Sir: We present a case of a woman who had suffered from chronic fatigue syndrome (CFS) for several years and was admitted for an acute psychotic episode. This association has rarely been described.
Case report. Ms. A, a 43-year-old mother of 2 children, was admitted in January 2006 with delusion and hallucinations following a period of exacerbated fatigue. She was afraid that her children would be abducted by the devil and tried to protect them. She begged her children not to get near the walls of her house for fear that the devil could erupt from the walls and take them.
Ms. A first experienced persistent fatigue 3 years before admission. Prior to this, she had been a very active woman. She had to stop working and was able to participate in only very few activities during the day. She attributed her fatigue to the overwhelming task of educating her hyperkinetic 9-year-old son.
She had a depressive episode of several months’ duration 10 years before admission, following an abortion of a pregnancy involving a malformed child. This episode had subsided without relapse. She had infectious mononucleosis 20 years before admission. A polysomnographic test 2 years before admission showed many awakenings interrupting Ms. A’s sleep pattern. She was then diagnosed with chronic fatigue syndrome according to the criteria of Holmes1 and Fukuda.2 Antidepressive medication was prescribed; it alleviated the secondary depressive symptoms but had no impact on her fatigue complaint.
During Ms. A’s hospitalization, her blood analysis results were unremarkable, excluding common organic causes of fatigue. Results of her neurologic examination at admission were normal. Her brain computed tomography (CT) scan showed frontal cortical atrophy, but neuropsychological tests failed to show major cognitive impairments.
Olanzapine was prescribed at the dosage of 15 mg/day, and her symptoms gradually subsided. She was discharged 1 month after admission, totally free of her psychotic symptoms. Her neuroleptic treatment was changed to 10 mg of aripiprazole because of excessive weight gain. Aripiprazole was as effective as olanzapine but allowed her to return to her usual weight. The treatment was gradually stopped after 1 year, with no recurrence of psychotic symptoms.
The association between CFS and psychosis has rarely been described. We are aware of only 2 other case reports. The first describes a 28-year-old man who developed CFS after mononucleosis and suffered afterward from a manic episode with psychotic characteristics.3
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Source: Kornreich C, Szombat M, Vandriette YM, Dan B. Association of chronic fatigue syndrome and acute psychotic episode: is it coincidental? Prim Care Companion J Clin Psychiatry. 2008;10(5):412. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629064/ (Full article)