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Depressive symptoms are very common in patients with a chronic medical illness such as sickle cell disease (SCD). Clinicians may fail to recognize depression in such patients when, as in SCD, the two conditions have many overlapping symptoms. Based on a Medline database search, we review papers addressing the relationship between depression and SCD. Data regarding this relationship are conflicting. We provide recommendations for improving the treatment of patients with SCD and depression.

The topic of foreign body ingestion has received extensive coverage in the areas of surgery, emergency medicine, and pediatrics. A subset of this topic, the intentional ingestion of foreign bodies, however, is much less common, and requires special evaluation and management. Here, we report a case of ingestion of a rolled, metal tuna can lid in a male prison inmate previously diagnosed with depression and paranoid schizophrenia. Following evaluation by the surgical team, the foreign body was removed by laparotomy and the patient was discharged back to the prison without complication. In many cases, ingestions of this type involve a command hallucination ordering the patient to swallow the foreign body. Interestingly, the patient in the present case reported auditory hallucinations commanding him not to swallow the can lid. On further investigation, we found that patient had a proclivity toward this swallowing behavior even prior to his incarceration. Early identification of inmates with this proclivity has important implications for treatment and prevention.

Clinicians should be aware of this adverse effect of isoniazid and that it may present with a broad clinical picture.

Multiple sclerosis (MS) is a fairly common condition that affects approximately 350,000 people in the United States. It is associated with various neuropsychiatric symptoms including cognitive and behavioral symptoms. However, visual hallucinations are rare in multiple sclerosis without the presence of cognitive deficits. We are describing the case of a 40-year-old married white female with isolated complex visual hallucinations compatible with the Charles Bonnet syndrome (CBS). The patient was successfully treated with the atypical antipsychotic olanzapine.

Clonidine should be considered as an alternative in the treatment of nightmares among patients with PTSD.

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