ABSTRACT
Primary hyperparathyroidism (PHPT) and subsequent hypercalcemia have been reported to be associated with psychosis. Here we report the case of a 28-year-old cannabis using male with his first contact with psychiatric care because of mood instability, bizarre behavior, and poor ability to carry out activities of daily living. Hypercalcemia was identified, and a subsequent endocrine workup confirmed PHPT. After parathyroidectomy, there was no longer any need for antipsychotic or other psychotropic medications; the report emphasizes the importance of considering organic causes, such as hyperparathyroidism, in patients presenting with psychotic-like symptoms, including in the setting of substance use disorder. Prompt recognition and appropriate management of the underlying condition are crucial for optimizing patient outcomes.
ABSTRACT
Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding environment, respectively. The phenomena co-occur on a continuum of severity, ranging from a transient experience as a normal reaction to a traumatic event to a highly debilitating condition with persistent symptoms, formally described as depersonalization/derealization disorder (DPDR). Lack of awareness of DPDR is partly due to a limited neurobiological framework, and there remains a significant risk of misdiagnosis in clinical practice. Earlier literature has focused on several brain regions involved in the experience of depersonalization and derealization, including adaptive responses to stress via defense cascades comprising autonomic functioning, the hypothalamic-pituitary-adrenal (HPA) axis, and various other neurocircuits. Recent evidence has also demonstrated the role of more complex mechanisms that are bolstered by dissociative features, such as emotional dysregulation and disintegration of the body schema. This review intends to abridge the prevailing knowledge regarding structural and functional brain alterations associated with DPDR with that of its heterogenic manifestations. DPDR is not merely the disruption of various sensory integrations, but also of several large-scale brain networks. Although a comprehensive antidote is not available for DPDR, a holistic route to the neurobiological context in DPDR may improve general understanding of the disorder and help afflicted individuals re-establish their sense of personal identity. Such information may also be useful in the development of novel pharmacological agents and targeted psychological interventions.
