| M, 38 yo, brown |
Admitted in May 2012 due to elevated mood and religious delusions that started two weeks before. The patient remained hospitalized for 16 days, being prescribed valproic acid and haloperidol. He exhibited remission of the symptoms and remained asymptomatic until a year later, when he needed a new admission due to poor treatment adherence. At this time, he presented with high self-esteem, mystical delusions, reduced sleep, increased psychomotricity, increased speech flow, and incoherent speech. He was discharged after 12 days. He was followed for the next two years, with good adherence to the outpatient treatment and without relapses. Final Diagnosis: Bipolar Disorder
|
2 |
Normal
[CT/MRI] |
Normal |
21 |
| F, 34 yo, black |
Admitted in July 2012 due to emotional lability, expansive mood, distractibility, increased psychomotricity, sexual disinhibition, aggressiveness, irritability, reduced sleep and behaviour suggestive of auditory and visual hallucinations beginning two months before. Patient was under treatment with sertraline, which was prescribed due to complaints of depressed mood, demotivation, thoughts of death and suicidal ideation. The patient was also under clinical follow-ups for hypothyroidism, obesity, diabetes and systemic arterial hypertension. Sertraline treatment was discontinued because the condition was considered a possible manic episode secondary to antidepressants, and haloperidol and lithium carbonate were introduced. The patient remained hospitalized for 13 days and was discharged with partial remission. Over a four-year follow-up period, the patient presented three depressive episodes and two other admissions, both due to manic episodes with psychotic symptoms. Patient remained euthymic in the last year of the follow-up, with monthly outpatient appointments, under treatment with bupropion, quetiapine and valproic acid. Final Diagnosis: Bipolar Disorder
|
7 |
Normal
[CT/MRI] |
Normal |
23 |
| F, 38 yo, white |
Admitted in November 2012 due to persecutory and jealous delusions for at least six months. The patient also complained of sadness, thoughts of death and two suicide attempts. She sought help from a psychiatrist and was medicated with sertraline. Patient presented with restlessness, psychomotor agitation and logorrhea after the introduction of sertraline, being first diagnosed as a manic episode secondary to antidepressants. Regarding the premorbid personality, there was a description of difficulties in interpersonal relationships, with few friendships, and additional impulsive, rigid and stubborn behaviour. The patient was followed for at least four years. Throughout the follow-up, the patient exhibited bad responses to several pharmacological treatments, poor adherence and reports of side effects even at low doses. She was readmitted twice due to depressive symptoms and suicidal thoughts. Final Diagnosis: Recurrent Depressive Disorder and Cluster B Personality Disorder
|
29 |
Normal
[CT] |
Normal |
21 |
| F, 30 yo, brown |
Admitted in April 2013 due to irritated mood, physical aggression, decreased sleep, increased psychomotricity and directed activity, and mystical delusions, starting 2 days before. A year prior, the patient underwent consultation with a psychiatrist due to anxiety complaints, and sertraline was prescribed; however, the patient did not use the sertraline. She had systemic arterial hypertension and was under treatment with enalapril. She was given lithium carbonate and haloperidol. The patient was discharged in 10 days after full remission. She was referred for an outpatient follow-up but attended only one appointment. Final Diagnosis: Bipolar Disorder
|
<1 |
Normal
[CT/MRI] |
Normal |
1 |
| M,17 yo, brown |
Admitted in April 2013 and referred with the diagnosis of a psychotic disorder due to multiple substances. Two months before, he presented with irritability, logorrhea, increased psychomotricity followed by disorganized speech, persecutory delusions, soliloquies and aggressive behaviour. The patient reported daily cannabis use since the age of 13 and sporadic use of cocaine since the age of 15. After four days of hospitalization, the patient presented full remission. He was discharged using haloperidol, valproic acid and lorazepam. Patient did not adhere to the outpatient treatment, and four months later, he was readmitted due to increased energy, reduction in sleep requirements, expansive mood, distractibility and hypersexual behaviour. Even though he was only partially remitted, he was discharged at the request of his relatives on the 23rd day after admission. The patient only attended the outpatient follow-up once. Final Diagnosis: Bipolar Disorder
|
5 |
Normal
[CT/MRI] |
Increased TSH |
15 |
| M, 19 yo, black |
Admitted in July 2013 due to psychomotor agitation, persecutions and behavioural disorganization that started one month before. Before being admitted to our psychiatric unit, the patient stayed for 15 days in other departments, where he was physically restrained and medicated intramuscularly countless times with haloperidol. The patient developed a condition suggestive of malignant neuroleptic syndrome, with cervical dystonia, tremors, sialorrhea, mental confusion, lowering of consciousness and autonomic instability, as well as increased CPK. At the time of admission, the patient had persecutory delusions and behaviour suggestive of auditory and visual hallucinations. According to relatives, since the age of 12, the patient had been more introverted and silent than other children, exhibiting schooling difficulties and repeating the eighth grade twice. He remained hospitalized for approximately one month until partial remission of symptoms under the treatment with risperidone. Over a three-year follow-up period with monthly appointments, the delusions and hallucinations remitted, but social withdrawal, blunting affect and a certain impairment in functionality remained. Final Diagnosis: Schizophrenia
|
4 |
Normal
[MRI] |
Increased TSH |
2 |
| M, 16 yo, brown |
Admitted in January 2014 due to irritability, decreased need for sleep, persecutory, religious and grandiose delusions, and risky behaviour that started one year before, with periods of remission and relapse. Patient had a history of cannabis use and personality traits marked by stubbornness, clutter and lack of acceptance of limits. Patient remained hospitalized for 33 days and was discharged under treatment with valproic acid and risperidone. Patient remained asymptomatic for at least one year, but he returned to cannabis use, and a relapse occurred 18 months after the index admission that featured grandiosity, psychomotor agitation, increased energy, decreased need for sleep, delusions and hallucinations. He was readmitted and remained hospitalized for 21 days. Patient was followed for the next year, without relapse of the symptoms. Final Diagnoses: Bipolar Disorder and Conduct Disorder
|
52 |
Normal
[CT] |
Normal |
12 |
| M, 20 yo, brown |
Admitted in June 2014 due to physical heteroaggression, psychomotor agitation, irritability and emotional lability, and behaviour suggestive of auditory and visual hallucinations that started more than one year before. He started once-a-week cannabis use at the age of 17 and, one year later, he started to exhibit delusional speech and behaviour suggestive of visual and auditory hallucinations, reduced sleep, logorrhea, psychomotor agitation and aggression. At that time, the patient was taken into consultation with a psychiatrist and was prescribed haloperidol, with full remission of symptoms. However, the patient ceased using medication and presented with relapses. From the beginning of the symptoms, the patient continued to use cannabis and presented residual psychotic symptoms. He stayed only two days in our inpatient unit and was forwarded to the referral service. Final Diagnosis: Schizophrenia
|
26 |
Normal
[CT/MRI] |
Increased GOT |
18 |
