Multiple sclerosis presenting with erotomanic delusions in the context of "Don't ask, don't tell".
A female patient presented with erotomanic delusions of other female soldiers sexually harassing her and plotting to sexually assault her. On MRI, the patient was found to have numerous periventricular foci of signal changes extending into the deep white matter of both hemispheres. The MRI findings, along with lumbar puncture findings of oligoclonal bands in the cerebral spinal fluid, were consistent with a diagnosis of multiple sclerosis. After treatment with aripiprazole acutely and interferon beta-1a for several months, the patient experienced a decrease in her psychosis. The discussion of this case includes a brief overview of psychosis as a presenting symptom of multiple sclerosis, and also includes consideration of the patient's initial reluctance to seek treatment in light of the policy known colloquially as "don't ask, don't tell".
Smith
Earl Justice
EJ
Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Bldg 6, Borden Pavilion, Washington, DC 20307, USA.
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D000068180:Aripiprazole; D001714:Bipolar Disorder / Q000175:diagnosis / Q000209:etiology*; D004882:Erotica; D005260:Female; D006801:Humans; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008889:Military Personnel; D008890:Military Psychiatry; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D016134:Organizational Policy; D010879:Piperazines / Q000627:therapeutic use; D015363:Quinolones / Q000627:therapeutic use; D021641:Recognition, Psychology; D012563:Schizophrenia, Paranoid / Q000175:diagnosis / Q000209:etiology*; D012742:Sex Offenses; D017406:Sexual Harassment; D013315:Stress, Psychological / Q000150:complications*; D013577:Syndrome
D000276:Adjuvants, Immunologic; D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D016899:Interferon-beta; D000068180:Aripiprazole; D000068556:Interferon beta-1a