A patient with presumed chronic paranoid schizophrenia had chronic thyroiditis and Grade I hypothyroidism. Psychosis cleared following treatment with thyroid replacement. The probable presence of two axis II disorders may have contributed to the missed medical diagnosis and the patient's eventual suicide. The personality disorders were a major problem in the patient's medical and psychiatric care. The differential diagnosis among hypothyroidism and primary axis I psychotic and depressive psychopathology has always been problematic. When axis II pathology is also present, the diagnostic dilemma is increased.
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References
1.
IngbarS. H., Diseases of the Thyroid, in Harrison's Principles of Internal Medicine, 11th ed.BraunwaldE.IsselbackerK. J. (eds.), McGraw Hill Book Company, 1987.
2.
AsherR., Myxedematous Madness, British Medical Journal., 2, p. 555, 1949.
3.
ReedK. and BlandR. C., Masked “myxedema madness.”Acta Psychiatrica Scandinavica, 56, pp. 421–426, 1977.
4.
JeffersonJ. W. and MarshallJ. R., Neuropsychiatric Features of Medical Disorders, New York, Plenum Medical Book Company, 1981.
5.
American Psychiatric Association, Committee on Nomenclature and Statistics, Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, American Psychiatric Association, Washington, D.C., 1980.
6.
OverallJ. E. and GorhanD. R., The Brief Psychiatric Rating Scale, Psychology Reports, 10, pp. 799–812, 1962.
7.
EndicottJ.CohenJ.NeeJ., Hamilton Depression Rating Scale. Archives of General Psychiatry1981; 38: 98–103.
8.
HamiltonM., A Rating Scale for Depression, Journal of Neurology, Neurology and Psychiatry, 23, pp. 56–62, 1960.
9.
BiegelA.MurphyD. L., and BunneyW. E., The Manic State Rating Scales, Archives of General Psychiatry, 25, p. 256, 1971.
10.
SpitzerR. L., Research Diagnostic Criteria, Rationale and Reliability, Archives of General Psychiatry, 35, pp. 773–782, 1978.
11.
TreadwayC. R., Myxedema Psychosis: Clinical and Biochemical Changes During Recovery, Journal of Psychiatric Research, 5, p. 289, 1967.
12.
WhybrowP. C., Behavioral and Psychiatric Aspects, in Werner's: The Thyroid, A Fundamental and Clinical Text, 5th Edition, IngbarS. H. and BravermanL. E. (eds.), J. B. Lippincott, Philadelphia, 1986.
13.
UyematsuS., A case of myxedematous psychosis, clinical and pathological report, Archives of Neurological Psychiatry, 3, p. 252, 1920.
14.
BrowningT. B.AtkinsR. W., and WeinerH., Cerebral metabolic disturbances in hypothyroidism: Clinical and electroencephalographic studies in the psychosis of myxedema and hypothryoidism. Archives of Internal Medicine, 93, p. 938, 1954.
15.
DeGrootL. J.LarsenP. R.RefetoffS., and StanburyJ. B., The Thyroid and its Diseases, 5th Edition, John Wiley and Sons, New York, 1984, p. 593 & 845.
16.
JosephsonA. M. and MacKenzieT. B., Thyroid-induced mania in hypothyroid patients. British Journal of Psychiatry, 137, pp. 222–228, 1980.
17.
ShawE.HalperJ.YiP. E., Diagnosis of “Myxedema Madness” (letter). American Journal of Psychiatry, 142: 5 p. 655, 1985.
18.
HaggertyJ. J.Jr.EvansD. L., and PrangeA. J.Jr., Organic Brain Syndrome Associated with Marginal Hypothyroidism. American Journal of Psychiatry1986; 143: 785–6.
19.
DackisC. A.GoggansF. C.BloodworthR., The Prevalence of Hypothyroidism in Psychiatric Populations, Fair Oaks Hospital Psychiatry Letter1986; IV(10): 49–54.
