RESUMO
This paper details the hospital course of a patient suffering from post-traumatic stress disorder (PTSD) who had been inadequately treated during previous hospitalizations and treatment programs. He also experienced symptoms not necessarily covered by the DSM-5 diagnosis of PTSD such as specific paranoia directed at his wife. This paper aims to expand upon the experiences of this patient from the standpoint of his disorder and his treatment history in order to demonstrate the potential benefits of the differentiation of complex PTSD (cPTSD) as a subset of patients within the greater scope of PTSD in order to more adequately address the needs of this subset of patients. Additionally, some common arguments against the recognition of cPTSD as a unique condition, such as diagnosing these patients as comorbid with bipolar disorder, are addressed.
RESUMO
This case report details the presentation of a patient who presented to Psychiatry via the Emergency Department following a diphenhydramine overdose in an attempt to seek relief from a perceived skin condition. Review of the patient's files demonstrated similar presentations to a number of other specialties including Family Medicine and Dermatology. Due to the description by the patient of his condition as well as the associated psychiatric symptoms and significant impairment to his life, he was diagnosed with Morgellons disease. This paper seeks to highlight the lack of physical findings by other specialties, elaborate on the treatment plan during his inpatient stay, and review the evidence regarding the psychosomatic presentation of the disease.
RESUMO
This case report details a patient with a complex medical history who was brought for psychiatric evaluation. An abrupt switch in Kratom use patterns was identified as the most likely causative factor of his symptoms. Adrenal insufficiency and posttraumatic stress disorder (PTSD) were considered both in the differential and potential confounding factors in his presentation. This paper discusses current Kratom use trends in the United States, the drug's legal status, and the common reasons patients may use it. Additionally, research gaps regarding the safety and efficacy of Kratom's use for self-medication are addressed.
RESUMO
BACKGROUND: Extrauterine ectopic pregnancy is a rare form of ectopic pregnancy, accounting for roughly 1:10,000-30,000 of all pregnancies. Primary omental pregnancy is the least common form of abdominal ectopic pregnancies, making it extremely rare. Typical presentation includes pelvic pain, secondary amenorrhea, with or without vaginal bleeding. Atypical presentations range from nonspecific pain to asymptomatic. CASE: A 19-year-old woman presented to the emergency department after several syncopal episodes. She had a positive urine pregnancy test (serum hCG 446 IU/L). Her hemoglobin level was 10.6 g/dL. Due to lack of pain or bleeding, abdominal imaging was not indicated. A head CT scan rendered negative results. She was subsequently diagnosed with idiopathic headaches and anemia and was discharged. She returned to hospital 48 h later with vaginal bleeding and additional syncopal episodes. She was not experiencing any abdominal pain or discomfort. Her anemia worsened (hemoglobin 7.5 g/dL). For this reason, imaging was performed. It was significant for massive hemoperitoneum. Due to the imaging findings and worsening anemia, diagnostic exploratory laparoscopy was recommended to evaluate for ruptured ectopic pregnancy. Laparoscopic findings revealed large hemoperitoneum and a 10-week gestational sac attached to the greater omentum near the transverse colon. This exceedingly rare presentation of extrauterine ectopic pregnancy offered few clinical clues other than worsening anemia until imaging later revealed the abnormality. Ruptured ectopic pregnancy, a potentially fatal complication of pregnancy, should be included into the differential diagnosis of any gravid patient with syncope and anemia unexplained by extensive diagnostic workup.
