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All Journal Jurnal Psikiatri Surabaya (Surabaya Psychiatry Journal) Vitamin: Jurnal Ilmu Kesehatan Umum
Devina Sagitania
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Health Professions Medicine & Pharmacology Nursing Public Health

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Graves Disease Presenting Psychosis: a Case Report Devina Sagitania; Agung Frijanto; Budi Yuwono
Jurnal Psikiatri Surabaya Vol. 13 No. 1 (2024): May
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jps.v13i1.43634

Abstract

Introductions: Graves' disease is the most common cause of hyperthyroidism. Neuropsychiatric manifestations may occur in thyroid disease. As the premier clinical manifestation of Graves disease, psychosis is highly uncommon; it was reported in 1% of cases. The major neuropsychiatric manifestations of hyperthyroidism are acute psychosis, dementia, apathy, agitation, mania, delusional behavior, and hallucinations, especially in older people. Psychosis is highly rare as the first clinical symptom of a grave disease. Case: A 48-year-old female with grave disease symptoms had been taken to the emergency department with psychotic manifestations. She had a three-month history of increasing irritability, increasing irrational talking, staying awake most of the night, muttering, night-time wandering, and poor personal hygiene. She was admitted to the hospital, and the laboratory investigations showed an elevated FT4 and a decreased thyroid-stimulating hormone (TSH). The patient was started on propanolol 3 x 10 mg, propylthiouracil 3 x 50 mg tab, risperidone 2x2mg, trihexylphenidil 2x2mg, lorazepam 1x2mg, and Zyprexa injection once, which showed improvement in psychotic symptoms. Conclusion: Graves' disease can present with neuropsychiatric manifestations such as psychosis, mania, or a combination of both. A detailed medical history and physical and psychiatric evaluation are necessary for diagnosing and giving adequate treatment. A detailed clinical evaluation, including thyroid function tests, could be recommended for all patients who showed psychotic symptoms. More research is needed to comprehend the pathophysiology underlying psychosis due to Graves' disease, so that it is expected that the management can be carried out properly.
Efektivitas Pemberian Tolvaptan pada Pasien Gagal Jantung dengan Resistensi Diuretik Suzette Daniel; Devina Sagitania
Vitamin : Jurnal ilmu Kesehatan Umum Vol. 4 No. 1 (2026): January : Jurnal ilmu Kesehatan Umum
Publisher : Asosiasi Riset Ilmu Kesehatan Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61132/vitamin.v4i1.2093

Abstract

Diuretic resistance is a serious complication in heart failure patients associated with increased morbidity and mortality. Tolvaptan, a vasopressin V2 receptor antagonist, offers an alternative therapeutic mechanism through aquaresis. This study aims to evaluate the effectiveness and safety of tolvaptan in heart failure patients with diuretic resistance. A retrospective cohort study was conducted on 58 hospitalized patients with NYHA III-IV heart failure and diuretic resistance (urine output <1000 mL/day despite furosemide use ≥80 mg/day) who received tolvaptan 7.5-15 mg/day for 7 days. Variables measured included weight change, urine output, serum sodium, and kidney function. The results showed a significant increase in daily urine output from 820±230 mL to 2180±520 mL (p<0.001), along with an average weight loss of 3.4±1.1 kg (p<0.001). Hypernatremia (>145 mEq/L) occurred in 8.6% of patients. In conclusion, tolvaptan is effective in improving diuresis and reducing congestion in heart failure patients with diuretic resistance, although the risk of hypernatremia should be monitored.
Co-Authors Agung Frijanto Budi Yuwono Budi Yuwono Suzette Daniel