OBJECTIVE:Wilson disease (WD) is a rare autosomal recessive disorder affecting copper metabolism, primarily manifesting with hepatic, neurological, and psychiatric symptoms. While psychiatric symptoms occur in 1025% of cases, nearly all patients experience mood disturbances, personality changes, or psychosis at some point during the disease course. CASE (The patient consent must be provided and specified with appropriate terms.):We present the case of a 20-year-old female who was diagnosed with WD in 2015 who exhibited treatment-resistant depressive disorder and multiple suicide attempts. In 2022, she sought medical attention for persistent anxiety and depressive mood. Despite receiving adequate doses and treatment durations of multiple SSRIs (fluoxetine, escitalopram, paroxetine, sertraline) and antipsychotics (olanzapine, risperidone, aripiprazole), her depressive symptoms and self-mutilative behavior persisted, suggesting a treatment-resistant trajectory. In December 2024, she was admitted to our hospital's emergency department following a suicide attempt by medication overdose. During psychiatric evaluation, she reported anhedonia, guilt, and feelings of worthlessness.The patient was hospitalized for 40 days for further evaluation and treatment adjustment in our psychiatry clinic. Physical examination and laboratory findings were largely unremarkable, except for mildly elevated liver function markers (ALT, AST, LDH). She was prescribed duloxetine (60 mg/day) and alprazolam (1 mg/day). On cerebral MRI, supraventricular and parietal cerebral atrophy was observed. However, while her MRI scan from March 2023 was initially normal, subsequent imaging revealed early-onset cerebral atrophy. This suggests that treatment-resistant depressive episodes may have accelerated the neurodegenerative process, leading to structural brain changes earlier than expected. Informed constent was obtained from the patient and her relatives.
DISCUSSION:This case highlights the potential role of psychiatric comorbidities, particularly treatment-resistant depression, in accelerating cortical atrophy in WD. Since neurodegenerative changes are usually observed in later stages or untreated cases, the presence of early cerebral atrophy in this patient suggests that severe psychiatric symptoms might contribute to disease progression.
OBJECTIVE:Late-onset psychotic depression is frequently underdiagnosed and undertreated, especially when predominant somatic delusions lead to unnecessary medical evaluations and delayed psychiatric intervention. This case report presents a 66-year-old patient with late-onset psychotic depression and severe somatic delusions. CASE :A 66-year-old male with no prior psychiatric history developed abdominal pain, social withdrawal, and anhedonia following a COVID-19 infection. His symptoms worsened over months, leading to severe somatic delusions, including believing he could not urinate or defecate and that eating would cause him to explode. Notably, his father had died of gastric cancer at a similar age, and despite one year of repeated medical evaluations with no pathology found, he remained convinced of having cancer. His fear progressively worsened, contributing to functional decline and significant weight loss. His family sought psychiatric consultation repeatedly; however, poor medication adherence led to no improvement. He was eventually hospitalized in a psychiatric unit and referred for ECT due to treatment-resistant psychotic depression. At admission, he was on venlafaxine 150 mg/day and olanzapine 10 mg/day. Venlafaxine was switched to sertraline 50 mg/day, and olanzapine was increased to 15 mg/day. The patient received eight ECT sessions, resulting in marked improvementhis weight increased from 51.6 to 58 kg, his somatic delusions resolved, and his self-care improved. During hospitalization, a cervical swelling was noticed after he resumed shaving. Initially suspected as an abscess, further imaging revealed hypoechoic, heterogeneous vascular lesions, later diagnosed as gingival squamous cell carcinoma. Despite the malignancy, he remained psychiatrically stable at follow-up with escitalopram 10 mg/day and olanzapine 5 mg/day. Informed consent was obtained for case report. DISCUSSION:Late-onset psychotic depression can present with severe somatic delusions, leading to misdiagnosis and delayed psychiatric care. This case highlights the role of ECT in
treatment-resistant depression and the need for a multidisciplinary approach, as psychiatric symptoms may mask underlying medical conditions.
OBJECTIVE:Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by progressive impairments in behavior, executive function, or language. It primarily affects individuals under 65 years of age. This case aims to highlight how FTD can be confused with depression. CASE (The patient consent must be provided and specified with appropriate terms.):Casereport:A 52-year-old male patient, married and with an elementary school education, was brought to the emergency department with complaints of reduced appetite, behavioral changes, social withdrawal, aggression, and decline in self-care over the past six months. The patient's Hamilton Depression Rating Scale (HAM-D) score was 21, suggesting depression. He was admitted to the psychiatry department and started on sertraline 25mg/day. The first symptoms were apathy and changes in behavior, including aggression toward his wife, collecting cardboard from trash bins, and even starting fires at work. He exhibited strange eating habits, only consuming snacks like chips and nuts. There was no family history of neurodegenerative or psychiatric diseases, and lab results were normal. Neurological examination revealed poor orientation, inappropriate behavior, and cachectic appearance. MRI of the brain showed significant volume loss in the orbitofrontal cortex and anterior temporal lobes, with atrophy in the hippocampus and cerebellum. The diagnosis was behavioral variant FTD. Despite no improvement in his symptoms, sertraline was continued, and olanzapine 10mg/day and donepezil 5mg/day were added. Follow-up outpatient visits continued post-discharge. DISCUSSION:Psychiatric disorders can mimic frontotemporal dementia. The most prominent early signs of behavioral variant FTD are personality changes, disinhibition, and apathy, which can easily be confused with depression. Careful differential diagnosis is essential and requires a detailed history, family background, neuropsychological testing, laboratory workup, and neuroimaging to distinguish FTD from other conditions. This case emphasizes the importance of excluding organic pathology early in the diagnostic process. Referencess:Bang, J., Spina, S., &
Miller, B. L. (2015). Non-Alzheimers dementia 1: Frontotemporal dementia. Lancet (London, England), 386(10004), 1672.
OBJECTIVE:Selective serotonin reuptake inhibitors (SSRIs) have been associated with hypoglycemia, though this adverse effect remains underrecognized. In this case report, we present a patient with empty sella syndrome who experienced worsening hypoglycemic episodes following sertraline initiation, which resolved after switching to vortioxetine. CASE (The patient consent must be provided and specified with appropriate terms.):A 42-year-old female with recurrent depressive episodes first sought psychiatric treatment 15 years ago. Between 2015 and 2020, she was intermittently treated with escitalopram, trazodone, mirtazapine, and reboxetine, leading to remission and eventual medication discontinuation. In 2019, she was diagnosed with partial empty sella syndrome and underwent three ventriculoperitoneal shunt surgeries over five years. She was on acetazolamide, acarbose, and levothyroxine sodium. She experienced occasional hypoglycemic episodes with dizziness and headaches but was not under continuous psychiatric follow-up. In 2022, she was prescribed escitalopram 10 mg for worsening depression but discontinued it due to suspected worsening of hypoglycemia, with glucose levels dropping to 40 mg/dL. Several months later, she presented with persistent symptoms, and sertraline 50 mg was initiated. Shortly after, she developed frequent and severe hypoglycemic episodes, with glucose levels dropping to 38 mg/dL. Due to suspected SSRI-induced hypoglycemia, sertraline was discontinued, and vortioxetine 10 mg was introduced. Subsequent glucose levels normalized to 78 mg/dL, and follow-ups showed stable glucose levels without further hypoglycemia. Informed consent was obtained. DISCUSSION:SSRIs, particularly those with strong serotonin reuptake affinity like sertraline and fluoxetine, may exacerbate hypoglycemia through mechanisms such as increased insulin secretion, impaired counterregulatory hormone response, and suppressed hepatic gluconeogenesis. While this effect is well-documented in diabetic patients, cases in non-diabetic individuals remain rare and poorly understood. Clinicians should consider SSRI-induced hypoglycemia in patients with recurrent unexplained episodes, especially those with metabolic or endocrine disorders.
OBJECTIVE:This case report presents periorbital oedema, a rare side effect of sertraline in a 60-year-old man. Although periorbital oedema is a known side effect of some drugs, it has not been commonly associated with sertraline. CASE (The patient consent must be provided and specified with appropriate terms.)::A 60-year-old man presented with complaints of emotional fluctuations, crying, ruminative thoughts, restlessness and insomnia in 2021. Initially, escitalopram 10 mg/day was started and increased to 20 mg/day due to inadequate response. However, since the patient could not tolerate this dose, treatment was changed to sertraline 50 mg/day. Due to inadequate response, sertraline dose was increased to 100 mg/day and depressive symptoms improved. After sertraline 50 mg/day was started, periorbital oedema developed in both eyes. The patient was referred to related specialities but no underlying pathology was detected. After the dose of sertraline was increased to 100 mg/day, oedema became severe. The oedema regressed after the drug was discontinued. However, when depressive symptoms recurred, sertraline was restarted at 50 mg/day and oedema reappeared. Detailed investigations revealed no other cause. Considering the temporal relationship between sertraline use and the onset of symptoms, it was considered as sertraline-induced periorbital oedema. DISCUSSION:Some psychotropic drugs, such as mianserin, fluoxetine, paroxetine, risperidone and olanzapine, have been associated with periorbital oedema. However, this side effect has rarely been reported with sertraline and the mechanism is not known. This case highlights the need to be aware of periorbital oedema as a potential side effect of sertraline use. It is recommended to consider this rare but important side effect when prescribing sertraline in clinical practice.[Informed consent has been obtained from the patient mentioned in this case report]
OBJECTIVE:Organic catatonia is a life-threatening neuropsychiatric syndrome that may arise from numerous psychiatric disorders as well as general medical conditions, including neurodegenerative, metabolic, and genetic diseases. Early identification of catatonia due to organic causes is crucial, as delayed treatment may lead to permanent neurological impairment. This case report presents a 20-year-old female with progressive neurological deterioration and catatonia, ultimately diagnosed with CLN3 disease (Batten disease). CASE (The patient consent must be provided and specified with appropriate terms.):A 20-year-old female with a history of epilepsy, progressive visual impairment, and mild intellectual disability presented with a six-month history of worsening gait disturbance, cognitive decline, severe weight loss (~30 kg) along with increased seizure frequency. Three months prior, following an emotional stressor, she developed persecutory delusions, visual hallucinations, mutism, and food refusal. She became increasingly withdrawn, irritable, and physically aggressive, leading her family to seek medical attention. Neurological and psychiatric evaluations resulted in levetiracetam, quetiapine, and olanzapine prescriptions; however, medication adherence was poor. Fifteen days prior to admission, her symptoms deteriorated further with autonomic instability, spasticity, and worsening catatonic features. After her transfer to our facility, neuroimaging and laboratory tests were unremarkable. She was admitted to the ICU with a preliminary diagnosis of organic catatonia and treated with diazepam. Despite partial improvement, rigidity persisted, necessitating electroconvulsive therapy (ECT). Following 10 ECT sessions, her psychomotor rigidity significantly improved, and she regained some verbal and social engagement, yet she remained unable to walk. Subsequent genetic testing revealed homozygous CLN3 mutation, confirming Batten disease. Informed consent was obtained. DISCUSSION:This case highlights the importance of recognizing organic causes in treatment-resistant catatonia, particularly in patients with neurodevelopmental disorders and progressive neurological symptoms. Early intervention with benzodiazepines and ECT remains crucial, yet underlying metabolic or genetic conditions should be explored when catatonia persists. A multidisciplinary approach is essential for accurate diagnosis and optimal management.
OBJECTIVE:This case study explores the integration of artificial intelligence (AI) in therapy for a married couple (Mrs. P, 32, and Mr. M, 39) recovering from infidelity. Both participants provided informed consent for the use of AI tools and the publication of anonymized findings. AI-driven tools were integrated with traditional therapy to help rebuild trust, restore intimacy, and improve emotional connection. Ethical guidelines from the American Psychological Association (APA) ensured responsible use of AI. This case underscores the potential of AI to complement traditional therapy in post-infidelity healing. CASE (The patient consent must be provided and specified with appropriate terms.):The therapeutic intervention followed three phases: 1. Assessment Phase: Baseline metrics were established using various inventories to track emotional and relational progress. These included: o Beck Depression Inventory (BDI) o Beck Anxiety Inventory (BAI) o Couples Satisfaction Index (CSI) o Trust Scale o Transgression-Related Interpersonal Motivations Inventory (TRIM) o Golombok-Rust Inventory of Sexual Satisfaction (GRISS) 2. Intervention Phase: AI tools such as ChatGPT-4, Paired, and Evergreen facilitated personalized exercises. These included writing apology letters, mood tracking, CBT-based interventions, and intimacy-building activities like sensate focus and creative writing. 3. Evaluation Phase: Progress was assessed at 4-week intervals, with AI dynamically adjusting interventions based on data trends. Significant improvements were noted: o 40% decrease in BDI scores o 35% decrease in BAI scores o 50% increase in CSI scores o 60% improvement in trust and forgiveness (TRIM) o 45% improvement in sexual satisfaction (GRISS) DISCUSSION:AI tools like Paired and Evergreen offer personalized interventions that enhance emotional connection and trust. Levin et al. (2020) highlighted Paireds role in improving communication, helping couples address issues like infidelity. Evergreens tailored relationship plans also improve satisfaction (Smith et al., 2021). These tools foster vulnerability and empathy, essential for overcoming emotional barriers after infidelity (Shapiro & Gottman, 2019). This case demonstrates AIs transformative potential in promoting emotional intimacy, creativity, and resilience in couples healing from infidelity.
İbrahim Barikan, Ömer Faruk Uygur, Hakan Emre Babacan
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OBJECTIVE: Bipolar affective disorder is a recurrent, disabling and potentially lethal illness that typically begins early in life.The depressive episodes are more numerous, last longer and are more difficult to treat than the manias.Treatment options are limited for patients with bipolar depression.Antidepressants added to mood stabilizers even carry risks of precipitating mixed/manic episodes.Accelerated transcranial magnetic stimulation(aTMS) may provide a safe and effective option for these patients.We aim to present a patient with bipolar depression who benefited from aTMS. CASE: A 23-year-old male patient was admitted with unhappiness, lack of pleasure, anhedonia and insomnia.He was diagnosed with Bipolar Affective Disorder, had a manic episode 1 year ago.We learned that his depressive symptoms had started 4-5 months ago and his current treatment was lithium carbonate 900 mg/day and aripiprazole 5 mg/day.We decided to apply aTMS to the patient and aTMS was applied to the left DLPFC(Dorsolateral prefrontal cortex) with intermittent theta burst stimulation(5 Hz,1800 pulses) and to the right DLPFC with continuous theta burst stimulation(5 Hz, 600 pulses) for 10 days with 3 sessions per day and 30-minute intervals for a total of 30 sessions.Hamilton Depression Rating Scale-17, Montgomery-Asberg Depression Rating Scale and İnsomnia Severity İndex scores decreased from 11,29 and 12 points to 2,2 and 0 points after treatment, respectively.No side effects were observed during aTMS.The patient, who is on lithium carbonate 900 mg/day has no active psychiatric complaints and continues to be followed up in our clinic with a remission for about six month.Verbal and written consent was obtained from the patient for the case report. DISCUSSION: Considering literature, efficacy of aTMS in bipolar depression remains uncertain.In our case, significant improvement was observed following aTMS, with no side effects.Through the presentation of this case, it is emphasized that aTMS is a safe and effective treatment option for bipolar depression.
İbrahim Barikan, Ömer Faruk Uygur, Hakan Emre Babacan
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OBJECTIVE:Approximately 50% of adults with major depressive disorder (MDD) who receive a first-line antidepressant treatment, at an appropriate dose, do not achieve an adequate response. Brexpiprazole is a novel serotonin-dopamine activity modulator in the second generation/atypical antipsychotic class that was approved by the Food & Drug Administration in 2015 for use as an adjunctive agent in the treatment of MDD inadequately responsive to antidepressant treatment. CASE (The patient consent must be provided and specified with appropriate terms.):A 52-year-old female patient who has been followed up for 2 years with a diagnosis of MDD. She was admitted to the psychiatry outpatient clinic with unhappiness, anhedonia, lack of pleasure and insomnia. In her history, we learned that she was unresponsive to sertraline 150 mg/day, quetiapine 50 mg/day and fluoxetine 40 mg/day. The patient's Hamilton Depression Rating Scale-17 (HDRS-17), Hamilton Anxiety Scale (HAM-A) and Montgomery-Asberg Depression Rating Scale (MADRS) scores were 27,25 and 44, respectively. We decided to apply accelerated transcranial magnetic stimulation (aTMS) to the patient. We applied bilateral stimulation (left dorsolateral prefrontal cortex iTBS 1800 pulses and right dorsolateral prefrontal cortex cTBS 600 pulses) for 10 days with 5 sessions per day and 30-minute intervals for a total of 50 sessions. HDRS-17, HAM-A and MADRS scores were 27,25 and 44 points, respectively after treatment.The patient was started on brexpiprazole 1 mg/day 2 weeks after the end of aTMS. The patient's HDRS-17, HAM-A and MADRS scores decreased from 25,26 and 40 points to 8,12 and 14 points, respectively, after 4 weeks. The scores remained 6,8 and 8 in the monthly follow-ups. Verbal and written consent was obtained from the patient for the case report. DISCUSSION:Our findings in this case suggest that brexpiprazole may be an effective option for patients with treatment-resistant depression who are unresponsive to aTMS. In our case, there was no response to aTMS but significant improvement was observed following brexpiprazole.
İbrahim Barikan, Ömer Faruk Uygur, Hakan Emre Babacan
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Electroconvulsive therapy(ECT) is the most effective treatment of depression. In recent years, transcranial magnetic stimulation(TMS), which uses electrical brain stimulation, has emerged as an alternative to ECT in depression treatment and TMS applied more than once a day is called accelerated TMS(aTMS). We aim to present in this case raport a patient with depressive symptoms and suicidal thoughts who benefited from aTMS. An 31-year-old man presented to the outpatient clinic with anhedonia, feeling worthless, suicidal thoughts and insomnia for three months and we learned that he had attempted suicide before coming to us. In his history, we learned that he had a depressive episode for 14 years and used varying doses of fluoxetine, venlafaxine, risperidone(for augmentation) and quetiapine(for sleep disorders) in the past.He was currently using venlafaxine 225 mg/day, quetiapine 400 xr mg/day + 100 mg/day.However, his depressive symptoms still continued and he had serious suicidal thoughts.Since the patient did not improve with drug treatments we applied bilateral stimulation(left dorsolateral prefrontal cortex iTBS 1800 pulses and right dorsolateral prefrontal cortex cTBS 600 pulses) for 10 days with 5 sessions per day and 30-minute intervals for a total of 50 sessions without changing the current drug doses.Hamilton Depression Rating Scale-17(HDRS-17) and Montgomery-Asberg Depression Rating Scale(MADRS) scores decreased from 20 and 22 points to 6 and 2 points after treatment, respectively.Monthly follow-up was performed, at the end of 3 months, HDRS-17 and MADRS scored 1 and 0, respectively.Suicidal scores in HDRS-17 and MADRS decreased from 2 and 4 to 0, respectively.Verbal and written consent was obtained from the patient for the case report. Rapid improvement in depression is very important, especially for preventing suicide. In this article,both depressive symptoms and suicidal thoughts improved rapidly in the patient treated with aTMS. We recommend that psychiatrists consider aTMS for the rapid treatment of depression.
OBJECTIVE:Bipolar disorder (BD) is a common and recurrent psychiatric illness, often challenging to diagnose. Mixed features involve simultaneous depressive and manic symptoms, leading to worse prognosis, higher treatment resistance, increased suicide risk, and greater comorbidities. Treatment options remain limited, with atypical antipsychotics, novel anticonvulsants, and electroconvulsive therapy (ECT) being primary choices. CASE (The patient consent must be provided and specified with appropriate terms.):A 39-year-old unemployed single male with bipolar I disorder for 18 years presented with irritability, insomnia, excessive spending, and anxiety. Over the past year, he had been hospitalized 15 times and showed persistent symptoms despite treatment. He had been on valproate (2500 mg/day), lithium (600 mg/day), quetiapine (600 mg/day), lamotrigine (50 mg/day), aripiprazole (20 mg/day), diazepam (5 mg/day), and recently started clozapine (25 mg/day). Due to ongoing anxiety and tremors, ECT was initiated. Lithium, valproate, and aripiprazole were gradually tapered off. After 4 ECT sessions, Young Mania Rating Scale (YMRS) scores dropped from 19 to 10. The patient completed 8 ECT sessions and was stabilized on quetiapine (400 mg/day) and valproate (1500 mg/day), with significant improvement in mood and reduced tremors. YMRS score was 2 at discharge. Informed consent was obtained from the patient for the publication of this case report. DISCUSSION:Mixed manic episodes differ from classic mania due to dominant depressive symptoms, requiring careful differential diagnosis. Pharmacotherapy is challenging, as treatments for one pole may worsen the other. ECT is highly effective in treatment-resistant cases, with response rates between 56% and 93%. This case highlights the limitations of polypharmacy and the efficacy of ECT in severe mixed episodes. Treating mixed episodes is complex, requiring both mood stabilizers and antipsychotics. Antidepressants should be used cautiously. ECT remains a crucial option for resistant and severe cases.
BACKGROUND AND AIM:Monitoring clozapine blood levels is important as it may help minimize side effects and ensure optimal therapeutic response. There are few studies on this subject in our country. This study aimed to measure serum clozapine and norclozapine levels in schizophrenia patients undergoing treatment with clozapine and investigate their association with metabolic parameters. METHODS (Ethics Committee Approval must be obtained and the number should be specified.):This study involved 80 patients (27 females, 53 males) with schizophrenia. Clinical assessments included interviews, the Positive and Negative Syndrome Scale (PANSS) to evaluate the severity of schizophrenia symptoms, and the UKU Side Effect Rating Scale to identify drug-related side effects. Measurements of waist circumference, body weight, height, and blood pressure were taken, and routine complete blood count and biochemical analyses were performed. Blood samples were collected for therapeutic drug monitoring, and serum levels of clozapine and norclozapine were determined using liquid chromatography-mass spectrometry (LC/MS-MS). The study was approved by Erciyes University Ethics Committee (2021/835) and funded by the Scientific Research Projects Unit (TTU-2022-11600). RESULTS:Only 10% of patients had clozapine blood levels within the normal therapeutic range (350-600 ng/mL). Clozapine level in 71.25% of patients were higher than the recommended therapeutic range, despite administered standard doses. This patient group had also higher clozapine dose, norclozapine level, clozapine/norclozapine ratio and clozapine concentration/dose ratio as well as higher body weight, BMI and waist circumference. Patients with clozapine blood levels in the therapeutic range had better metabolic values than the other groups. Clozapine levels were positively correlated with BMI (r=0.249, p=0.026) and total cholesterol levels (r=0.247, p=0.027), but no association with other side effects. CONCLUSIONS:The study revealed that therapeutic blood levels of clozapine can be effectively achieved with lower dosages in our country population. Additionally, maintaining clozapine blood levels within the therapeutic range through personalized dosing may help minimize metabolic side effects.
Zeliha Büşra Durgungöz, Canay Pamukcu, Mehmet Buğrahan Gürcan, Merih Altintas
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OBJECTIVE: Delirium tremens (DT) is a fatal complication of alcohol withdrawal syndrome (AWS). Early psychiatric intervention is crucial for prognosis. In alhocol use disorder (AUD) poor insight complicates treatment and increases comorbid risks. This case indicates the relation of insight and treatment resistance in AUD which can cause more fatal complications like DT and Mallory-Weiss Syndrome (MWS). CASE: Informed consent was obtained from the patient and relatives. A 43-year-old single male,university graduate, with a 20-year history of alcohol use. He consumes approximately 30 standard units of alcohol a day for 5 years. Patient admitted to the emergency clinic with melena, hematemesis, confusion and ataxia. CIWA-Ar score was 19. Detailed evaluation revealed MWS and DT. Benzodiazepine and Thiamine treatment started in emergency department. In fourth day of admission, patient was hemodynamicaly stabilized and transferred to psychiatry clinic for AUD management. Alcohol Use Awareness and Insight Scale score was 6,5 which indicates poor insight of illness. He was lack of knowledge about AUD. Insight intervention was conducted by taking inspiration from the problem-oriented, control-oriented, and environment-oriented sessions included in the brief intervention model. Cognitive restructuring helped the patient reassess his beliefs about alcohol use. By discharge, his insight had improved, and he showed openness to structured treatment DISCUSSION: Poor insight in AUD hinders treatment adherence. Timely recognition and intervention in AWS reduce complications and mortality.This case highlights the importance of psychoeducation and motivational techniques in AWS management. Future research should focus on standardized approaches to improving insight and their impact on relapse prevention and treatment adherence. Strengthening multidisciplinary collaboration among psychiatry and other clinics is essential for comprehensive AWS management.
OBJECTIVE:The symptoms of post-traumatic stress disorder have been documented for a considerable number of patients even after 12 months. In this case report, we aimed to present a case diagnosed with Post-Traumatic Stress Disorder and Depressive Disorder and to
emphasize that it occurs in a timely manner and place during natural disasters or catastrophes that frequently occur. CASE (The patient consent must be provided and specified with appropriate terms.):In this case report, we will talk about a 40-year-old female patient who was followed up and treated as an outpatient in our clinic and who applied to us 14 months after the February 6 Pazarcık earthquake. After the evaluation, we diagnosed the patient with post-traumatic stress disorder and depressive disorder, and the follow-up was started. In addition to pharmacotherapy, debriefing method was applied in each session, and cognitive behavioral therapy sessions were started. A significant regression was observed in the patient's Post-Traumatic Stress Disorder Inventory (CAPS), Beck Hopelessness Scale, and Beck Depression Inventory scores. DISCUSSION:There are studies on the risk of developing post-traumatic stress disorder with some interventions made after traumatic experiences; Trauma-focused brief methods behavioral psychotherapy has been found to be effective in this regard.(4,5) As in our case, after major traumas, the failure to heal or break down within the required time leads to more complex and resistant clinical pictures. Depression also follows this process and is a very common clinical result. In addition to mental health professionals having the necessary knowledge and experience, it is also important to have easy access to treatment and active systems. Timely and appropriate interventions can help alleviate trauma.
OBJECTIVE:Alcohol use disorder and eating disorders are interconnected psychiatric conditions that present significant diagnostic and therapeutic challenges. Their co-occurrence is often associated with impulsivity, impaired impulse control, and psychogenic polydipsia. This report discusses the case of a patient with both conditions, highlighting clinical management strategies and the importance of a multidisciplinary approach. CASE (The patient consent must be provided and specified with appropriate terms.): The patient's consent has been obtained. A 24-year-old female factory worker, living with her family, attempted suicide by ingesting multiple medications after excessive alcohol consumption. She was admitted to intensive care and later transferred to the psychiatry ward. Her history revealed a previous similar attempt, psychiatric follow-up since age 13, and treatment for anxiety and anger control. She was hospitalized in 2023 for alcohol use disorder and had recently experienced severe stress.
Psychiatric evaluation indicated an anxious and dysphoric mood, auditory and visual hallucinations, delusions of reference, tremors, and cravings. Alcohol detoxification was initiated with benzodiazepines, olanzapine was increased to 10 mg/day for psychotic symptoms, and valproic acid was introduced for impulse control. As symptoms improved, olanzapine was reduced due to increased appetite, and risperidone was prescribed. During hospitalization, she developed alcohol withdrawal symptoms, hypotension, dizziness, and electrolyte imbalances, requiring replacement therapy. Further assessment revealed a history of self-induced vomiting since age 14, amenorrhea, and significant weight loss. Psychogenic polydipsia was diagnosed, requiring fluid restriction. Electrolyte balance improved with ongoing monitoring. DISCUSSION:The strong link between alcohol use disorder and eating disorders involves genetic, neurobiological, and psychosocial factors. Impulsivity, anxiety, and emotional dysregulation contribute to this comorbidity. A comprehensive approach, integrating psychiatric stabilization, nutritional management, and pharmacological interventions, is crucial for effective treatment. This case highlights the need for individualized and multidisciplinary therapeutic strategies.
About this publication
Turkish Journal of Psychiatry
Turkish Journal of Psychiatry (Turk Psikiyatri Derg) is the scientific journal of Turkish Association of Nervous and Mental Health. The journal has been published on a subscription basis four issues annually in March, June, September and December since 1990. Turkish Journal of Psychiatry is indexed in PubMed, Index Medicus, TUBITAK Tıp, Psych-Info, Türkiye Atıf Dizini and has been ranked in Social Science Citation Index (SSCI) since 2005.
27th National Clinical Education Symposium Presentation Abstracts