Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2014-0053
Trends in Psychiatry and Psychotherapy
Case Report

Where does her mood come from? An organic approach to a once functional patient

De onde vem seu humor? Uma abordagem orgânica para um paciente previamente funcional

Pablo Eduardo Pereira Dutra; Wagner de Sousa Gurgel; Renato Alves Higa; Carolina Costa

http://dx.doi.org/10.1590/2237-6089-2014-0053 Trends Psychiatry Psychother, vol.37, n2, p.100-103, 2015
PDF
SciELO
Downloads: 0
Views: 588

Abstract

Objective: To report the rare development of manic symptoms in a patient with schizophrenia and discuss its differential diagnosis.Case description: Diagnostic criteria were based on the International Classification of Diseases, 10th edition (ICD-10). A 63-year-old female (diagnosed with schizophrenia since she was 28) was brought to the emergency room with symptoms consistent with manic episode and physical examination suggestive of thyrotoxicosis. Graves' disease was confirmed by subsequent laboratory tests. She was treated successfully with radioiodine ablation, leading to full remission of manic symptoms.Comments: Schizophrenia is a chronic disease that affects about 1% of the population worldwide. The main symptoms of the disorder are altered affection, delusions, and hallucinations. Graves' disease is an autoimmune condition in which antibodies increase the production and release of thyroid hormones. There are reports about the development of mood symptoms in patients with Graves' disease that remit with adequate treatment.

Keywords

Schizophrenia, Graves' disease, mood symptoms, radioiodine, thyroid gland, schizoaffective disorder

Resumo

Objetivo: Relatar um caso raro de desenvolvimento de sintomas maníacos em uma paciente com esquizofrenia e discutir o diagnóstico diferencial desses sintomas.Descrição do caso: Foram utilizados como base os critérios diagnósticos da Classificação Internacional de Doenças, 10ª edição (CID-10). Paciente de 63 anos do sexo feminino e com diagnóstico de esquizofrenia desde os 28 anos foi levada a emergência com sintomas compatíveis com episódio de mania e exame físico sugestivo de tireotoxicose. Doença de Graves foi confirmada por exames subsequentes. A paciente foi tratada com sucesso com ablação por iodo radioativo, levando à remissão dos sintomas maníacos.Comentários: A esquizofrenia é uma doença crônica que afeta cerca de 1% da população mundial. Os principais sintomas do transtorno são o embotamento afetivo, alucinações e delírios. A doença de Graves é uma doença autoimune em que o estímulo humoral aumenta a produção e liberação de hormônios pela tireoide. Há relatos na literatura sobre o desenvolvimento de sintomas maníacos em pacientes com doença de Graves, os quais remitem mediante tratamento adequado.

Palavras-chave

Esquizofrenia, doença de Graves, sintomas de humor, radioiodo, tireoide, transtorno esquizoafetivo

References

Akiibinu MO, Ogundahunsi OA, Ogunyemi EO. Inter-relationship of plasma markers of oxidative stress and thyroid hormones in schizophrenics. BMC Res Notes. 2012;5:169.

Graves RJ. Newly observed affection of the thyroid gland in females. Lond Med Surg J. 1835;7:516-7.

Bunevicius R, Prange Jr AJ. Psychiatric manifestations of Graves' hyperthyroidism, pathophysiology and treatment options. CNS Drugs. 2006;20:897-909.

Peiris AN, Oh E, Diaz S. Psychiatric manifestations of thyroid disease. South Med J. 2007;100:773-4.

Boelaert K, Newby PR, Simmonds MJ, Holder RL, Carr-Smith JD, Heward JM. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am J Med. 2010;123:183.e1-9.

Stahl SM. Psychosis and schizophrenia. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. 2010:168-217.

Stahl SM. Antipsychotic drugs. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. 2010:218-300.

Minzenberg MJ, Yoon JH, Carter CS. Schizophrenia. The American psychiatric publishing textbook of psychiatry. 2012:431-82.

Nordyke RA, Gilbert Jr FI. Optimal iodine-131 dose for eliminating hyperthyroidism in Graves' disease. J Nucl Med. 1991;32:411-6.

DeGroot LJ, Jameson JL. Endocrinology: adult and pediatric. Marinò M, editor. Graves' disease. 2010.

Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams textbook of endocrinology. 2011.

Fornaro M, Iovieno N, Clementi N, Boscaro M, Paggi F, Balercia G. Diagnosis of comorbid axis-I psychiatric disorders among women with newly diagnosed, untreated endocrine disorders. World J Biol Psychiatry. 2010;11:991-6.

Gregory I. Mental disorder associated with thyroid dysfunction. Can Med Assoc J. 1956;75:489-92.

Radhakrishnan R, Calvin S, Singh JK, Thomas B, Krishnamachari S. Thyroid dysfunction in major psychiatric disorders in a hospital based sample. Indian J Med Res. 2013;138:888-93.

Rønnov-Jessen V, Kirkegaard C. Hyperthyroidism - a disease of old age. Br Med J. 1973;1:41-3.

Snaboon T, Khemkha A, Chaiyaumporn C, Lalitanantpong D, Sridama V. Psychosis as the first presentation of hyperthyroidism. Intern Emerg Med. 2009;4:359-60.

Chittiprol S, Venkatasubramanian G, Neelakantachar N, Babu SV, Reddy NA, Shetty KT. Oxidative stress and neopterin abnormalities in schizophrenia: a longitudinal study. J Psychiatr Res. 2010;44:310-3.

Cheniaux E, Landeira-Fernandez J, Telles LL, Lessa JL, Dias A, Duncan T. Does schizoaffective disorder really exist? A systematic review of the studies that compared schizoaffective disorder with schizophrenia or mood disorders. J Affect Dis. 2008;106:209-17.

6169f253a95395619e5d48a3 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections