Psychiatric manifestation of dengue virus infections is seldom reported. Here a case is presented of a 21-year-old man who developed mainly neuropsychiatric symptoms which he caught one week after a feverish infection during his stay in India: troubles with concentration and memory, confusion, as well as depressive delusions and agoraphobia. Liquor diagnosis as well as CCT and MRI was mainly inconspicuous. The FDG-PET showed a diffuse lack of activity. IgM and IgG antibodies of dengue virus were positive. We interpreted these psychiatric symptoms as a result of a dengue virus infection.
During the years 2003 to 2006 compulsory admissions and physical restraints were recorded in a psychiatric department. During this period the rate of compulsory admissions per all psychiatric admissions rose from 29.4% in 2003 to 33% in 2006. The rate of patients with at least one episode of physical restraint rose from 2.6% to 5.6%. The rate of compulsory admissions per inhabitants of the catchment area rose from 320/100.000 inhabitants in 2003 to 411/100.000, the rate of admissions with at least one episode of physical restraint from 28.6/100.000 inhabitants to 69.3/100.000. The mean duration of compulsory treatment over the whole period was 8.6 days, the median was 3 days. The mean duration of physical restraints was 132 minutes, the median duration 45 minutes.
Psychiatric inpatient treatment leads to clinically relevant deterioration of metabolic parameters within a short time, most pronouncedly in patients with psychotic disorders.
IntroductionIt is not uncommon that patients suffering from psychosis reveal a comorbidity of attention-deficit/hyperactivity disorder (ADHD). There is lack of evidence how to treat these patients as amphetamines are considered contraindicated for patients with psychosis.Objective/aims/methodsTo provide the case history of such a comorbid patient.ResultsA 21 year old male patient is committed to the psychiatric clinic displaying massive assaultive behavior. He has been consuming cannabis heavily over the last few years; for a couple of days now he has been displaying psychotic features. Occasional aggressive outbursts have been known to occur since childhood. The patient’s own accounts and those of his relatives also make an ADHD highly probable. During inpatient stay there are massive, dangerous aggressive assaults without detectable reasons along with complete disorganized behavior and massive thought disorders on three different occasions. Medication with very high doses of antipsychotics, benzodiazepines as well as mood stabilizers could not prevent the patient from his aggressive outbursts. The lack of efficacy of conventional treatment led us to propose to the patient a trial dose of methylphenidate, which calmed the patient instantly. Psychotic symptom, aggression and symptoms of ADHD improved during further treatment with methylphenidate, which was replaced by atomoxetine later. The patient was dismissed on a regimen of atomoxetine, Risperidone and Valproate and was well at a follow-up investigation 2 months later.ConclusionsThe use of methylphenidate in patients with adult ADHD comorbid with psychosis seems to be possible and helpful on some occasions.
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