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- Title
Acute Psychosis as a Representation of Meningoencephalitis: A Case-report on a Young Woman Referred to an Outpatient Psychiatry Unit.
- Authors
Sardashti, Sara
- Abstract
Introduction: Evidences suggest that 9 to 20 percent of the patients with acute psychotic symptoms who attend emergency departments suffer from a general medical condition. This statistic highlights the significance of the complete medical workup before finalizing the diagnosis of non-organic psychiatric disorders. In this respect, a wide range of diagnoses should be taken into account, including physical traumas, the use of drugs and toxins, the failure of organs, structural brain lesions, nutritional deficiencies, and infections. For the majority of these patients psychiatrists are the last resort in diagnosing who may have been missed by other medical doctors. Methods: In this study, a case of the acute onset of psychosis is studied in a 35 year old woman. The patient was married with 3 children and had been on a 10-day trip to the central parts of Iran (Kashan city) before the development of the symptoms. The patient had experienced a sudden onset of disorientation, amnesia, and visual and auditory hallucinations as well as persecutory delusions two days prior to the first visit by the neurologist. As she had a generalized headache with no fever or chills, she was referred to the outpatient clinic. After undergoing a careful examination, the patient was referred to the general emergency department to rule out organic etiologies. The initial brain CT scan showed no intracranial lesions. Neutrophilia was observed in the complete blood count, and other tests were normal. Lumbar puncture was tried by internists and despite the presence of no sign of meningeal irritation, it failed due to the patient's non-compliance and probability of the vertebral deformity. The injection of acyclovir was initiated due to the patient's fluctuating level of consciousness. After 10 hours with no changes to the clinical picture and two other failed LP trials, ceftriaxone and vancomycin were prescribed. A dramatic improvement was observed in 24 hours. In a week, the mental status examination was performed with no abnormal findings. The patient had reported no prior psychiatric symptoms before the present illness; she was only reported to have been in touch with an adult with chronic ear infections on her last trip to Kashan. Conclusion: The sudden onset of the psychotic disorder should always provoke the diagnosis of organic causes .Even in absence of typical symptoms and signs of infectious diseases, atypical representations and life-threatening causes of psychiatric representations must be taken into account.
- Subjects
IRAN; PHYSICIANS; SUDDEN onset of disease; SYMPTOMS; BLOOD cell count; MENTAL status examination; IRRITATION (Pathology)
- Publication
Iranian Journal of Psychiatry & Behavioral Sciences / Progress in Psychiatry & Behavioral Sciences, 2018, p163
- ISSN
1735-8639
- Publication type
Article