Malignant catatonia represents a severe and life-threatening neuropsychiatric syndrome that demands prompt recognition and intervention. This condition poses particular diagnostic and management challenges in adolescents, especially when genetic predispositions and neurodevelopmental vulnerabilities complicate the clinical picture.

This report examines a complex case of malignant catatonia in a 17-year-old female with developmental delay but no prior psychiatric diagnoses, who developed severe cognitive and behavioural deterioration. We explore the diagnostic complexities, therapeutic challenges and potential genetic contributions to her presentation.

We present a comprehensive case analysis documenting clinical progression, treatment responses and genetic findings through whole-exome sequencing. The patient’s journey spans from initial presentation to long-term follow-up, with systematic assessment using standardised catatonia rating scales.

The patient’s condition manifested as severe psychomotor impairment, mutism and autonomic instability, showing minimal response to initial treatment. Electroconvulsive therapy yielded significant but temporary amelioration of symptoms. Genetic analysis revealed a heterozygous mutation in the pogo transposable element derived with zinc finger domain (POGZ) gene – a gene implicated in neurodevelopmental disorders – suggesting this variant contributed to her neurobiological vulnerability. Concurrent features of functional neurological disorder further compounded the diagnostic complexity, illustrating the intricate interplay between genetic susceptibility and clinical presentation.

This case illuminates the challenges clinicians face when diagnosing and treating complex neuropsychiatric presentations in adolescents, particularly when genetic predispositions intersect with functional neurological symptoms. The findings emphasise how comprehensive, multidisciplinary approaches remain essential for optimal patient care. Moreover, this case highlights the selective utility of genetic investigation in elucidating potential underpinnings of complex, treatment-resistant malignant catatonia, whilst demonstrating that genetic variants may confer vulnerability rather than direct causation.

Patients with cancer frequently experience insomnia that significantly impacts their quality of life, worsens existing symptoms, and potentially hinders treatment outcomes and recovery. Here, we report on 3 cancer patients whose insomnia was improved with low-dose olanzapine.

A retrospective review of medical records was conducted for 3 cancer patients experiencing insomnia treated with olanzapine at Johns Hopkins Hospital. The data collection included the type of cancer diagnosis, the level of insomnia severity experienced by individuals, and treatment results and outcome.

Olanzapine improved sleep in all 3 patients and decreased nausea/vomiting and anxiety in patients 2 and 3.

A low dose of olanzapine has potential to treat insomnia in cancer patients. The ideal dosing regimens and potential risks are unclear, especially for long-term use. More research and clinical trials are needed to evaluate off-label use of olanzapine for insomnia, including its efficacy and risks, and to optimize the dosage to reduce its side effects in cancer patients. Oncology providers should consider olanzapine as a potential treatment for insomnia, especially given its off-label uses and potential benefits.

The relationship between oocyte morphology and developmental potential has been a hot research topic in assisted reproductive technology (ART). Whether inclusions in the perivitelline space (PVS) affect ART outcomes remains controversial.

We present a case report of a 34-year-old G3P1A2 woman who sought ART treatment because of sequelae of pelvic disease. As her husband had severe oligospermia due to the stress on the day of oocyte retrieval, intracytoplasmic sperm injection (ICSI) was performed. After denudation, varying degrees of debris were found in the PVS, but all the oocytes were subjected to ICSI. Among the eleven retrieved oocytes, eight were fertilized. The morphology of the embryos was scored on Days 2 and 3. Five embryos were frozen on Day 3, and two best-quality embryos were subsequently transferred via frozen embryo transfer.

Severe debris in the PVS seems to affect embryo quality but not fertilization. Mild debris in the PVS may have little effect on the outcome of ART treatment. In our patient, after two embryos that were derived from oocytes with relatively few debris in the PVS were transferred, a successful live birth occurred.

Psilocybin is being investigated as a treatment for a myriad of disorders, including treatment-resistant depression. The main focus has been on positive effects, with little attention paid to negative outcomes, especially in clinical settings. Quantitative methodology limits further exploration of such events and can also miss improvements not captured on rating scales.

To highlight potential adverse events of psilocybin and underline limits of quantitative methodology, calling for process evaluations alongside clinical trials.

This is a case of a participant in a phase 2b clinical trial of psilocybin for treatment-resistant depression who presented with increased suicidal ideation and a prolonged period of severely restricted eating following administration, leading to a period of destabilisation and a need for support. Despite the difficulties encountered and the participant's limited improvement on rating scales, she found the experience to have been helpful and led her to make changes to her life which she found beneficial. She described her experience in a written account to the authors.

The case was summarised and the written account was thematically analysed and synthesised into a logic model.

Psilocybin could lead to temporary worsening of suicidal ideation and instigate prolonged adverse events that outlast its acute effects. Paradoxically, it could simultaneously lead to an improvement in functional outcomes which is not clear on depression rating scales. This calls for a qualitative exploration of serious adverse events and participant accounts to deepen our understanding of the psilocybin experience and its different outcomes.

Diagnosing Borrelia miyamotoi disease (BMD) presents challenges due to its overlap with Lyme disease (LD) symptoms and the lack of reliable laboratory diagnostics. This case study demonstrates the successful use of phage-based PCR (phb-PCR) in identifying B. miyamotoi in a patient with multiple tick bites. A 46-year-old female presented with joint and muscle pain, chronic fatigue, and cognitive impairment after being bitten by ticks in Europe. Standard diagnostic tests, including Enzyme-linked immunosorbent assay (ELISA), immunoblot for LD, and antibody tests for Bartonella, Anaplasma, and autoimmune conditions, all returned negative results. However, phb-PCR identified the presence of B. miyamotoi. The patient was treated with intravenous ceftriaxone, oral azithromycin, and intravenous vitamin and mineral therapy, resulting in significant improvement in symptoms, including reduced pain, improved cognitive function, and decreased fatigue. This case emphasises the importance of direct diagnostic methods like phb-PCR for accurately identifying BMD, especially when conventional serological tests fail. Clinicians should consider testing for B. miyamotoi in cases of complex tick-borne diseases for timely and effective management.

While the pressure points technique for proximal hemorrhage control is long known, it is not recommended in standard prehospital guidelines based on a study showing the inability to maintain occlusion for over two minutes.

This report details a gunshot wound to the left axillary area with complete transection of the axillary artery, leading to profuse junctional hemorrhage and profound hemorrhagic shock.

Proximal pressure of the subclavian artery was applied against the first rib (the pressure points technique) and maintained for 28 minutes.

Cessation of apparent bleeding and excellent, enduring physiologic response to blood transfusion were observed.

The pressure points technique can be life-saving in junctional arterial hemorrhage and should be reconsidered in prehospital guidelines.

Maladjustments and failures of programmable ventriculo-peritoneal shunts have been reported in patients encountering powerful electromagnetic fields, e. g. MRI.

We describe the case of a 53-year old man treated for hydrocephalus with a programmable Codman-Hakim shunt valve. During his hospitalization in Forensic Psychiatry, the patient’s valve pressure setting changed randomly despite frequent reprogramming and surveillance.

Maladjustments and failures of programmable ventriculo-peritoneal shunts have been reported in cases in which patients have encountered powerful electromagnetic fields, e.g., MRI. Through a case, this study shows easy maladjustment of a Codman-Hakim programmable valve also by small magnetic fields from everyday life.

A 53-year old man presented with periventricular hydrocephalus due to aqueductal stenosis. The patient was treated with a left ventriculo-peritoneal Codman-Hakim programmable shunt valve. During his hospitalization in Forensic Psychiatry, the patient’s valve pressure setting changed randomly, presumably by walking through electromagnetically controlled doors of a hospital ward. With a test dummy, changes in pressure settings were tracked.

Both - pressure settings of the patient’s Codman-Hakim programmable valve as well as pressure settings of a new valve - were unwantedly modified simply by walking through standard doors in a hospital ward.

Thus already weak magnetic fields (< 200 mT) might cause changes in the pressure settings of programmable shunt valves and therefore lead to maladjustment. Patients should be informed and pay attention to using everyday life’s devices, like rod magnets or mobile phones.

No significant relationships.

Acute measles encephalitis is a pathology of the central nervous system. It is most frequent in children but can also be described in adults. Given the rarity of this pathology, we present the case of this patient.

present a rare neuropsychiatric complication of measles

Présentation d’un cas clinique d’encéphalite rougeoleuse et revue de la littérature

Mrs. HJ, 45 years old, without any somatic history, was followed for an antisocial personality with a substance use disorder. She consulted the emergency for psychomotor agitation, a fever of 39, and a rash on the face, thorax, and limbs. At the psychiatric interview, she was disoriented and very unstable. She seemed to be hallucinating.

The brain imaging and the lumbar puncture (CT scan and brain MRI) were without abnormality. The rapid test (HIV) was negative and the biological check-up showed a hyperleukocytosis at 12660 and a crp at 138. The patient was put on double antibiotic therapy.

The evolution was marked by the non-improvement of the symptomatology with the persistence of agitation. Her speech was almost absent with a refusal to answer and to execute orders. She maintained certain postures. The patient was put on 400 mg of amisulpride.

After recovery of the viral serology, the diagnosis of a measles encephalopathy was confirmed (IgM positive) and the patient improved after a few days of hospitalization and was addressed to the psychiatric outpatient clinic.

Measles encephalitis is a rare but serious complication that requires multidisciplinary management

No significant relationships.

Acute measles encephalitis is a pathology of the central nervous system. It is most frequent in children but can also be described in adults. Given the rarity of this pathology, we present the case of this patient.

To assess perfectionism and depression and to study the relationship between these two parameters in a population of medical students.

We conducted a descriptive and analytical cross-sectional study among students of the Faculty of Medicine of Sfax during the months of June, July, and August 2020. The data were collected through a self-questionnaire disseminated on the social network “Facebook”.This questionnaire included identification of socio-demographic characteristics as well as the personal history of students. Perfectionism was assessed by the Rheaume scale and depression by the Beck scale.

A total of 206 students participated in the survey. The mean age was 21.49 ± 1.37 years. The majority of students were female (57.2%) with a sex ratio (F/H) of 1.34. Of the participants, 39.8% were enrolled as undergraduates and 60.19% as graduate students. According to their scores on the Rheaume scale, the students were non-perfectionists (NP) in 21.4% of cases; moderately perfectionists (MP) in 70.38% of cases, and highly perfectionists (HP) in 8.25% of cases. Severe depression was objectified in 7.3% of the cases. Students living alone were less perfectionist (p=0.01). Perfectionism score was higher in depressed students (35 ± 6.34) versus (31.428 ± 6.37) with a statistically significant correlation ( p ≤ 0.001).

It is true that perfectionism is an essential element for academic success. However, screening and prevention of depression are deemed necessary given its significant association with perfectionism.

No significant relationships.