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

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

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

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

The psychological impact of the diagnosis of congenital anomalies is an area with limited research; and more limited still when such congenital anomalies are not very obvious. MayerRokitansky-Kuster-Hauser (MRKH) syndrome can be one of those less apparent congenital anomalies. Owing to their inability to bear children, women confronted with the diagnosis of MRKH can be left stressed, or worse, traumatized by the fact that they can no longer function in their traditional gender roles. This may leave any individual wanting to deny the diagnosis or even withhold such information. And the experience is a fertile ground for the development of any mental illness. MRKH occurs in every 1 out of 4000-5000 females. Although the psychological impact of stress is a well –established fact, there are fewer literature on the possible genetic link of MRKH and mental illness, the psychodynamic underpinnings and the similarities to trauma of the diagnosis of MRKH, in particular. We present here a case of MRKH syndrome with an initial presentation of major depression and psychosis; with the diagnosis of MRKH initially withheld from the resident psychiatrist. We would also want to highlight a trauma perspective of the case presented as well as to emphasize the need for more research congenital anomalies are accompanied by co-morbid psychiatric illnesses.
Depression ; Psychotic Disorders ; Psychological Distress

The clinical symptoms and signs of methamphetamine-associated psychosis (MAP) and schizophrenia are highly similar, but the situation is completely different when MAP and schizophrenia patients need to be assessed for criminal responsibility after they comitted a harmful behavior. Therefore, the distinction between the two psychoses is very important in forensic psychiatry. At present, the identification of these two psychoses is mainly dependent on the corresponding criteria such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Chinese Classification of Mental Disorders Version 3 (CCMD-3). It's challenging to diagnose and distinguish between the two in practical cases due to their similar clinical symptoms and the lack of effective objective indexes. Different from the limitations of single omics, integrative omics intergrates data from multiple dimensions and has been extensively studied in the field of schizophrenia and has achieved some preliminary results. In view of the correlation between MAP and schizophrenia and the potential application value of integrative omics, this paper proposes an integrative omics strategy for MAP pathogenesis and forensic identification, aiming to improve the further understanding of the relationship between the two psychoses and the corresponding pathogenesis. It also provides references for the future exploration of integrative omics in forensic precise identification and effective monitoring and early warning methods.
Humans ; Methamphetamine/adverse effects* ; Psychoses, Substance-Induced/etiology* ; Psychotic Disorders/genetics* ; Schizophrenia/genetics* ; Diagnosis, Differential