[Dreaming madly or escaping reality through dreams?] / Rêver à la folie ou échapper au réel par le rêve ?

Dreams can be seen as a way of letting your mind wander while you're awake, an act of imagination that occurs during sleep, or a more or less chimerical imaginary representation of what you ardently hope for. In all three cases, it questions both our relationship with reality (what exists in itself) and with reality (what I perceive and understand of reality). From this point of view, dreams and madness are undeniably two experiences that radically question our access to reality.

'Eccentricity', by DH Tuke (1892).

An astronomical concept up to the eighteenth century, 'eccentricity' started to be used to refer to behaviours considered as odd, strange, rare, extravagant, etc. Once reified into a personality trait, it gained explanatory power. This not only increased its popularity but also facilitated its links with psychopathology and neuropsychology, and, via the shared concept of madness, with the notions of genius and creativity. This Classic Text describes the process whereby Alienism (Psychiatry) medicalized eccentricity. To this day, the latter remains firmly attached to 'psychoticism' and to some personality disorders.

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.

De lunatico inquirendo: managing family inheritance across madness in eighteenth-century London.

An 'inquisition' (or inquiry) held before a Justice of the Peace was the primary instrument for management of lunacy in eighteenth-century England. Yet its purpose was to protect wealth rather than the individual. The 1766 case book of Dr John Monro, London's leading doctor for madness, unexpectedly records a consultation that links two siblings who both had inquisitions. Nicholas Jeffreys' only son was attested lunatic in 1744: to circumvent inheritance through primogeniture, Jeffreys directed the family wealth to his last living child. One of his three daughters married Lord Camden, a former Lord Chancellor: after her and her second sister's deaths, the last-surviving sister was also placed under inquisition in 1780, to ensure the inheritance for his own family.

Discursos e imágenes sobre la desigualdad. Políticas públicas e institucionalización de la locura en el noroeste argentino (1935-1954) / Discourses and images on inequality. Public policy and institutionalization of madness in the argentinean northwest (1935-1954)

En la presente investigación analizaremos la primera institución psiquiátrica del noroeste argentino, específicamente en la provincia de Tucumán, el Hospital de Alienados (HA), desde el evento que impulsó su creación -la negativa de traslados interprovinciales de pacientes a colonias nacionales en 1935- hasta el retorno a dicha práctica por parte del Estado nacional -en 1954-. Hasta la creación del HA, las posibles respuestas para las personas con problemáticas psiquiátricas eran el traslado a instituciones en otras provincias o el encierro en un asilo de la ciudad y en establecimientos policiales. Ante las graves consecuencias de las últimas alternativas, y la cancelación de los traslados, tuvo que ser el propio Estado provincial el que hiciera frente a la problemática. El HA se constituyó como el primero en Argentina en pertenecer a un Estado provincial y no depender de las arcas nacionales. Este trabajo inaugural en los estudios historiográficos de la región nos permitirá analizar algunos procesos institucionales de las políticas en salud mental a nivel provincial y nacional, las concepciones sobre locura y encierro que se sostenían en aquella época, el flagelo de la pobreza como causa para enloquecer y el efecto de todo lo anterior en la opinión pública.(AU)

In the present investigation we will analyze the first psychiatric institution in northwestern Argentina, specifically in the province of Tucumán, the Hospital de Alienados (HA), from the event that prompted its creation -the refusal of interprovincial transfers of patients to national colonies in 1935- until the return to this practice by the national State -in 1954-Until the creation of the HA, the possible responses for people with psychiatric problems were transfer to institutions in other provinces or confinement in a city asylum and in police establishments. Given the serious consequences of the last alternatives, and the cancellation of the transfers, it had to be the provincial State itself that faced the problem. The HA was established as the first in Argentina to belong to a provincial State and not depend on the national coffers. This inaugural work in the historiographical studies of the region will allow us to analyze some institutional processes of mental health policies at the provincial and national level, the conceptions about madness and confinement that were held at that time, the scourge of poverty as a cause of craziness, and the effect of all of the above on public opinion.(AU)

Detransition Narratives Trouble the Simple Attribution of Madness in Transantagonistic Contexts: A Qualitative Analysis of 16 Canadians' Experiences.

Emerging evidence suggests that transgender individuals are more likely than cisgender peers to receive a diagnosis with a primary mental disorder. Attributions of madness, though, may serve the social function of dismissing and discrediting transgender individual's self-perceptions. The narratives of individuals who stop or reverse an initial gender transition who also identify as living with mental health conditions can sometimes amplify these socio-political discourses about transgender people. Through a critical mental health lens, this article presents a qualitative analysis of 16 individuals who stopped or reversed a gender transition and who also reported a primary mental health condition. Semi-structured, virtual interviews were conducted with people living in Canada. Applying constructivist grounded theory methodology, and following an iterative, inductive approach to analysis, we used the constant comparative method to analyse these 16 in-depth interviews. Results show rich complexity such that participants narrated madness in nuanced and complex ways while disrupting biased attitudes that madness discredited their thoughts and feelings, including prior gender dysphoria. Instead, participants incorporated madness into expanding self-awareness and narrated their thoughts and feelings as valid and worthy. Future research must consider provider's perspectives, though, in treating mad individuals who detransitioned, since alternate gender-affirming care models may better support the identification and wellness of care-seeking individuals who may be identified (in the past, present, or future) as mad.

[Les demoiselles de Rochefort, or a clinical illustration of madness in pairs]. / Les demoiselles de Rochefort, ou une illustration clinique de folie à deux.

Although folie à deux is a confidential entity that has disappeared from psychiatric textbooks and is disguised in current international classifications of mental disorders, which tend to obscure the fundamental notion of the dyad, recent case reports highlight the topicality of the disorder. The richness of the clinical encounter with twin sisters, presenting a common delusion of parasitic infestation, may prompt us to question the disorder differently, guided in particular by ancient writings and the analytic compass.

European madness 1910-1980: lessons for today from Alastair Morgan's Continental Philosophy of Psychiatry: The Lure of Madness.

In Continental Philosophy of Psychiatry: The Lure of Madness Alastair Morgan surveys the contributions of a loosely conceived school of psychiatrists, philosophers and social theorists to understanding and responding to madness during the years 1910-1980. Taking my cue from him, I highlight some of the contributors discussed in Morgan's book and reflect that although madness may be difficult or even impossible to articulate effectively in discourse it remains a 'limit experience' which demarcates and illuminates the contours of other thinking and being, including reason and activism. I discuss social and cultural factors that have dulled clinicians' sensitivities to the sounds of madness in recent decades and advocate the need for a reappraisal of our expertise and for a new activism today. What may at first appear as a failed clinical-philosophical tradition remains of professional relevance in today's rapidly transforming circumstances of practice both as inspiration and as cautionary tale.

Maddening pre-service early childhood education and care through poetics: Dismantling epistemic injustice through mad autobiographical poetics.

In this article, the author forwards the importance of mad autobiographical poetic writing to challenge and disrupt epistemic injustice within pre-service early childhood education and care. They explore their own mad autobiographical poetic writing as a queer, non-binary, mad early childhood educator and pre-service early childhood education and care faculty member, and argue that mad poetic writing can methodologically be used as a form of resistance to epistemic injustices and epistemological erasure in early childhood education and care. This article argues for the importance of autobiographical writing in early childhood education and care, and the necessity of centralizing early childhood educators' subjectivities and histories when addressing - and transforming - issues of equity, inclusion and belonging in early childhood education and care. The personal and intimate mad autobiographical poetic writing of this article - written by the author - focuses on how personal experience with madness as it pertains to working within pre-service early childhood education and care can challenge norms that govern and regulate madness. Ultimately, the author argues that transformation in early childhood education and care can take place by reflecting on experiences of mental and emotional distress, and considering poetic writings as starting places for imagining new futurities and a plurality of educator voices and perspectives.

Approaching Polish madness: concepts and treatment of psychosis in Polish psychiatry of the inter-war period.

The institutional organization of psychiatry in Poland when it became independent faced the problem of the integration of three ex-partition territories having different laws, health-care systems and psychiatric cultures. Due to the high incidence of mental health problems, among which psychosis was the most frequent, psychiatric care facilities had to be organized as quickly and efficiently as possible and had to address the issue of psychosis both conceptually and practically. This study investigates the concept of psychosis and methods of its treatment in inter-war Polish psychiatric care facilities in relation to the sociocultural context of the institutional organization of psychiatry in Poland and the influence of major European concepts and treatment practices regarding psychoses.

Entre mujeres-locas y hombres-psiquiatras: asimetrías emocionales en la sala 20 del Manicomio Provincial de Málaga (1909-1950) / Between female psychiatric patients and male psychiatrists: emotional asymmetries in room 20 of the provincial institute of malaga (1909-1950)

El tipo de relación que se desarrollaba entre un psiquiatra (hombre) y una paciente (mujer) durante la primera mitad del siglo XX, en un psiquiátrico de la periferia como el Manicomio Provincial de Málaga, estuvo marcado por el proceso legitimador de la especialidad, los esfuerzos por encontrar datos positivos en la medicina mental, así como elementos relacionados con la construcción generizada de la locura. Tras la Guerra Civil, veremos el desarrollo de los actos diagnósticos y la aplicación de las terapias de choque en la institución, y como se fue haciendo aún más profunda la brecha relacional entre psiquiatras y “locas”. El objetivo de este trabajo es abordar qué elementos estuvieron presentes en la construcción de las subjetividades de las mujeres-locas de la sala 20, qué regímenes emocionales influyeron en estas relaciones y mostrar, por último, cómo la tecnificación de la terapéutica durante los años 40 dio lugar a la perpetuación y amplificación de una asimetría emocional entre psiquiatras y “mujeres-locas” de la sala 20, circunstancia en la que las mujeres mostraron también sus estrategias de resistencia.(AU)

The type of relationship that was developed between a psychiatrist (male) and a patient (female) during the first half of the 20th century in a psychiatric hospital on the outskirts such as the Provincial Asylum of Malaga, sustained many peculiarities related to the legitimizing process of the specialty, the efforts to find positive data in mental medicine, as well as elements related to the gendered construction of madness. After the Civil War, National Catholicism permeated the diagnostic acts and the application of shock therapies in the institution, deepening the gap between psychiatrists and mad women. The objective of this work is to highlight what elements were present in the construction of the subjectivities of the mad women in room 20, what emotional regimes influenced these relationships and to show, finally, how the technification of therapeutics during the 40s gave rise to the perpetuation and amplification of an emotional asymmetry between psychiatrists and mad women in room 20, a circumstance in which the women also developed their strategies of resistance.(AU)

Representação de professoras em Mário de Andrade: Loucura e velhice / Representation of female teachers in Mário de Andrade: Madness and old age

O presente artigo busca analisar as representações de professoras presentes no conto "Atrás da Catedral de Ruão" (1947) e no romance Amar, verbo intransitivo (1944), ambos de Mário de Andrade, com ênfase nas questões insertas sobre a noção de velhice e loucura. São textos escritos sob a égide do Modernismo e que tematizaram as respectivas práticas pedagógicas, mas ressaltam também as angústias de mulheres trabalhadoras e itinerantes, que são malvistas por exercerem funções de natureza pública em espaços privados. Se por um lado era emblemático o fato de ser mulher, por outro, eram ainda mais acentuados os destaques feitos pelo escritor, pois a idade estava à mostra e a loucura era vista como condição inata de um gênero supostamente inferior. A literatura no presente estudo significou importante artefato cultural, também serviu como peculiar fonte para interpretação pelos historiadores do presente, de modo que o método aqui utilizado foi aquele sintetizado na noção de operação historiográfica preconizada por Michel de Certeau (1975/2020).

This paper analyzes the representations of female teachers in the short story "Behind Ruão's Cathedral" (1947) and in the novel "To Love, intransitive verb" (1944), both by Mário de Andrade, with emphasis on the questions about the notion of old age and madness. These texts were written under the aegis of Modernism, and they thematize the respective pedagogical practices, but also highlight the anguish of working and itinerant women, who are disliked for performing public functions in private spaces. If on the one hand it was emblematic that she was a woman, on the other, the writer's highlights were even more pronounced, for age was on display and madness was seen as an innate condition of a supposedly inferior gender. Literature in the present study meant an important cultural artifact, and also served as a peculiar source for interpretation by historians of the present, so that the method used here was that synthesized in the notion of historiographical operation advocated by Michel de Certeau (1975/2020).

Psychiatrization, assertions of epistemic justice, and the question of agency.

Thus far, the concept of epistemic injustice in the context of psychiatry has been discussed more widely by clinical academics than by authors with personal experience of psychiatrization. It is from the latter perspective that I critique the practice of attributing testimonial injustice solely to the "stigma against mental illness", and point to psychiatric diagnosing itself as a principal enabler and re-producer of this form of injustice. In relation to hermeneutical justice, I take a closer look at initiatives seeking to incorporate (collective) first-person knowledge into the epistemic systems that currently dominate mental-health service provision and research. Highlighting the incompatibility of psychiatric knowledge claims with first-person ways of knowing, I discuss some of the issues and challenges involved in achieving epistemic justice for psychiatrized people and advancing our collective knowledge base. Finally, I turn to the questions of identity and agency in these processes.

The Surgeon, or The Extraction of the Stone of Madness, by Jan Sanders van Hemessen (c 1500-1566).

The Surgeon, or The Extraction of the Stone of Madness is one of the most striking representations of neurosurgery in art. The focus of the painting is occupied by a surgeon who, with a concentrated gaze and wry smile, attempts to remove a stone from the forehead of an anguished young man who is tied to a chair, crying in agony. The artist of this dramatic work is the relatively obscure Jan Sanders van Hemessen (c 1500-1566). Hemessen lived in a time of artistic ferment in the Netherlands as conservative local traditions gave way to new ideas imported from Italy, which marked the beginning of the Romanism period. Romanists were aspiring young Netherlandish artists who traveled to Rome, Florence, Milan, and Venice to study the works of High Renaissance masters such as Michelangelo, Raphael, and Leonardo da Vinci. With these lessons in mind, they combined the typical features of early Netherlandish painting-a high degree of realism, the use of symbolic iconography, and a focus on genre painting and still life-with the dramatic gestures, heroic postures, chiaroscuro, space and volume, and grand humanistic themes of the Italian Renaissance. Hemessen's interpretation of the allegory of the stone of madness reveals these Italian influences while also retaining the early Netherlandish tradition of realism and iconography, in which the objective world represents a realm of symbolic implication carrying allegorical moralistic messages. The predominant interpretation of The Surgeon, or The Extraction of the Stone of Madness is as a metaphor for stupidity and gullibility, a common theme in Netherlandish art of this time. As such, Hemessen's painting symbolizes the limits of the medical profession and underscores the persistent hope for neurosurgery to treat psychiatric disease in the future.

As ressonâncias da loucura materna nos processos de subjetivação de uma filha / Resonances of maternal madness in the subjectivation processes of a daughter / Résonances de la folie maternelle dans la subjectivation d'une fille / Las resonancias de la locura materna en los procesos de subjetivación de una hija

Este artigo aborda as ressonâncias da loucura materna na subjetivação de uma filha a partir de um estudo de caso. Trabalhou-se com história de vida e foi realizado um diálogo com os processos de subjetivação e práticas de cuidado de si. A análise temática organizou os resultados a partir das seguintes categorias: as ressonâncias da loucura materna nos processos de subjetivação; o cuidado de si como horizonte transformador nos processos de subjetivação; o trabalho de subjetivar um legado transgeracional e a elaboração da mãe como referência de maternidade. Entre os resultados, destacam-se: a presença de afetos ambivalentes, a inconstância da presença física e da disponibilidade psíquica maternas e o desenvolvimento, por parte da entrevistada, de práticas de cuidado destinadas a si e a ao outro. Uma trajetória marcada por violência, questões de raça, gênero e classe, dificuldades sociais e econômicas que intensificaram a condição de sofrimento psíquico

This article approaches the resonances of maternal madness in the subjectivation of a daughter from a case study. We worked with life history and a dialogue was carried out with the subjectivation processes and self-care practices. Narrative interviews were thematically analyzed to organize the results: the resonances of maternal madness in the subjectivation processes; the self-care as a transforming horizon in the subjectivation processes; the work of subjectifying a transgenerational legacy; and the elaboration of the mother as a reference of motherhood. Among the results, the following stand out: the presence of ambivalent affections; the inconsistency of the maternal physical presence and psychic availability; and the development, on the part of the interviewee, of care practices aimed at herself and at the other. A trajectory marked by violence, issues of race, gender and class, social and economic difficulties that intensified the condition of psychic suffering

Cet article aborde les résonances de la folie maternelle dans la subjectivation d'une fille avec une étude de cas. Nous avons travaillé avec l'histoire de la vie et un dialogue a été mené avec les processus de subjectivation et les pratiques d'autosoins. Des entretiens narratifs ont été analysés de façon thématique pour organiser les résultats : les résonances de la folie maternelle dans les processus de subjectivation ; l'autosoins comme horizon transformant dans les processus de subjectivation ; le travail de subjectivation d'un héritage transgénérationnel et l'élaboration de la mère comme référence de la maternité. Parmi les résultats, ressortent : la présence d'affections ambivalentes, l'incohérence de la présence physique et de la disponibilité psychique maternelle et le développement, de la part de l'enquêtée, de pratiques de soins visant soi-même et l'autre. Une trajectoire marquée par des violences, des questions de race, de genre et de classe, des difficultés sociales et économiques qui ont intensifié l'état de souffrance psychique

Este artículo trata de las resonancias de la locura materna en la subjetivación de una hija mediante un estudio de caso. Se trabajó con la historia de vida y se dialogó con los procesos de subjetivación y prácticas de cuidado de sí. Se realizaron entrevistas narrativas de forma temática para organizar los resultados: las resonancias de la locura materna en los procesos de subjetivación; el cuidado de sí como horizonte transformador en los procesos de subjetivación; el trabajo de subjetivación de un legado transgeneracional y la elaboración de la madre como referente de la maternidad. Entre los resultados se destacan: la presencia de afectos ambivalentes, la inconsistencia de la presencia física materna y disponibilidad psíquica, y el desarrollo por parte de la entrevistada de prácticas de cuidado dirigidas a sí misma y al otro. Una trayectoria que estuvo marcada por cuestiones de raza, género y clase, dificultades sociales y económicas, y violencias que intensificaron la condición de sufrimiento psíquico

Práticas antirracistas na rede de atenção psicossocial: racializar e desnortear / Prácticas antirracistas en la acción de colectivos de profisionales en la red de atención psicosocial: racializar y desnortar / Anti-racist practices in psychosocial care network: racializing and disorienting the north

Resumo O debate sobre os efeitos psicossociais do racismo ganha crescente presença no campo da Reforma Psiquiátrica Antimanicomial. Consideramos que a manicomialização no Brasil tem ancoragem na colonialidade, configurando o manicolonial: a vinculação do significante negro à loucura. Visando investigar movimentos críticos, acompanhamos, de 2019 a 2021, na perspectiva metodológica da pesquisa cartográfica, dois coletivos antirracistas na Rede de Atenção Psicossocial do Município de São Paulo - Kilombrasa e Café Preto. O material colhido, em uma participação-observante das atividades; entrevistas e rodas de conversa com os profissionais, foi trabalhado na forma de fragmentos narrativos. A prioridade da experiência relacional, como racialização - enegrecer - e como experiência diaspórica - desnortear -, produz efeitos antirracistas e um resgate da radicalidade ético-política libertária da Luta Antimanicomial. Todavia, dessa vez, radicalizada como antimanicolonialidade: ressignificação do louco e do negro em um vaivém no Atlântico negro, em um pensamento da travessia contrário ao pensamento fixo, característico da manicolonialidade.

Resumen El debate sobre los efectos psicosociales del racismo ha crecido en el campo de la Reforma Psiquiátrica Antimanicomial. Consideramos que la manicomialización en Brasil está anclada en la colonialidad, configurando el manicolonial: la vinculación del significante Negro a la locura. Con el objetivo de investigar movimientos críticos, acompañamos, de 2019 a 2021, en la perspectiva metodológica de la pesquisa cartográfica, dos colectivos antirracistas en la Red de Atención Psicosocial del Município de São Paulo - Kilombrasa y Café Preto. El material recogido, en participación-observante de las actividades; entrevistas y charlas con los profesionales, fue trabajado en forma de fragmentos narrativos. La prioridad de la experiencia relacional, como racialización (enegrecer) y como experiencia diaspórica (desnortar), produce efectos antirracistas y un rescate de la radicalidad ético-política libertária de la Lucha Antimanicomial. Sin embargo, de esta vez, radicalizada como antimanicolonialidad: resignificación del loco y del negro en un vaivém en el atlántico negro, en un pensamiento del cruce contrario al del pensamiento fijo, característico de la manicolonialidad.

Abstract The debate on the psychological consequences of racism is becoming more prominent in the field of Anti-Asylum Psychiatric Reform. We consider institutionalization in Brazil to be rooted in coloniality, defining manicolonial as a tie between the black signifier and madness. Aiming to investigate critical movements, from the methodological perspective of cartographic research, we followed two anti-racist collectives in the Psychosocial Care Network of the Municipality of São Paulo - Kilombrasa and Café Preto - between 2019 and 2021. The information gathered through observative participation of activities, interviews, and conversation circles with professionals was transformed into narrative fragments. The prioritization of relational experience as racialization - blackening - and diasporic experience - disorienting the north - produces anti-racist effects and a rescue of the liberatory ethical-political radicality of the Anti-Asylum Fight. This time, however, radicalized as antimanicoloniality: re-signification of the insane and the black in a black Atlantic passage, a crossing idea opposed to the fixed thought characteristic of manicoloniality.

The therapeutics of madness according to Etienne-Jean Georget / La terapéutica de la locura según Étienne-Jean Georget.

Incluye:  Fragmentos del Capítulo V: Tratamiento de la locura, escrito por Étienne-Jean Georget para su obra De la folie. Considérations sur cette maladie (1820), pp. 260-294. Traducción Juan Manuel Ferraro.

Sustained remission of psychotic symptoms secondary to hypothyroidism (myxedema psychosis) after 6 months of treatment primarily with levothyroxine: a case report.

BACKGROUND: Psychotic symptoms associated with hypothyroidism, also known as "myxedema psychosis," are a treatable cause of psychosis often associated with complete recovery. While most cases receive both thyroxine and a short course of antipsychotics, some reports indicate that symptoms can resolve without antipsychotic treatment, though follow-up in these cases has often been short or not reported. This is one of the first case reports demonstrating sustained remission of psychotic symptoms at 6 months in a case of myxedema psychosis treated with minimal antipsychotic medication. CASE PRESENTATION: We describe the case of a 40-year-old Caucasian woman who was brought to hospital with a 7-day history of anxiety and decreased sleep and 1 day of disorganized speech, paranoid delusions, and auditory hallucinations. After being admitted to psychiatry for management, screening blood work revealed elevated thyroid-stimulating hormone. The patient was initiated on treatment with levothyroxine and low doses of antipsychotics. Her symptoms resolved on the third day of her admission with ongoing symptomatic remission at 6 months follow-up. CONCLUSIONS: The identification of myxedema psychosis is important owing to the implications on treatment and prognosis of the disorder. Our case suggests that sustained symptom resolution may occur with little to no antipsychotic treatment, though these findings are preliminary and additional study is needed before definitive conclusions on the optimal approach can be made.

First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto's Thyroiditis: A Case Report.

This case report describes a woman with no psychiatric history and previously diagnosed Hashimoto's thyroiditis who presented to the psychiatric emergency department with a first episode of psychosis. The initial workup for organic causes of psychosis revealed an astronomically high thyroid stimulating hormone (TSH) (> 1,000 µIU/mL) out of proportion to the patient's minimal physical symptoms of hypothyroidism. Additionally the patient's head imaging showed an enlarged pituitary, a rare, but reversible, presentation of chronically untreated primary hypothyroidism. The patient was transferred to a medical unit to receive IV thyroid hormone replacement as well as an adjunctive antipsychotic to assist with remission of her distressing auditory hallucinations and persecutory delusions. This case highlights the importance of a thorough medical workup for causes of new onset psychosis and the need for further consensus in the literature regarding choice of antipsychotic and duration of treatment for psychosis secondary to hypothyroidism.