Obstructive Sleep Apnea-Hypopnea Syndrome in a Patient with Severe Psychopathology

A 46-year-old man with severe obesity (body mass index [BMI] of 52 kg/m2) was admitted for hospitalization in the psychiatric department of a general hospital because of behavioral disorders and constant suicidal and homicidal ideation. The patient had posted a threatening message on a social media network about his manager at work after a conflict between them, stating that he had “a specific plan to harm either himself or his manager.” Initial evaluation included a semi-structured diagnostic interview by a clinical psychiatrist, the Hamilton Depression Scale-21 items test (HAMD-21) (score of 27), the Hamilton Anxiety Scale (HAM-A) (score of 26), the Montreal Cognitive Assessment (MoCA) (score of 22), and the Brief Psychiatric Rating Scale (BPRS) (score of 96). At the time of the initial psychiatric assessment, the patient presented with poor insight and judgment. He was confused, irritated, suspicious, and incapable of describing his feelings. He had a remarkable dysfunction in emotional awareness, social attachment, and interpersonal relating (all of which are core characteristics of alexithymia). The patient's colleagues who accompanied him to the hospital reported that the patient presented with high levels of anxiety, psychomotor agitation, social withdrawal, poor personal hygiene, and constant suicidal and homicidal ideation in the last 20 days before his admission, and that the symptoms had been gradually worsening. Laboratory test results revealed moderate liver damage and hyperlipidemia, with a serum aspartate aminotransferase level of 47 U/L (normal range, 13-30 U/L), total cholesterol level of 267 mg/dL (normal range <200 mg/dL), and triglyceride level of 258 mg/dL (normal range, 40–150 mg/dL). He had remarkably high blood pressure (210/130 mm Hg). Drug test results were negative, and magnetic resonance imaging showed no pathological signs. He had been diagnosed previously with hypertension and had a history of two previous hospitalizations in a psychiatric department because of depressive symptoms and suicidal ideation. In the past, he had refused any medication for hypertension or for the psychiatric symptoms. Six years ago, he had also been diagnosed with alopecia areata related to high levels of anxiety. © SLACK Incorporated.