We are presenting the case of a 52 year old female with three distinct episodes of clinical deterioration over a 20 year period after thyroid cancer treatment. The first decrease in functioning happened after the diagnosis of thyroid cancer, resulting in the patient not achieving her PhD thesis. The second deterioration happened ten years later when she presented with psychotic symptoms and the symptoms of anorexia. The last period of deterioration occurred one year before this hospitalization. During that time the patient worsened to the point where she became bedbound and dependent on a PEG tube for feeding. Once hospitalized, the patient had partial response to lorazepam (27 mg a day) and so dextroamphetamine was added with positive response. The addition of memantine helped with the residual symptoms. The PEG tube was finally able to be removed and the patient was discharged home in stable condition.
Hypersexuality and gender dysphoria have both been described in the literature as symptoms of mania. Hypersexuality is listed in the Diagnostic and Statistical Manual of Mental Disorders 5 as part of the diagnostic criteria for bipolar disorder. Gender dysphoria is less often described and its relation to mania remains unclear. This case report describes a young homosexual man presenting in a manic episode with co-morbid amphetamine abuse whose mania was marked by hypersexuality and the new onset desire to be a woman. Both of these symptoms resolved with the addition of valproic acid to antipsychotics. This case report presents the existing literature on hypersexuality and gender dysphoria in mania and describes a treatment option that has not been previously reported.
Hypersexuality and gender dysphoria have both been described in the literature as symptoms of mania. Hypersexuality is listed in the Diagnostic and Statistical Manual of Mental Disorders 5 as part of the diagnostic criteria for bipolar disorder. Gender dysphoria is less often described and its relation to mania remains unclear. This case report describes a young homosexual man presenting in a manic episode with co-morbid amphetamine abuse whose mania was marked by hypersexuality and the new onset desire to be a woman. Both of these symptoms resolved with the addition of valproic acid to antipsychotics. This case report presents the existing literature on hypersexuality and gender dysphoria in mania and describes a treatment option that has not been previously reported.
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