Resistant psychosis in a patient with coexisting beta-thalassemia and latent toxoplasmosis

Abstract

We present the case of a 44 year-old Caucasian male (V.B) with a known psychiatric history of paranoid schizophrenia, admitted to “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry during the months of May-July 2015 (67 days of hospitalization) for: compound and complex auditory and visual hallucinations, paranoid delusions, hallucinatory behavior, psychotic anxiety and sleep disturbances, symptoms which had intensified in the several months preceding admission despite following adequate antipsychotic treatment. We present the difficulties we encountered in treating his resistant psychosis, the process of diagnosing his co-morbidities (beta-thalassemia and latent Toxoplasma gondii infection), a differential diagnosis of the intense positive symptoms the patient presented and the implications of toxoplasmosis in the evolution and treatment of a paranoid schizophrenic patient. Conclusion. The scope of this paper was to show the importance of performing a differential diagnosis and a thorough workup however certain we are of the patient's initial presentation. We also wanted to emphasize the need for studies that present more effective treatments of resistant psychosis with fewer adverse reactions. The etiology of schizophrenia presents a tremendous challenge for both researchers and physicians, the latent toxoplasmosis infection observed in high prevalence among schizophrenic patients representing only a small part of what remains to be discovered. Ultimately we must draw attention to the importance of a multidisciplinary approach to every case encountered.