, cytotoxicity, or combinations of these mechanisms and can result in poor outcomes including significant changes in personality and cognitive impairments in memory, cognition, and attention. We report a case of a male patient with normal premorbid functioning who developed prolonged delirium following hypoxic-ischemic brain insults subsequent to cardiac arrest. The case highlights the importance of adopting a multidisciplinary treatment approach involving the coordinated care of medical and nursing teams to optimise management of patients suffering from such a debilitating organic brain syndrome.

De novo Tardive Tourette-like syndrome after prolonged combination depot and oral neuroleptic therapy.

Introduction Tardive Tourette-like syndrome is recognised by the observation of several motor and vocal tics often in individuals receiving psychotropic medications and can happen within 1-3 months of treatment. Clinical case We report a case which is unique in its onset of Tardive Tourette-like syndrome comprising of vocal, motor tics and coprolalia after more than three decades of treatment with combination depot and oral neuroleptics. Discussion Use of the Naranjo Adverse Drug Reaction Probability Scale indicates a probable relationship between the onset of Tardive Tourettism and the antipsychotic therapy in this patient. This was in contrast to earlier reports which noted earlier onset and partial reversal with termination or change of medications. Clinicians need to pay heed to the emergence of late-onset Tourettism in order to better manage its manifestation and prevent its worsening in the context of holistic care for patients with neuropsychiatric conditions including schizophrenia.

Persistent, severe hypoglycemia-induced organic brain syndrome with neurological sequelae: a case report.

Hypoglycemia is a biochemical abnormality and often the rate-limiting step in the treatment of both type 1 and type 2 diabetes mellitus. Left uncorrected and prolonged, hypoglycemia can result in neuronal dysfunction and death, with deficits ranging from measurable cognitive impairments to aberrant behavior, seizures and coma. In this case report, hypoglycemia resulted in severe and persistent neurological (slurred speech and gait abnormalities), cognitive (inattention, disorientation and memory deficits) and behavioral manifestations (verbal hostility and irritability). It highlights the potentially severe neuropsychiatric sequelae following hypoglycemia and is timely for clinicians to be reminded that hypoglycemia prevention needs to be more of a focus of diabetes care in general.