OBJECTIVES

To present a rare case of recurrent urethral and intravesical foreign body insertion driven by command hallucinations in schizophrenia, to describe the surgical and psychiatric management strategies employed, and to emphasize the importance of interdisciplinary care and treatment adherence in preventing recurrence.

METHODS

Reported here is the case of a 37-year-old male with schizophrenia who presented with multiple episodes of urethral and intravesical foreign body insertion over a six-year period (2018–2025). Inserted objects included metallic wires, electrical cords, and a LED Christmas light rope, each requiring surgical removal via cystoscopy or open cystotomy. Psychiatric evaluation revealed poor adherence to antipsychotic medication, with recurrent episodes associated with command hallucinations. Psychiatric management was reinitiated with olanzapine and structured follow-up to improve treatment compliance.

RESULTS

Six documented episodes of self-inflicted urethral and intravesical trauma required repeated urologic interventions. Despite recurrent instrumentation and foreign body insertion, serial cystoscopic evaluations demonstrated preserved urethral and bladder integrity without evidence of stricture formation. The most recent episode required open cystotomy for removal of a coiled LED light rope, which was successfully extracted without complications. Following coordinated psychiatric management and improved adherence to antipsychotic therapy, the patient remained asymptomatic and free of recurrence at three months follow-up.

CONCLUSION

This case highlights the unusual preservation of urethral integrity despite recurrent traumatic self-insertion. Effective management requires sustained psychiatric stabilization, multidisciplinary collaboration, and strict treatment adherence. Integration of psychiatric and urologic care is essential to prevent recurrence and improve long-term outcomes in patients with schizophrenia-related self-inflicted genitourinary injury.

Human ; Male ; Adult: 25-44 Yrs Old ; Schizophrenia ; Cystoscopy ; Self-injurious Behavior ; Psychotic Disorders ; Antipsychotic Agents ; Olanzapine ; Constriction, Pathologic ; Hallucinations ; Urinary Bladder ; Foreign Bodies

Introduction: Neuropsychiatric manifestations of thyrotoxicosis range from mild anxiety to severe psychosis. While the BurchWartofsky Point Scale (BWPS) reliably identifies systemic thyroid storms, an isolated “cerebral storm”—where profound thyrotoxic encephalopathy presents without peripheral autonomic signs—remains a diagnostic challenge. This case highlights the neuromodulatory pathogenesis of thyrotoxic psychosis and the critical role of biochemical control for psychiatric resolution. Case: A 31-year-old male with Graves’ disease and poor medication adherence presented with a 2-week history of aggressive behavior and auditory hallucinations. Initial investigations revealed overt thyrotoxicosis (thyroidstimulating hormone <0.01 mIU/L; free thyroxine 4 (FT4) 59.53 pmol/L) and an unremarkable computed tomography brain. Despite his severe neuropsychiatric decompensation, a BWPS of 20 precluded a clinical diagnosis of systemic thyroid storm. His symptoms remained refractory to aggressive psychotropic polypharmacy, including haloperidol, olanzapine, lithium, and diazepam. Management was therefore focused on the underlying thyrotoxicosis with an optimized antithyroid regimen of carbimazole and propranolol. Clinical resolution of psychotic symptoms was achieved only after FT4 declined significantly to 20.46 pmol/L, allowing the successful tapering of all psychiatric medications. He was discharged in a stable, clinically euthyroid state with integrated medical and psychiatric follow-up. Conclusion The failure of standard antipsychotics suggests that thyrotoxic psychosis is driven by distinct neuromodulatory mechanisms rather than primary dopaminergic dysfunction. The chronic thyrotoxic state secondary to prolonged treatment non-adherence likely upregulates and sensitizes dopamine receptors while simultaneously suppressing inhibitory GABAergic pathways. This neurochemical imbalance lowers the neurological threshold, precipitating an isolated cerebral storm. This case illustrates the limitations of the BWPS in purely neuropsychiatric presentations and reinforces that restoring euthyroidism is the definitive treatment for thyrotoxic psychosis.
Graves Disease ; Psychotic Disorders

Humans ; Transcranial Magnetic Stimulation ; Pain Management ; Psychotic Disorders/therapy* ; Depressive Disorder, Major ; Treatment Outcome ; Transcranial Direct Current Stimulation

Background: Stroke is currently the second leading cause of death worldwide and is one of the leading causes of long-term disability . Mood disorders are prevalent after a stroke and may hinder physical, functional, and cognitive recovery; hence, it is undeniably necessary to recognize them early. Stroke mortality is generally higher in Asia as most of the countries therein are in economic transition . Socioeconomic status is a major contributor to stroke burden as greater odds of disability are found in patients with lower educational status and income. Objectives: The primary objective of this study is to identify the psychiatric morbidities commonly seen after a stroke in Asia. Search Methods: The following databases were utilized for extensive literature search: PubMed (January 2002 to June 2022), Cochrane Library (January 2002 to June 2022), and EBSCO (January 2002 to June 2022). The search made use of keyword combinations, Boolean operators "AND" and "OR," truncations, and field tags last October 2022. Selection Criteria: Articles on the prevalence and cross-sectional studies were included if they involved stroke survivors who developed post-stroke psychiatric morbidities in Asia. Additional inclusion criteria consisted of studies that have to be written in the English language and having free full texts available. Data Collection and Analysis: This systematic review made use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. The JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data was used in the assessment for the quality of articles to be included in this systematic review. Results and Conclusion Affective disorders and generalized anxiety disorder were the common psychiatric morbidities identified post-stroke. The Hospital Anxiety and Depression Scale (HADS) may be used to diagnose post-stroke depression and anxiety. Males in their middle to late adulthood with higher National Institutes of Health Stroke Scale (NIHSS) scores and poor stroke outcomes (higher scores in the Modified Rankin Scale) were associated with a higher likelihood of developing the aforementioned psychiatric morbidities.
Depression ; Anxiety ; Mania ; Psychotic Disorders ; Asia

Brain ; COVID-19 ; Psychotic Disorders ; Psychiatry

Adrenal Cortex Hormones ; COVID-19 ; Psychotic Disorders

Humans ; Parkinson Disease/drug therapy* ; Prevalence ; Southeast Asian People ; Psychotic Disorders/drug therapy* ; Antipsychotic Agents

Humans ; Aged ; Psychotic Disorders/therapy* ; Acute Disease

Sheehan’s syndrome is characterized by hypopituitarism following ischemic necrosis of the pituitary gland caused by postpartum hemorrhage and impaired blood supply to the enlarged pituitary gland during pregnancy. The worldwide prevalence has since decreased due to improvements in obstetric care. Behavioral change is a rare presentation and is often misdiagnosed and managed as psychosis. We report a 42-year-old woman presenting with behavioral changes associated with postpartum failure of lactation and amenorrhea. Hormonal work-up revealed panhypopituitarism; serum cortisol, 98.93 (NV: 138–690 nmol/L); free T4, less than 5.15 (NV: 11.5–23.00 pmol/L); free T3, less than 2.30 (NV: 2.89–4.88 pmol/L); FSH, 3.63 (NV: 30–135 mIU/mL); LH, 3.88 (NV: 13–80 mIU/mL); serum estradiol, 3.89 (NV: 10.41–35.0 pg/mL); IGF-1, 13.13 (NV: 56–194 ng/mL); and serum prolactin, 1.8 (NV: 2.6–24.8 ng/mL). Cranial MRI with contrast revealed an atrophic pituitary gland consistent with Sheehan's syndrome. The symptoms improved substantially upon replacement with steroids and thyroid hormones and she was able to resume her routine activities. The psychiatric features of hypopituitarism can be attributed to a combination of hypothyroidism, hypoglycemia, and hypocortisolism and have been shown to reverse with adequate hormone replacement.
Hypopituitarism ; Psychotic Disorders ; Hypopituitarism

Evidence suggests that acute severe coronavirus disease 2019 (COVID-19) may be associated with neuropsychiatric symptoms. This is a case report of a patient who had recently been infected with COVID-19 and had no history of psychiatric disorders presenting a few days after inpatient discharge from COVID-19 treatment with acute onset of psychosis and manic symptoms. This case illustrates the psychiatric presentation, possible causes, and management of post-COVID-19 psychosis.
COVID-19 ; Psychotic Disorders ; Mania