A Case Report on Myxedema Madness: Curable Psychosis
Mrs. X, a 30-year-old female without a known significant past medical history was brought with a 1½ year continuous disturbance in the form of having suspiciousness, fearfulness and quarrel with neighbors with gradual and progressive work impairment.\nShe, on provocation, anxiously reported that “someone has done black magic on her. She along with her children would be harmed and daughters sold off in flesh trade by the neighbors.”\nFor self-defense, she used to sleep with a knife under her pillow.\nAt home, mostly she was noted to be withdrawn and fearful. Whenever husband went out to work then she’d run to her sister's house and had to be fetched back home for which she was reluctant always in coming.\nOn active enquiry; she reported a voice commanding her to run away from the house if she wished to be safe, also of having other auditory hallucinations of people (neighbors) talking amongst themselves about ways of harming her and her family.\nPatient was admitted to our psychiatry ward for evaluation and work-up.\nAfter admission Mrs. X's vitals were normal. Facial puffiness was observed in physical examination. Her neurological examination was normal. On mental status examination, she was conscious and oriented to time, place and person with poor eye contact, low tone rough voice with a paucity of speech, psychomotor activity was decreased and affect was apathetic. She was guarded about her hallucinations but came out easily with her delusions with a BPRS score of 41. Depressive features or death wish were not reported.\nGeneral blood profile was normal with a normal chest X-ray and electrocardiography. Thyroid profile was altered with thyroid stimulating hormone - 63.71 mIU/L, Free tri iodo thyronine (FT3) - 2.1 pg/ml, Free tetra iodo thyronine(FT4) - 0.6 ng/ml and normal ulltrasound-thyroid. Patient was started on thyroxin 100 μg after consultation from the endocrine department of our hospital and a low dose risperidone 2 mg, which was then withdrawn over a week with the recovery of her behavioral abnormalities and then she was continued with thyroxin alone. She was discharged after about 2 weeks of hospitalization with the absence of any hallucinations and delusions with a BPRS score of 8. After 1 month, on second follow-up, relatives reported a 90% overall improvement and absence of delusions and hallucination. Brief Psychiatric Rating Scale score was three.