A case of paranoid disorder associated with hyperthyroidism

Catatony in Graves' disease

We report a 27-year-old female patient with prior history of Graves' disease and relapsing episodes of tachycardia, hyperpyrexia, muscular rigidity and coma. With the subsequent manifestation of an acute schizophreniform psychotic disorder unresponsive to neuroleptics, the primary syndrome was re-classified as febrile catatony. Hyperthyroidism was ruled out with normal serum thyroid hormone levels, as were toxic effects of thyrostatic treatment, drug-induced hypothyroidism and a malignant neuroleptic syndrome. All psychiatric symptoms subsided completely following subtotal thyroidectomy. Febrile catatatony has to be added to the spectrum of psychotic phenomena that may be caused by Graves' disease, irrespective of serum thyroid hormone levels.

Graves' disease presenting as paranoid schizophrenia in a Nigerian woman: a case report

Paranoid syndromes in Graves’ disease are rare. The true incidence is lacking. Most reports have emanated from developed countries where medical investigations are readily available. No report of such has emanated from Nigeria. We report a 43-year-old female Nigerian with Graves’ disease associated with paranoid schizophrenia and review the literature.

Affective symptoms and cognitive functions in the acute phase of Graves' thyrotoxicosis

In the acute phase of Graves' thyrotoxicosis patients often have subjective cognitive complaints. Continuing controversy exists about the nature of these symptoms and whether they persist after treatment. This prospective study included 31 consecutively referred, newly diagnosed, and untreated patients with Graves' thyrotoxicosis. A control group of 34 individuals matched for age, education and premorbid intelligence was also included. At baseline all patients and control subjects were examined with psychiatric rating scales and a comprehensive neuropsychological battery. The effect of treatment on affective symptomatology was examined in the patient group after reaching euthyroidism and 1 year after treatment initiation. At initial examination patients had significantly higher scores on psychiatric rating scales as compared with controls, and the majority reported memory and concentration problems. No significant differences between the patient and the control group on neuropsychological test performances were found. Thyroid levels did not correlate with the neuropsychological test performances or psychiatric ratings. After reaching euthyroidism the level of affective symptoms (including reports of cognitive deficits) had decreased significantly, with further normalisation 1-year after treatment initiation. In conclusion, patients had subjective reports of cognitive deficits in the toxic phase of Graves' thyrotoxicosis but comprehensive neuropsychological testing revealed no cognitive impairment. Reports of cognitive dysfunction may reflect affective and somatic manifestations of thyrotoxicosis and in most patients these symptoms disappear after treatment of Graves' thyrotoxicosis.

Adrenal carcinoma and hypertension presenting with catatonic stupor

A case of adrenal carcinoma with severe hypertension referred for treatment of "catatonia" illustrates the need for a high index of suspicion of organic mental disorder in medical patients, even when there is clinical evidence of a psychiatric condition and a history of psychosocial stressors. This case illustrates the need for concurrent medical and psychiatric investigation when there is a problem differentiating medical from psychiatric disturbance.