Psychosis, Catatonia and Post-psychosis PTSD.

We are describing the case of a 27-year-old female with no previous psychiatric history who developed post-psychotic PTSD after presenting with first episode catatonia and psychosis. The patient initially presented to the emergency department with increasingly disorganized behavior and paranoid thinking over the course of one week in the context of multiple life stressors. Soon after admission, the patient became catatonic; demonstrating mutism, stereotyped behaviors, and echolalia. After ruling out an organic cause for the catatonia, the patient was treated with Lorazepam, which minimaly improved her catatonia, but revealed active psychosis. In particular, she voiced a scenario that she was sexually assaulted by several men at her mother’s home in the time leading up to her admission. An investigation by law enforcement ruled out the occurrence of assault. However, the patient, expressed vivid dreams, nightmares, and distress centered on her assault. Various anti-psychotics were trialed with little effect (Risperidone, Olanzapine, Haloperidol, and Clozapine). Given that she exhibited several characteristics of PTSD, other agents inlucluding: Escitalopram, Prazosin, and Divalproic were initiated to target her PTSD-like symptoms. On this regimen, the patient showed significant improvement in her mental status and functioning. Thiothixene was added to target residual symptoms of her psychosis. She was discharged to home in the care of her mother and on follow-up remembered little of her psychosis and denied any trauma or occurrence of sexual assault in the past.

Writing on One’s Own Demise: Suicide Notes in the Age of the Internet.

One to two people out of six who attempt suicide will leave a note behind. In comparison to notes written on paper, internet suicide notes may differ in a variety of characteristics, as they illustrate different degrees of real-time experiences. Given continuous internet traffic, awareness, likelihood of rapid detection and discovery by potential readers is more likely online. Therefore, internet traffic may change the communication dynamic of suicidal wish and intent. The question posed then is: are internet suicide note writers a different population of suicidal individuals compared to those who leave behind paper suicide notes? While some strides on suicide prevention on the internet are emerging, we propose that four areas of exploration on cybersuicide could benefit from the development of safeguards and intervention: exploration of suicide sites; Facebook traffic on suicide; Suicide blogs and bloggers, and personal communication via email and social media. While many unanswered questions remain regarding the feasibility of a unified approach, in the long run the development of intervention strategies should become a priority in research. Such strategies would include the development of extended online professional networks. While these networks would create a major privacy challenge for the online community, they may also become a model for addressing healthcare issues online. In order to accomplish such an online community, allocation of significant resources, the development of specialized technology and the worldwide cooperation of mental health professionals would be necessary.

Periodic Catatonia after Thyroid Cancer.

We are presenting the case of a 52 year old female with three distinct episodes of clinical deterioration over a 20 year period after thyroid cancer treatment. The first decrease in functioning happened after the diagnosis of thyroid cancer, resulting in the patient not achieving her PhD thesis. The second deterioration happened ten years later when she presented with psychotic symptoms and the symptoms of anorexia. The last period of deterioration occurred one year before this hospitalization. During that time the patient worsened to the point where she became bedbound and dependent on a PEG tube for feeding. Once hospitalized, the patient had partial response to lorazepam (27 mg a day) and so dextroamphetamine was added with positive response. The addition of memantine helped with the residual symptoms. The PEG tube was finally able to be removed and the patient was discharged home in stable condition.