In this, the fourth volume of the case reports series, there is a focus on psychiatric disorders. As with our previous three issues 123, we highlight topics related to treatment and management of these illnesses. Papers cover novel treatment strategies as well as draw our attention to some potential new mechanisms of mental illness. Adverse events such as tardive dyskinesia are always a possibility and this volume provides some advice on how to best use some therapeutics and also some cautionary notes. This Editorial first presents novel approaches to the treatment of psychiatric illnesses followed by some considerations for the use of these medications.In this volume, some papers advance treatment of psychiatric disorders with new approaches. Consistent with recent evidence that psychedelics may be effective in treating other psychiatric disorders 4,5, Drange et al. demonstrated that psilocybin has some, but not complete, promise in the treatment of obsessive-compulsive disorder (OCD) and related symptoms. In this study of twins discordant for OCD, the affected twin was administered psilocybin, which resulted in the remittance of OCD symptoms. However, compared to the unaffected twin, cognitive deficits remained. Thus, psilocybin may be effective in treating some aspects of OCD. On a different note, Ghaliani et al describe the treatment of a case of post-traumatic confusional state (PTCS) in a 9 year old boy with severe traumatic brain injury with paliperidone and adjunct risperidone. A number of agents including risperidone, methylphenidate, olanzapine and aripiprazole were tried over a number years with no success. However, over two years after treatment with long-acting injectable paliperidone palmitate with adjunct risperidone the aggression markedly decreased. This volume also presents some possible new etiology to psychiatric disorders. Ozaki et al. highlight the possibility that some psychiatric disorders can be caused by endocrine disorders and may respond better to endocrine treatment such as in the case of a patient with psychiatric symptoms related to recurrent small-cell carcinoma of the cervix due to endogenous Cushing's syndrome caused by ectopic adrenocorticotropic hormone production. In another report, Geiser at al. posit that vitamin C levels can affect the pharmacokinetics of lithium. In a patient with autism spectrum disorder and severe intellectual disability who presented with severe behavioural dysregulation lithium levels failed to reach therapeutic levels. Upon diagnosis of vitamin C deficiency and treatment of scurvy, serum lithium concentrations rose and the patient showed rapid behavioural improvement This volume suggests that some medications should be used with caution. Fesenmeier et al. describe a case of venous thromboembolism (VTE) that emerged in the hours after initiating treatment with olanzapine, quetiapine, levomepromazine and lorazepam for treatment of a psychotic episode. This is earlier than the onset that is normally reported within the first months or weeks of treatment, and provides a cautionary account for the use of antipsychotics. Further, Qin et al. report on selective serotonin-reuptake inhibitor (SSRI)-associated vasculitis. In the patient, leukocytoclastic vasculitis (LCV) emerged seven months after initiation of fluoxetine therapy for generalized anxiety disorder. The symptoms resolved upon discontinuation of fluoxetine but recurred upon reinitiation of treatment with fluoxetine. Further, subsequent treatment with paroxetine, another SSRI, resulted in a similar less severe rash, suggesting cross-sensitization. Treatment with venlafaxine, a serotonin-norepinephrine reuptake inhibitor did not result in the lesions. Finally, Fiala and Lenz report on a menopausal woman who developed persistent genital arousal disorder after pharmacotherapy with trazodone, pregabalin, vaginal estriol and depot medroxyprogesterone. The symptoms remitted upon complete discontinuation of all medications. Not all tales are cautionary: there is some new hope for psychiatric treatments. Preiss et al report on the case of a patient who was exposed to milnacipran during pregnancy to treat severe post-traumatic disorder and severe major depressive disorder with psychotic features. The female had been taking milnacipran prior to pregnancy but then it was replaced with sertraline plus quetiapine due to the unestablished safety data on milnacipran during pregnancy. Upon discontinuation of milnacipran the symptoms returned, and, upon a risk-benefit analysis, milnacipran treatment was resumed until gestational week 22 when it was discontinued due to moderate hyperemesis gravidarum. At three years post delivery, pediatric development screenings remained within normal limits. Similarly, Alshahrani et al report on three patients where tardive dyskinesia remitted after cessation of aripipraxole. This adds to the literature where the remitting nature of tardive dyskinesia is debated.
Štuhec et al. (Tue,) studied this question.