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Patient with psychosis and mental retardation in comorbidity with double pituitary gland and Hashimoto's thyroiditis - A case report

Patient TS, female, born in 1985, was hospitalized in Department for Biological Psychiatry, University Psychiatric Hospital Vrapče in January 2010 because of acute psychotic disorder (visual and auditory hallucinations, persecutory delusions). Psychiatric treatment started in July 2009 (in another hospital), in admission to our hospital extrapyramidal syndrome was also recorded (as a result of extremely high doses of olanzapine). In personal anamnesis: born from regular pregnancy (mother was 20 years old) as a premature baby (eight months). Had a cleft palate, which is operated in the second year of life, then operated torticollis in the fifth year of life. As a child treated for paralytic strabismus and Baker cyst of the knee. When enrolling in elementary school she was categorized as mild mental retardation (IQ 55) and finished school for florist thru special program. In the eighth year of life had secretion in the breast and was examined by an endocrinologist – diagnosed as precocious puberty. Six months before the hospitalization in our hospital secondary amenorrhea was recorded. Family history: father prone to alcohol, brother had juvenile epilepsy. During hospitalization in our Department, patient underwent extensive diagnostic evaluation when it was first verified congenital malformations of the brain - in MRI findings: "MRI shows an anomaly of development with double-sellar area within which can been seen the double basilar artery and soft tissue formation in the third chamber (changes characterized by duplication of the pituitary gland). Lipoma in the interhemispheric fissure.“ After stabilization of mental state (with low doses of quetiapine and lorazepam), the patient was referred for further diagnostic endocrine treatment in another institution where Hashimoto's thyroiditis was diagnosed (now treated with levothyroxine). The patient has been in stable remission of mental state since then, regularly participates in outpatient psychiatric treatment, without psychotic decompensation, functioning in accordance with the capacities of person with mental retardation.

psychosis; mental retardation; Hashimoto's thyroiditis; double pituitary gland; patient; case report

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