Periodic psychosis associated with pseudo-pseudohypoparathyroidism

Article Abstract:

Pseudohypoparathyroidism (PHP) occurs when organs become resistant to parathyroid hormone (PTH), causing low levels of calcium and phosphate in the blood despite adequate levels of PTH. In pseudo-pseudohypoparathyroidism (PPHP), the skeletal abnormalities associated with PHP are present, but calcium deficiency not present and organ response to PTH is normal. The literature has reported three cases of PPHP with concurrent psychosis, delusions of persecution, paranoia, general delusions, and hallucinations. A case is reported of a 43-year-old Japanese male who was unusually irritable and unable to sleep prior to coming to the hospital. He had become paranoid as well, and the night before he experienced hallucinations. The present episode was his fifth; first occurred at age 28. All but the first incident, which lasted four months, continued for about two weeks. The patient had not experienced hallucinations until the most recent episode. Upon examination, all neurological signs were normal, as were biochemical measures. To test for PPHP, the patient was given the Ellsworth-Howard test, an injection with 100 units of human PTH; a positive urine response was obtained. There are five criteria for the diagnosis of PPHP: physical characteristics of both PHP and PPHP; normal levels of calcium and phosphate in the blood; normal PTH levels in the blood; exclusion of Turner syndrome; and a positive urine response to the Ellsworth-Howard test. This patient met all five criteria. It is suggested that the patient's psychotic symptoms may have been the result of a genetic vulnerability associated with PPHP. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Diagnosis, Causes of, Endocrine gland diseases, Endocrine diseases, Pseudo-pseudohypoparathyroidism

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Late-onset psychosis: clinical, research, and ethical considerations

Article Abstract:

A 60 year old Caucasian man with no history of psychiatric illness was presented with auditory hallucinations and paranoid delusions. Neuropsychological testing did not show dementia although magnetic resonance imaging showed moderate central and mild cortical volume loss. The man's condition was diagnosed as a case of late-onset schizophrenia. Haloperidol was prescribed for the man's condition with the option of switching to an atypical antipsychotic medication. The patient's prostate nodule and tardive dyskinesia were considered the main ethical and legal issues for his care.

Research, Psychotherapy patients, Psychiatric research, Schizophrenia

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Clinical case: unknown

Article Abstract:

A suicide attempt involving a 50-year-old man who was brought to the emergency room of a New York medical center after he was found in his skid row hotel room with a suicide note is studied. An analysis of the incident showed that the man was suffering from mood disorders due to the structure of the suicide note and not schizophrenia. He also denied that he was into substance abuse. But there were also symptoms of axis II pathology based on the contents of the suicide notes.

Suicide, Psychiatric emergencies

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