1006 How Insomnia Masked a Young Man's First Episode Psychosis

Abstract

Abstract Introduction Sleep disturbance is a common sign across many mental health disorders. Particularly, insomnia is a frequent issue among patients with mood disorders. However, there is increasing evidence that suggests that sleep disturbance may be a risk factor for developing psychosis, or conversely, an early warning sign of psychosis. In this case report, we describe a young patient’s first episode of psychosis, which was masked by an initial presentation of insomnia, diagnosed as major depressive disorder, and the patient decompensated further until his psychosis was appropriately diagnosed and treated. Report of case(s) A 20-year-old African-American male was evaluated at a major tertiary hospital after he was found calling his mother while crying and speaking incoherently. He was eventually admitted there for two weeks with the diagnosis of Major Depressive Disorder, and discharged on Bupropion 300 milligrams(mg) daily for depression, with Quetiapine 50mg and Trazodone 100mg at night for sleep. Following discharge from this hospital, the patient’s psychiatric history was significant only for one additional outpatient psychiatry clinic visit at a major community hospital, where he was again diagnosed with Major Depressive Disorder, and prescribed Zoloft 25mg daily. The patient eventually presented to our hospital with reports of worsening depression, poor sleep, poor appetite, and more recently, increasingly bizarre behavior. The patient initially presented to the unit disorganized (nursing staff frequently described patient as looking "lost"), staring blankly at the walls, internally preoccupied and laughing inappropriately as if responding to internal stimuli. Patient had episodes of emotional outbursts with aggression and bizarre behavior that required emergent medication. The patient’s Bupropion was discontinued in favor of oral Risperidone, titrated up to 4mg twice daily. Patient’s symptoms, including his sleep, gradually improved with the single antipsychotic regimen, and was eventually discharged after returning to his baseline. Patient was also evaluated by a clinical psychology team who also supported the assessment of first episode of psychosis. Conclusion This case highlights the importance of evaluating sleep disturbances in accurately diagnosing mental disorders. Studies show sleep is an important risk factor in the precipitation of many mental illnesses, while sleep disturbances are also frequently resolved by treating the underlying mental illness. Support (if any)