Suicidal Ideation in the Setting of Neurocysticercosis.

Neurocysticercosis (NCC) is considered a significant health concern in developing countries in parts of Asia, Africa, and Central and South America. However, with the increased immigration, it is now becoming increasingly prevalent in the United States. NCC has psychiatric implications often neglected and not recognized in the initial diagnostic workup of patients from developing countries suffering from seizures and psychiatric illnesses, such as depression. This case report aims to signify the presentation of NCC and illustrate the importance of the psychiatric manifestations of NCC in patients. We discuss the case of a 32-year-old female patient from a rural town in Central America who immigrated to New York and presented with uncontrolled seizures and symptomatic depression with suicidal ideations.

Lithium-Induced Hypercalcemia Presenting as Catatonia in a Patient With Schizoaffective Disorder.

Catatonia, a relatively rare and less explored consequence of lithium-induced hypercalcemia, represents a notable yet understudied side effect. Lithium is utilized in the management of acute mania and as a maintenance therapy for bipolar disorder. However, the specific catatonic presentation resulting from hypercalcemia remains poorly understood. Here, we present a case study involving a 55-year-old male with a history of schizoaffective disorder, bipolar type, who had been receiving lithium therapy. The patient presented with catatonia and altered mental status. Manifesting as mutism, rigidity, immobility, and staring, these symptoms were subsequently attributed to hyperparathyroidism-induced hypercalcemia. Markedly elevated levels of both calcium and parathyroid hormone (PTH) were detected in the patient's laboratory results. The patient's lithium therapy was promptly discontinued. Serum calcium and PTH levels began to decrease gradually and returned to normal limits over 29 days. The patient returned to his baseline level of functionality. There was a notable improvement in his mental status and his ability to communicate using simple sentences. This case underscores the significance of recognizing uncommon clinical presentations of hypercalcemia in patients undergoing chronic lithium therapy. Given the broad range of neuropsychiatric manifestations associated with hypercalcemia, it is crucial to enhance our understanding of this phenomenon and develop the capacity to differentiate it from primary psychiatric disturbances.

Neuroleptic Malignant Syndrome From Oxcarbazepine and Topiramate Withdrawal: An Unusual Case.

Neuroleptic malignant syndrome (NMS) is a rare, but fatal adverse reaction that is most commonly seen with typical antipsychotic medications. However, NMS can also be triggered by other dopamine-modulating agents that physicians are unlikely aware of, leading to being underdiagnosed or precluding early recognition of the syndrome. We describe a case involving a 20-year-old male who presented to the emergency department with altered mental status and failure to thrive. On admission, he subsequently developed an insidious onset of muscle rigidity and autonomic instability, and laboratory work-up was significant for leukocytosis, transaminitis, and elevations in creatinine phosphokinase, lactate, and C-reactive protein. After a battery of negative diagnostic tests, his clinical features fulfilled the NMS criteria by a diagnosis of exclusion, even in the absence of any antipsychotic regimen or dopaminergic medications. Management with dantrolene, amantadine, and aggressive fluid therapy provided a gradual return of the patient's baseline mentation along with normalization in laboratory assessments. In this novel case of NMS, we suspect oxcarbazepine and topiramate withdrawal as possible attributing factors for the patient's presentation. This article emphasizes the need for hypervigilance in future cases with high suspicion of NMS, in addition to raising a broader clinical awareness of other potential etiologies of NMS that are not restricted to only antipsychotic medications. We further discuss a review of the pathophysiology, various etiologies, clinical features, diagnostic criteria, treatment plans, and complications of NMS.

Escalation of Gambling Associated With Aripiprazole: A Case Report and Literature Review.

Impulse-control problems such as gambling, increased spending, hypersexuality, and compulsive eating are thought to be influenced by temperamental, genetic, and physiological risk factors. In addition, dopamine receptor agonists have been implicated in some cases. It is postulated that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We present the case of a patient with bipolar disorder and previous gambling behavior, in whom the gambling behavior escalated with the introduction of aripiprazole and its upward titration. The patient's gambling problems were alleviated with a decrease in aripiprazole dosage. Clinicians should be vigilant for possible gambling and other impulse-control behaviors in patients taking aripiprazole. Our literature review suggests cariprazine and brexpiprazole, which have mechanisms of action similar to that of aripiprazole, may also be associated with possible risks of impulse-control problems and pathologic gambling.