We present the case of a patient who after a year of psychotic symptoms is diagnosed with thyroid cancer with hyperthyroidism.

A brief review is made of the psychotic symptoms in a patient with hyperthyroidism secondary to cancer of the gland.

We present the case of a 52-year-old patient, a former injecting drug addict, who after a year with psychotic symptoms, is diagnosed with thyroid cancer with hyperthyroidism. The patient reported that a year ago, he suddenly had a painless and indurated lump in his neck, associated with weight loss and confusional symptoms. One month after the appearance of the tumor, the patient began to present visual, kinesthetic and haptic hallucinations, with the sensation that supernatural beings were passing through and possessing him. Likewise, he referred to being able to see and feel the atoms of matter, being able to communicate with a superior being whom he called “creator”.

The patient is admitted for psychotic symptoms. During it, the necessary complementary tests are carried out, objectifying a clinical situation of hyperthyroidism. The study is extended, observing a hyperfunctioning nodule, which corresponded to thyroid cancer.

Neuropsychiatric symptoms in hyperthyroidism are relatively common. In most cases, the most frequent are cognitive alterations, attention problems and working memory problems. It can also lead to depressive episodes, and more rarely, psychotic symptoms.

No significant relationships.

Schizophrenia (SCZ) is a severe mental disorder that is among the leading causes of disability worldwide. Multiple sclerosis (MS) is a chronic inflammatory neurological disease with a major impact on the quality of life of young adults. Despite the distinct nature of these two disorders, research studies have identified similarities in underlying pathological mechanisms and risk factors.

To illustrate, through a case report, the central role of inflammation in schizophrenia and its relationship with multiple sclerosis.

Case Report of a 31-year-old male patient with schizophrenia who has been diagnosed with multiple sclerosis.

Mr M. is a 31 year old patient who was diagnosed with schizophrenia at age 17. Between the ages of 25 and 27, the patient had two severe psychotic relapses each one requiring inpatient treatment. At that time, he experienced predominantly severe positive symptoms and persistent suicidality. He was initially prescribed amisulpride up to 600mg, followed by haloperidol up to 45mg daily. Due to poor clinical response, the patient was put on clozapine 400mg/d and has been stabilized since 2017, with outpatient checkups. The patient has reported vertigo and trouble walking in August 2021. He has been referred to the Neurology Department. Clinical, biological and imaging findings were highly suggestive of Multiple sclerosis and the patient has received short courses of intravenous corticosteroids.

This case report highlights the possible association between Multiple Sclerosis and schizophrenia. Further research is needed to clarify the role of inflammation in the central nervous system in schizophrenia and the overlap with Multiple Sclerosis.

No significant relationships.

Aripiprazole once-monthly is a long-acting intramuscular injectable formulation of aripiprazole. The starting dose can be administered by following one of two regimens: • One injection start: On the day of initiation, administer one injection of 400 mg Aripiprazole once monthly and continue treatment with 10 mg to 20 mg oral aripiprazole per day for 14 consecutive days • Two injection start (New regimen): On the day of initiation, administer two separate injections of 400 mg Aripiprazole once monthly at separate injection sites, along with one 20 mg dose of oral aripiprazole.

To assess the effectiveness and tolerability of Aripiprazole long-acting injectable (ALAI) in patients with schizophrenia. The starting dose was administered following the two injection start regimen

Sample:10 patients with schizophrenia (DSM 5 criteria) who started treatment with ALAI. The starting dose was administered following the two injection start regimen. On a tri-monthly basis, the following evaluations were performed during a follow-up period of 6 months: The Clinical Global Impression-Schizophrenia scale (CGI-SCH), treatment adherence, the number of hospitalizations and Side effects reported

Mean variations from baseline scores at 6 months was (-1.1 ±0.89) on the GCI-SCH. The percentage of patients who remained free of admissions at the end of the 6 months was 90%. The rate of adherence to treatment after 6 months was 80%. The most frequent side effect was transient mild insomnia (20%) .

Aripiprazole long-acting injectable (The starting dose was administered following the two injection start regimen) is effective, safe and well tolerated in clinical practice conditions

No significant relationships.

Delusional idea disorders are a group of syndromes whose main or unique characteristic is the presence of consolidated delusional ideas that usually have a chronic character and do not fit into other diagnoses such as schizophrenia, affective disorder or other organic diseases. On the other hand, Charles Bonnet syndrome is an organ hallucinosis in whose context visual hallucinations may appear in patients with a visual deficit. Historically, it has been considered that the presence of another psychiatric condition is an exclusion criterion for the diagnosis of Charles Bonnet syndrome, although the presence of similar etiological and maintenance factors means that this situation of dignous exclusion must be reconsidered.

The objective of the present communication is to study the current state of the topics “delusional disorder” and “Charles Bonnet syndrome”. Another objective is to reconsider that the presence of previous or concurrent psychiatric pathology is an exclusion criterion for the diagnosis of Charles Bonnet syndrome..

A bibliographic review on “delusional ideas disorder” and “Charles Bonnet syndrome” has been carried out, as well as a discussion on the diagnostic and exclusion criteria, based on the etiopathogenic and maintenance factors.

Both in “delusional ideas disorder” and in “charles bonnet syndrome” advanced age, social isolation and deficiencies in sense organs constitute etiological factors that facilitate the appearance of these syndromes and make their treatment difficult.

Due to this, we consider that the appearance of another previous or present psychiatric illness should not be an exclusion criterion, both can appear in the same patient.

No significant relationships.

Clozapine is highly effective in patients with treatment-resistant schizophrenia but, to ensure optimal clinical response it is important to optimize its use and this depends on adequate pharmacological monitoring.

Evaluate the therapeutic response rate according to clozapine plasma concentration.

It was a cross-sectional, retrospective and analytical study, carried out over a period of six months, in the F and A psychiatry departments of the Razi hospital in Tunis, including patients followed for treatment-resistant schizophrenia and receiving clozapine. We evaluated the response to clozapine using the Brief Psychiatric Rating Scale (BPRS).

The average age was 37.7 ± 9.4. The mean age of introduction of clozapine was 31 years and the mean time to its introduction was 9.3 years. Clozapine was administered as a single drug in 85% of cases. The mean dose of clozapine was 373 mg/day. The mean of clozapine plasma concentration was 386.5 ng/ml with a minimum of 89 ng/ml and a maximum of 913 ng/ml. The clinical response rate to clozapine was 25% with a BPRS good response threshold value of less than 35. Patients with clozapine levels above the conventional cut-off of 350 ng/ml (n=34) had a response rate of 34.6%. A response rate of 37% was observed in the group of patients with a clozapine plasma concentration interval of 200-350 ng/ml. There was no statistically significant difference in therapeutic response (p=0186)

Our study revealed a therapeutic response variation according to plasma clozapine concentration and showed the existence of a non-negligible and effective response rate.

No significant relationships.

The concept of trema refers to an initial phase in the psychotic process that is characterized by intense anguish, an experience of hostility and a feeling of imminent catastrophe. This situation engenders in the patient a sensation of being in a tunnel than can only lead to something terrible but ineffable.

To illustrate the incipient phase of psychotic disorder though the presentation of a case.

A presentation of a clinical case.

A 29-year-old man attends the emergency department due to anxiety of one moth of evolution, that had debuted after a stressful event in the patient’s life such as loss of employment. He suffered from intense morning-predominance anguish, depersonalization episodes, insomnia, hallucinosis, cognitive blocks that occasioned him great anxiety and apragmatic behaviors. Besides, he had language alteration and autolytic ideation with previous autolytic gestures. After evaluation, he was diagnosed with psychotic episode. He was hospitalized, and treatment with olanzapine and lorazepam was started.

With the exhibition of this case, we intended to point up the importance of a differential diagnosis with different disorders marked by anxiety as the main symptom. In our case, panic disorder should be taken in account as a differential diagnosis. Furthermore, as the evidence shows, the identification of prodromic phases in schizophrenia allows an early diagnosis and early intervention, improving the prognosis.

No significant relationships.

Anticholinergic syndrome (AS) is a complication that can appear due to different drugs with antimuscarinic effects, such as antihistamines, alkaloids, antipsychotics, tricyclic antidepressives or anesthetics, and it is characterized by urinary retention, dry mouth and skin, mydriasis, low-grade fever, and confusion or coma.

To describe a clinical case of AS admitted to our hospital.

We present a case report of a patient with schizophrenia who presented an anticholinergic syndrome. We also searched for previous studies of AS using a pubmed query.

A 53-year-old male was admitted for a psychotic decompensation to another hospital in Barcelona. The usual treatment at home was amisulpride 1200mg/d, olanzapine 30mg/d and lormetazepam, and haloperidol 6mg/d and clotiapine 40mg/d were added to treat the decompensation. Then, the patient started to present mydriasis, mucocutaneous dryness, low-grade fever, slight hypertension and tachycardia, repeated retentions of urine, confusion, unintelligible speech and agitation, so he was referred to our hospital. Once he was admitted, haloperidol was withdrawn and support measures (bladder catheterization, fluid therapy, etc.) were applied. After a few days, most of the mentioned alterations were stabilized, but the psychotic symptoms, such as thought and behavioural disorganization, persisted and required electroconvulsive therapy, with subsequent improvement.

AS is a relatively frequent side effect of psychiatric medication, which diagnosis is clinical, so, we must be capable to identify it and initiate early treatment to prevent possible complications. The first step, as reflected in the case described, is to stop the causative drugs, and apply support measures. Additionally, physostigmine can be used, as it is an effective antidote.

No significant relationships.

Psychotic symptoms are not exclusive to schizophrenia, they can be due to paranoid development and can be treated differently.

The objective of this paper is to study, from the following case, the effect of psychotherapeutic treatment in patients with paranoid development.

A bibliographic search was performed from different database (Pubmed, TripDatabase) about psychological intervention for the improvement of paranoid symptoms. 20-year-old man, born into a family with marital problems, without difficulties in psychomotor development, socialization or academic performance, who began with behavioral alterations from the age of 5 that he had begun to suffer abuse from his father, showing aggressiveness towards other children and progressively worsening over the years: consuming cannabis, isolating himself, listening to protective voices and distrusting of people, to whom he responded aggressively believing that they wanted to harm him.

Initially, he was treated with antipsychotics that were later suspended when acute psychotic symptoms were ruled out, diagnosing a paranoid development secondary to trauma, for which he had felt fear and defenselessness, and had learned to be alert and respond aggressively to everything he considered threatening, showing anger that he did not know how to express. During therapy, abstinence to drugs was worked on, therapeutic link, mentalization-based therapy, emotions, narrative techniques, trauma and systemic family therapy.

To conclude, we need to pay attention to development of pathologies like this so as not to rush with antipsychotics, when it may be due to a development secondary to trauma that needs to be treated psychotherapeutically.

No significant relationships.

Although visual impairment appears to be a risk factor for schizophrenia, early blindness may be protective , It’s a phenomenon that has puzzled even the smartest scientific brains for decades. It might surprise you: no person born blind has ever been diagnosed with schizophrenia.

The objective of this research is to discover the relationship between schizophrenia and congenital blindness is there a protective gene ! is that visual perception constitutes an essential stage in the onset of the disease itself !

Case study of a family consisting of thirteen brothers and sisters, three of whom were blind at birth, three with schizophrenia. the study of the files of schizophrenic patients hospitalized in our structure since it opened in the 1970s

Case study of a family consisting of thirteen brothers and sisters, three of whom were blind at birth, three with schizophrenia, but there is none with blindness at birth and schizophrenia. PLus on the basis of medicals files there is no case of schizophrenia with blindness at birth. Preliminary observational analysis of this clinical case suggests the following hypothesis: the presumed protective role of congenital blindness against schizophrenia. The bibliographic research has objectified three recent studies in this direction in Australia, Denmark, and the USA.

The relationship between schizophrenia and congenital blindness is still unrecognized and controversial

Several studies are done in this direction, but so far there is no assertion or confirmation of the hypothesis

No significant relationships.

Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptoms. Negative symptoms are a major health concern and a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. Adequate treatment would mean important progress and Distinguishing primary from secondary negative symptoms may inform about treatment options.

Objective: to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia.

We searched Pubmed and Cochrane Library database for english language articles.

Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes. Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.

Clinically relevant negative symptoms of schizophrenia need to be recognized, assessed, and as well managed as possible in order to achieve improved outcomes for patients. More studies are needed to establish the better approach to negative symptoms.

No significant relationships.

Ekbom syndrome is a clinical term for delusional parasitosis, a condition characterized by the belief that one’s skin is infested by invisible parasites. Despite having no medical evidence, patients strive to prove their illness and interpret different sensations and symptoms as infestation with parasites.

Our objective was to present a case report of a patient with Ekbom syndrome with detailed clinical information and treatment complications.

We included patient’s history, psychiatric evaluation, complete diagnostic work-up, therapy and follow-up.

A 60-years old female patient was admitted to her first hospital treatment in our psychiatric clinic. Upon admittance, she was extremely tense, preoccupied with the idea that bed bugs have infested her body. She showed extensive medical documentation, including numerous dermatologic reports regarding her condition, interpreting them in accordance with her delusions. In attempt to help herself and “release” the bugs, she harmed herself causing multiple skin lesions across her body and face. The treatment was complicated with secondary skin infections, ulcers, cellulitis and oedemas. Initial treatment with olanzapine was switched to risperidone due to side-effects (sedation, increase of appetite, weight gain). Gradually, with pharmacological treatment, psychoeducation and support, remission was achieved, but poor insight to her previous condition and psychiatric symptoms remained.

Ekbom syndrome presents a serious disorder that can be complicated with secondary somatic complications, often requiring involvement of different medical specialists. Moreover, lack of insight into the need for psychiatric treatment can lead to therapy discontinuation and relapse of symptoms.

No significant relationships.

Current evidence contradicts the idea that cannabis-induced psychotic disorder (CIPD) has an overall benign prognosis, with up to half of these patients being with a schizophrenia spectrum disorder later in life.

To characterize sociodemographic and clinical characteristics and treatment plan of inpatients with multiple admissions for CIPD over a one-year period, compared to those with a single admission.

Retrospective observational study of inpatient episodes with CIPD between january 1st 2018 and september 30th 2021 in a tertiary psychiatric inpatient unit. Statistical analysis was performed using SPSS software, version 27.0.

Our sample included 80 inpatients, 15 (18.8%) with multiple admissions for CIPE within one year period and 65 (81.3%) with a single admission. The multiple admissions group had a median of 1 ±0,915 admissions within the same year. Being readmitted for CIPE was associated with outpatient compulsory treatment at discharge (OR 3,01 (95% CI 1,27-7,18, p=0,034). These patients had 3.14 higher odds of future admissions to psychiatry unit (CI 95% 1.70-5.78, p<0.001). We found no statistically significant differences regarding the sociodemographic and clinical characteristics, daily vs. occasional use of cannabis in patients with multiple admissions for CIPE.

Patients with multiple admissions for CIPD tend to have more relapses and require assertive treatment measures. However, they did not differ regarding the sociodemographic and clinical characteristics studied from patients with single admissions. This suggests that additional assessment of these patients might be important to predict the course of the disease.

No significant relationships.

The discovery of second-generation antipsychotics represented an authentic breakthrough for the management of psychotic disorders. Nevertheless, they still don’t adequately manage some aspects of these disorders, such as negative symptoms (NS), cognitive impairment, or extra-pyramidal symptoms (EPS). New-generation antipsychotics present different pharmacological mechanisms and have been reported to ameliorate these aspects. Among them, cariprazine acts as a D2/D3 partial agonist with variable affinity with serotoninergic receptors, and many studies show its efficacy for preventing and treating positive symptoms as well as for the management of NS and EPS.

To report a case of a patient diagnosed with schizophrenia with highly invalidating antipsychotic-induced EPS that remitted after switching to cariprazine, while maintaining clinical stability. To review literature about cariprazine and its relationship with NS and EPS.

We describe the case of a 66-year-old woman diagnosed with schizophrenia and under treatment with three-month injectable paliperidone 175mg. During her follow-up at outpatient clinic, she presented a progressively highly invalidating non-trembling parkinsonian syndrome attributable to medication. Paliperidone plasmatic levels were within therapeutic range. An antipsychotic switch was agreed, and cariprazine was started.

The switch from a second-generation antipsychotic to cariprazine entailed the remission of a highly invalidating EPS while improving some of the NS and maintaining psychopathological stability.

Assessing and differentiating NS and EPS is of an utmost importance during the follow-up of patients under antipsychotic treatment. Cariprazine is an interesting alternative when treating patients diagnosed with psychotic disorders that present mostly NS and antipsychotic-induced EPS.

No significant relationships.

Ornithine transcarbamylase (OTC) deficiency is the most frequent congenital defect among the urea cycle enzymatic disorders, due to mutations a!ecting the OTC gen (Xp21.1) that are inherited with an X-linked pattern. As it happens with sex-linked genetic disorders, late-onset OTC deficiency is more prevalent among women, so that females may be asymptomatic over the years and manifest symptoms only when they are submitted under severe metabolic stress, such as pregnancy, infections or new medications. The enzymatic defect involves a blockage a!ecting the main biochemical route that converts ammonia into urea. This leads to analytic hyperammonemia and the outburst of gastrointestinal, neurological and psychiatric symptoms with variable severity.

Expounding the importance of inborn errors of metabolism as possible causes of a psychotic episode.

Describing the case, supporting our data with a bibliographic research made on PubMed.

We describe a psychiatric adult-onset OTC deficiency in a 37-year-old woman with borderline intellectual functioning and a psychotic episode in the context of an infection that was wrongly diagnosed at first as schizophrenia, until the genetic study was carried out. The woman’s familiar history shown an OTC deficiency among some family members, a mutation- carrier sister and at least two male children death by the first month of life.

Organic psychosis can be caused by a large number of medical diseases. A di!erential diagnosis of possible cerebral, toxic or metabolic causes of psychosis is necessary to avoid mistakes in diagnosis.

No significant relationships.

Although visual impairment appears to be a risk factor for schizophrenia, early blindness may be protective. It’s a phenomenon that has puzzled even the smartest scientific brains for decades. It might surprise you: no person born blind has ever been diagnosed with schizophrenia.

The aim of this research is to discover the relationship between schizophrenia and congenital blindness and whether there is a protective gene and whether visual perception is an essential stage in the onset of diseases itself.

It’s a case study of a family consisting of 13 brothers and sisters, three of whom were blind at birth, three with schizophrenia. We proceeded with a study of the medical files of all the schizophrenic patients and also ophthalmological exams for all the family members.

Preliminary observational analysis of this clinical case suggests the following hypothesis: the presumed protective role of congenital blindness against schizophrenia. Moreover, the ophthalmological exams showed no visual impairment in schizophrenic patients. The bibliographic research has objectified more than three recent studies in this direction.

The relationship between schizophrenia and congenital blindness is still unrecognized and controversial. Several studies are done in this neurodevelopmental field but so far there has been no assertion nor confirmation of the suggested hypothesis. More research is needed.

No significant relationships.

Schizophrenia (SZ) is associated with changes in haematological parameters related to low-grade inflammation state and could be amplified via oxidative stress (OS) related mechanisms. Although studies confirm this relationship, the results could be cofounded by patients’ treatment.

The study aimed to assess the connection between venous blood count and OS in drug-naïve first-episode SZ patients.

The study consisted of 24 SZ drug-naïve patients during first episode of psychosis (median age: 22 years), and 31 healthy individuals (HC) as a control group (median age: 28 years). The examination included clinical data, OS parameters (enzymatic and non-enzymatic antioxidants), peripheral blood counts.

We did not find differences between SZ and HC in blood count parameters (p>0.05). In patients group, white blood cells (WBC), neutrophils and neutrophils-to-lymphocyte ratio (NLR) were positively related with the severity of positive symptoms (R=0.59, R=0.53, R=0.50; p<0.05, respectively). WBC was related to superoxide dismutase (SOD-1) levels (HC: R=-0.36, SZ: R=0.70; p<0.05). Neutrophils were positively related to catalase (CAT) (R=0.52; p<0.05) and ferric reducing antioxidant power (FRAP) (R=0.61; p<0.05), but only in the patients’ group. There was a positive relationship between NLR and CAT (R=0.45; p<0.05) in the SZ group.

The results indicate potential connection and interplay between OS and blood count parameters in the onset of psychotic episode. Further studies on a larger group of patients are needed.

No significant relationships.

Cannabis-induced psychotic disorder (CIPD) is defined by the development of psychotic symptoms during or briefly after intoxication with cannabis or withdrawal from cannabis. The social measures and restrictions implemented following the COVID-19 pandemic might have had an impact on cannabis availability, as suggested by patients from our clinical practice, reporting a shortage of the substance.

To compare sociodemographic, clinical characteristics and admission rates of inpatient treatment for cannabis-induced psychotic disorder in COVID-19 pandemic period and pre-pandemic period.

Retrospective observational study of inpatient admissions for CIPD in a psychiatry inpatient unit of a tertiary hospital. The statistical analysis was performed using SPSS software, version 27.0.

Our sample included 120 inpatient admissions, corresponding to 80 patients. Compared to 2018 and 2019, in 2020 there was an overall reduction of 21.5% in inpatient admissions (n=618, 549 and 458, respectively). The number of admissions for CIPD in 2018, 2019, 2020 and 2021 up to september were, respectively, 29, 32, 10 and 31 (5.2%, 6.1%, 2.2% and 7.2% of respective annual admissions). We found no statistically significant differences regarding sociodemographic and clinical characteristics in patients admitted for CIPD during 2020.

These results suggest a disproportionate reduction of inpatient admissions due to CIPD in 2020, followed by an expressive increase in the number of admissions in 2021up to september. This might be related to cannabis availability returning to regular levels. However other factors must be considered, such as the delay of treatment due to reduced accessibility to health care.

No significant relationships.

Kraepelin’s systematic paraphrenia (SP) has been historically used to identify a group of patients in the psychosis-spectrum with good global functioning and reduced impairment in volition and emotions.

Cross-sectional study comparing a group of patients with SP with another with schizophrenia (SZ).

We consecutively recruited SP cases from a single centre. SZ cases were selected to match those in the SP group in terms of age and sex. We diagnosed SP using the Munro Criteria and SZ using ICD-10. We collected standard sociodemographic and clinical data. All patients were under follow-up in a community mental health team at the time of the study. We used PANSS total score (PANSS-TS) to assess disease severity and its subscales to evaluate positive (PANSS-P) and negative (PANSS-N) symptoms, and general psychopathology (PANSS-GP). We applied SOFAS to assess social and occupational functioning.

We recruited 32 patients, 16 with a diagnosis of SP and 16 with a diagnosis of SZ. The two groups did not differ in terms of sociodemographic data. SP cases showed lower values for PANSS-TS (SP: mean=51.63±12.49; SZ=77.76±14.12; p<0.001), PANSS-NS (SP: mean=15.50±5.97; SZ: mean=26.06±5.39; p<0.001), and PANSS-GP (SP: mean=24.31±5.51; SZ: mean=37.13±5.62; p<0.001). Groups did not differ in terms of positive symptoms. SOFAS scores were significantly higher in SP (SP: median=68, interquartile range (IQR)=19; SZ: median=41, IQR=24; p<0.01). PNSS-NS negatively correlated with SOFAS only in the SP group (r=-0.716; p=0.002).

SP differs from SZ in negative symptoms and social and occupational functioning. These findings suggest clinical features can differentiate SP from SZ.

No significant relationships.

Folie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar delusional system. However, folie à deux is still a matter of study and debate today as it remains a challenge for psychiatrists.

The aim of this article is to report a clinical case of folie à deux, between na inducer son and an induced mother. Review the nosological significance of folie à deux and to explore the disorder among patients with psychosis.

Search in the PubMed/MedLine and Medscape databases with the following key words: folie à deux; shared psychosis; shared delusion.

We presente a case of folie à deux between na inducer son 28 years old and the induced, his mother. They were found to be sharing similiar delusional beliefs. The patient has assumed the role of “man of the house” since his father’s death.

Many years after it was first described, folie à deux is still an interesting and challenging disorder to psychiatrists. Its recognition and correct referral for a rare diagnosis, such as folie a deux, are extremely important.

No significant relationships.

Antipsychotics are the mainstream treatment of delusional disorder. However, limited therapeutic effect was recognized due to side effect and lack of insight.

This article presents a case with Ekbom’s syndrome, also known as delusional parasitosis, who has significant response with Brexpiprazole.

A 58-year-old female developed her very first episode of psychosis 3 weeks before she visited our emergency department. Delusion of spiders laying eggs and bitsy spiders crawling over her body was claimed, followed by depressed mood and insomnia. The patient denied any substance use in recent months. Examination including biochemical studies, complete blood count, vitamin, and endocrine during admission were all normal. Brain image revealed senile cortical atrophy without apparent acute infarction. Cognitive abilities screening instrument (CASI) revealed total score 75, indicating borderline cognitive function. Ophthalmologist and dermatologist were consulted, and no specific abnormality was found.

Brexpiprazole 2mg was prescribed. After 3 weeks of treatment, the delusion improved with less parasitosis content. We discharged the patient, and kept following her at outpatient department with Brexpiprazole 2mg for 2 months. We tried to taper Brexpiprazole to 1mg at clinic, but her delusional parasitosis relapsed within 1 month. Therefore, we titrated the medication back to 2mg, and kept some dosage for 4 months. No more relapse of psychosis or significant movement dysfunction was observed. The total treatment course was 7 months.

Brexpiprazole, with its D2 partial agonism, shows impressive antipsychotic effect to Ekbom’s syndrome. Little side effect was observed in clinical practice, making Brexpiprazole a worth-trying psychopharmacological management of delusional parasitosis.

No significant relationships.