ABSTRACT
Objective: Meningioma is the most common type of primary central nervous system and intracranial tumor, and psychiatric changes attributed to meningioma include depression, apathy, psychosis, and personality changes. We present a case of a 59-year-old man with right parietal meningioma who developed mania with psychotic features throughout multiple hospitalizations. Method: Single-case report. Results: The patient originally presented with headache and bilateral lower extremity weakness. He was found to have a large medial sphenoidal wing meningioma and a small right parietal meningioma. The sphenoidal wing meningioma was removed via craniotomy, but the right parietal meningioma was not resected. In the following years, the patient developed symptoms of mania and psychosis which coincided with an increase in size of the right parietal meningioma. Conclusions: Previous studies have linked right parietal meningioma to psychosis, but this case is one of the first to suggest that right parietal meningioma may be associated with the development of mania along with psychotic features.
Subject(s)
Bipolar Disorder/etiology , Meningeal Neoplasms/complications , Meningioma/complications , Parietal Lobe/diagnostic imaging , Psychotic Disorders/etiology , Bipolar Disorder/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/diagnostic imaging , Meningioma/diagnostic imaging , Middle Aged , Psychotic Disorders/diagnostic imagingABSTRACT
BACKGROUND: Trichotillomania (obsession with one's hair) was first described in the literature over 100 years ago and was recognized by the American Psychiatric Association as a distinct disorder in 1987. OBJECTIVE: The authors discuss a rare presentation of a case of recurrent Rapunzel syndrome in a 37-year-old woman. METHOD: The authors present a biopsychosocial treatment plan for a therapeutic approach. RESULTS: This patient was unique for her relatively advanced age at onset, the recurrent nature, association with pancreatitis, and the consumption of artificial hair extensions, rather than her own hair. This patient presented with small-bowel obstruction requiring laparotomy. After surgery, she was evaluated by the psychiatric service; after discharge, she removed her hair extensions, continued to take her prescribed medication, attended a psychiatric program, and was monitored by family and friends. CONCLUSION: There are no definitive guidelines for treating trichotillomania. In this case, quetiapine, hair-extension removal, family involvement, and regular follow-up helped with the initial cessation of her hair consumption. Antidepressant treatment helped control the obsession while behavioral therapy and family involvement provided the means for habit-reversal training.
