Treatment-resistant depression prior to the diagnosis of cryptococcal meningitis: a case report.

Comorbidity of chronic infectious disorders is one of the common causes of treatment-resistant depression. Depression may alter some aspects of immunity that can contribute to the development of infection. Here we describe an elderly male with treatment-resistant depression. Ten months after antidepressants were administered, he was found to have cryptococcal meningitis. After successful treatment of the central nervous system infection, his depressive symptoms improved apparently. A possible interaction between depression and cellular immunity was discussed. Physicians should be cautious about the risk of opportunistic infection in patients with depression, especially in immunocompromised condition.

Microsurgical tissue transfers for head and neck reconstruction in patients with alcohol-induced mental disorder.

BACKGROUND: Free tissue transfer in patients with organic mental disorder has always been known to be risky. Herein, the outcomes of free tissue transfers for head and neck reconstruction in those with alcohol-induced mental disorder were analyzed. MATERIALS AND METHODS: We retrospectively reviewed and analyzed data from the past 10 years of 1,364 patients who had undergone microsurgical tissue transfers after head and neck cancer ablation. Among them, 54 patients had been diagnosed with alcohol-induced mental disorders post-operatively. Age ranged from 33 to 71 years. Alcohol-drinking history averaged 17.5 years. Reconstructive procedures included 25 forearm flaps, 13 anterolateral thigh (ALT) flaps, 10 fibula osteocutaneous flaps, and 6 double flaps (fibula+ALT). The outcomes and complications were analyzed. RESULTS: Onset periods ranged from the first to fourth days post-operatively. Duration of alcohol withdrawal or delirium tremens was 3-10 days. All patients gradually stabilized after immediate psychiatric consultation and intensive medical treatment. The flap survival rate in patients with alcohol withdrawal was significantly decreased in comparison with patients not suffering alcohol withdrawal (83% versus 96.4%, P < 0.001). During this critical post-operative period, 28 (52%) patients with alcohol withdrawal syndrome experienced complications; 26 (48%) suffered flap-related complications, and 19 (35.2%) required additional surgery. The analytical parameters revealed that secondary operative procedures and duration of hospitalization differed significantly between the complication and non-complication groups (P < 0.001). CONCLUSION: Higher rates of complications and level of critical care were needed in patients with alcohol-induced mental disorder after head and neck microsurgical reconstructions. Treatment requires a multidisciplinary approach, rapid diagnosis, and intensive medical care.

Penile tumescence assessment used for a diagnosis of paraphilia: a pedophilia case report.

We report on the use of penile tumescence assessment to diagnose a paraphiliac client who was in denial about his problem. An 18-year-old male was accused of sexually assaulting a 4-year-old girl using physical restraint and vaginal penetration with a finger. During a psychiatric evaluation requested by the court, a comprehensive psychosexual assessment revealed that the subject was in denial about clarification of the paraphiliac experience. Penile tumescence under distinct visual stimulus was evaluated with electrobioimpedence volumetric assessment using child and adult female pictures in separate time frames. Both types of stimuli evoked arousal responses. However, child female stimuli demonstrated stronger responses than did adult female ones. Deviant sexual interest in children as well as a diagnosis of pedophilia was implied. Paraphiliac clients tend to be in denial toward psychosexual assessment which limits the interpretation of its results. Penile tumescence assessment may be more reliable than psychosexual assessment alone for detecting and diagnosing paraphilia. Further study is warranted in order to aid in more accurate diagnoses of paraphilia.