ABSTRACT
Takotsubo syndrome is a condition that mimics acute coronary syndrome. The exact pathogenesis of the condition is unclear but it tends to occur more frequently in elderly women and a large proportion of cases have acute, former, or chronic neurologic or psychiatric disorders. Here we describe a 55-year-old female patient, who was brought to the emergency department presenting with a new-onset manic episode characterized by grandiosity, distractibility, decreased need for sleep, and increased goal-directed behaviours. She experienced chest pain approximately two days later, and non-ST elevation myocardial infarction was observed. The emergent coronary angiogram showed patent coronary arteries, and a diagnosis of Takotsubo syndrome was made. We suggest clinical multidisciplinary vigilance for somatic complaints, especially cardiac ones, in people with psychiatric disorders in order to make timely therapeutic interventions.
Subject(s)
Acute Coronary Syndrome , Takotsubo Cardiomyopathy , Acute Coronary Syndrome/diagnosis , Aged , Coronary Angiography , Emergency Service, Hospital , Female , Humans , Mania , Middle Aged , Takotsubo Cardiomyopathy/diagnostic imagingABSTRACT
OBJECTIVE: To describe a case of lung cancer with brain metastasis in a patient who developed new late-onset bipolar disorder 2 years previously. BACKGROUND: The typical onset age of bipolar disorder is approximately 20, and the first episode is usually a depressive episode. It is still not clear which age-specific factors contribute to the underlying risk. MATERIALS AND METHODS: A 65-year-old male patient presented with a new-onset manic episode characterized by labile mood, impulsivity, decreased need for sleep, and grandiosity. He was diagnosed with late-onset bipolar disorder after excluding other possible physiological conditions. He was hospitalized in the acute psychiatric ward, and a combination of mood stabilizers and antipsychotics was prescribed. His mental condition improved, and he remained stable for 2 years. However, he experienced abrupt cognitive decline for 2 months and was referred to the emergency room for physiological examination. RESULTS: The patient was diagnosed with lung cancer with brain metastasis by brain magnetic resonance imaging and whole-body positron emission tomography. CONCLUSION: In geriatric patients, who are at high risk of multiple medical conditions, excluding secondary causes of bipolar disorder is important.
Subject(s)
Antipsychotic Agents , Bipolar Disorder , Brain Neoplasms , Lung Neoplasms , Aged , Antipsychotic Agents/therapeutic use , Humans , Lung Neoplasms/drug therapy , Male , Mood DisordersABSTRACT
Ketamine immunoassay urine drug screen (UDS) is commonly used in Taiwan. However, there was limited report about possible drug which may cause false positive results in ketamine screen test. We report two cases who used quetiapine showed positive in ketamine urine immunoassay screen initially, and found to be false positive in confirmation test. Clinicians should be aware of the false positive result of ketamine UDS caused by currently used medication.
