Affected

A 34 year old woman is brought in by her family, after she became violent at home, and attempted to assault her mother.

On questioning, she complains of feeling 'down', being fatigued all the time, and having difficulty in sleeping.

She also claims that she won the 1st place in an international art competition, outperforming Pablo Picasso, and that she is an adoptee, with her real parents being the Queen of England, and King Louis XVI of France.

She denies suicidal ideation, or experiencing guilt, reduced self esteem, reduced interest in her usual activities, or reduced concentration.

Her mother mentions that she had an episode of similar behavior around 1 year ago, which lasted for 3 weeks, and resolved spontaneously. During this, she attempted suicide via a self inflicted injury to the forearm.

Her family had also noticed her talking to imaginary people on multiple occasions during the last 9 months.

Her birth history is unremarkable, and all developmental milestones were age appropriate. Her surgical, drug and family histories are unremarkable.

She does not smoke and only drinks socially. She denies recreational drug abuse; this is corroborated by her family.

Select Relevant Investigations
Complete Blood Count

Performed

WBC: 10,200/mm3 (4,500-10,500)
N: 65% L: 30%
Hb: 13.4 g/dL (12.0-15.0)
Platelets: 212,000/mm3 (150,000-450,000)
Serum Electrolytes

Performed

Na+: 140 mEq/L (135-145)
K+: 4.0 mEq/L (3.5-5.3)
Cl-: 100 mEq/L (95-105)
Ca++: 9.1 mg/dL (8.8-10.3)
Toxicology Screen

Performed

The toxicology screen is reported to be negative for alcohol, controlled substances, and other toxins.
Contrast CT Brain

Performed

The CT scan of the brain appears normal.

Select Relevant Management
Hospitalization
Clozapine
Fluoxetine
Electroconvulsive Therapy