PSYCHIATRIC CASES

AHMED NABIL RAMADAN

MD. PSYCHIATRY
CASE 1

• MRs Z, 52 years old, with hypertension and diabetes.

• Presented with gradual onset and progressive course of false fixed conviction that she has been
infested with parasites and she has been always feeling of their movements on her scalp for
past 8 months.
• She was so anxious about this sensation and consulted a lot of dermatologists without being
reassured, she has been always convicted about these ideas and these sensations
• She has secondary for these symptoms, symptoms suggesting MDD, in form of depressed
mood, loss of interest, loss of appetite, and lost her weight about 9 kilograms for past 8
months.
• She had also guilt sensation, and wishes of death without any attempt or plan.
• She denied any unusual experience of auditory or visual perceptions
• She has not any past history of substance use disorder, or any previous mood or psychotic
episodes
• She has not any family history of any psychiatric disorders
• First we do some scales of PHQ-9, Zung for anxiety, panss for psychosis
• Weve done a lot of investigations including:
• 1.Brain imaging: MRI brain without contrast which showed no abnormalities
• 2.Blood : thyroid functions, CBC, HBA1C, serum electrolytes , serum cholesterol fasting,
LDL, HDL and TG which were all free except for HBA1C was 8.
• We did ECG which was also free
• We started treatment including CBT and pharmacological treatment of cipralex 10mg and
ability 5 mg.
• After 3 week there was initial response in term of depression and delusion but patient
started to feel akathetic.
• I added inderal 10 mg twice daily and low dose bromazepam which made the patient has
bronchial asthma, she seems to have asthma but provoked by inderal.
• I switched abilify to REXulti 3mg with gradual titration from 1 mg weekly increase to 3
mg
• Patient followed us after 6 weeks with ggod response without evident akathesia.
CASE 2

• Mr K, 28 years old, single, postgraduate student, with no evident history of medical

disorders.
• He complained of depressed mood , anhedonia, severe pychomotor retardation , guilt
sensation, he lost appetite and weight with 6 kilograms for previous couple of months
• These symptoms lasted for 2 years with multiple trials of SSRIs
• He denied any suicidal attempts or plans
• He had no previous manic, hypomanic or depressive episodes
• He had no history of substance use disorders
• He had no family history of psychiatric disrders
• Weve done PHQ-9 Zung for anxiety panss for psychosis
• Investigations like CBC, thyroid functions, cholesterol fasting LDL cholesterol fasting
LDL HDL levels, ESR were done, and all were free
• I prescribed for him Effexor 150 mg, and olanzapine 5mg, with good response but with
quite harsh side effects which stick around like dizziness, sleepiness and weight gain for
5 kg for 1 month.
• I shifted olanzapine to REXulti at dose of 1 mg with the same response and without these
disabiling side effects
• Weight gain from REXulti was present for 2 kg for 3 months
THANK YOU