The patient that changed my practice: A rare case of organic psychosis

Abstract

Correspondence Address Jaime Moya, Psychiatry Resident, University Clinic, University of Navarra, Avda. Pio XII N8 36 CP: 31080 Pamplona, Navarra, Spain E-mail: jmoya@unav.es This article presents a patient with a history of depression, progressive impairment of brain functions, diarrhoea and faecal incontinence. A cobalamin deficiency, without megaloblastic anaemia was detected, and an abnormal Schilling test not due to intrinsic factor deficiency was obtained. Once other causes of cobalamin deficiency were ruled out, it was considered caused by blind-loop syndrome. Treatment with vitamin B complex and long-term oral antibiotic therapy led to a complete resolution of neurological and digestive symptoms. This case illustrates B12 deficiency as a possible cause of reversible dementia, as well as the importance of considering B12 screening in a patient with a history of gastric surgery. Given the depressive history of the patient, the case also emphasizes the relevance of distinguishing a dementia from the cognitive symptoms of depression. (Int J Psych Clin Pract 2003; 7: 147 /150)