Page 56 - JCBP-1-1

Journal of Clinical and
Basic Psychosomatics Crouzon comorbidity with psychiatric disorders

departments specializing in the oral cavity, plastic surgery,
otolaryngology, or ophthalmology. Seeking medical
attention in the psychiatry department, like in the present
case, is rare. Taylor and Bartlett proposed that mental
health should be given great importance throughout the
[6]
treatment of patients with CS .
2. Case presentation
2.1. Medical history
A 15-year-old girl was brought in by her mother and
admitted to the department of psychiatry for treatment
on November 9, 2022. She had visited the local outpatient
clinic with limited improvement. Her parents reported
that she was positive before Grade 4 of primary school. Figure 1. Physical examination: scaphocephaly (“scaphocephalic” skull
shape), exophthalmos (prominent eyeballs), beaked nose, facial anomalies
Since junior high school, she often felt unhappy due to with hypoplastic maxilla, and relative mandibular prognathism.
her appearance and poor interpersonal relationships. In
addition, she rarely spoke to others, resulting in an intense tension in the limbs increased with passive posture without
relationship. She experienced full-term normal delivery, active resistance.
and her brother did not report similar medical issues. Her
academic performance remained at an average level. 2.4. Laboratory examination

2.2. Mental status examination A suspicion of CS was raised, and imaging examinations
were requested. The results revealed the following:
The girl harmed herself with her nails when experiencing
an unstable mood. She was anhedonia and refused to (i). Imaging examinations: A head computed tomography
complete homework 7 days before the visit. She insisted that (CT) showed a “hammered silver” (beaten metal/
someone had drugged her in a glass of water and argued copper beaten) pattern, once regarded as a marker
that it was from her classmates. Her mother, who worked in of increased intracranial pressure (Figure 2A). Spinal
a private pharmacy, treated her with “Promethazine 18mg” dysplasia was also indicated in the CT report. Besides,
to help her sleep without an appropriate subscription. a head MRI showed the widening of the anterior brain
She was able to fall asleep after the injection. Her parents pool in the left temporal lobe without excluding a
claimed she repeatedly spoke single words, such as “mom” small arachnid cyst and leftward deviation of the nasal
and “dad.” septum (Figure 2B-F).
(ii). Psychological examinations: Psychiatric examination
Fear, nervousness, and the urge to walk outside were indicated that infrared thermal imaging examination
presented in her during the visit to the local hospital on prompted mildly abnormal cerebral blood flow activity;
November 4. The following day, she would not talk or mental stress analysis showed the level of fatigue and
eat at all. She was given oral medications (lorazepam and psychological stress was normal, but the activity of
olanzapine, at a dosage of 2.5 mg/night) for about 1 week, the autonomic nerve was relatively strong; event-
but the improvement was poor. related potential (ERP) showed mild abnormalities
in attention and immediate memory; the scores of
2.3. Physical examination
extraversion (E), neuroticism (N), psychoticism (P),
On the day of admission, the head examination showed and validity (L) in Eysenck Personality Questionnaire
scaphocephaly (“scaphocephalic” skull shape), and the (standard score) were 10, 50, 35, and 50, respectively;
head circumference was 54 cm. The physical examination electroencephalography (EEG) indicated that
showed that normal height (147 cm), weight (35 kg), and subthreshold electroencephalogram occurred. There
body mass index (16.2 kg/m ) were comparable to the were no obvious abnormalities in the suicidal ideation
2
children of the same age. The patient was stupor at the time self-assessed test and intellectual development.
of examination, presented with physical facial features such (iii). Others: Electrocardiogram revealed sinus arrhythmia;
as exophthalmos (prominent eyeballs), hypertelorism, polysomnography suggested no indication of sleep
hypopsia, beaked nose, facial anomalies with hypoplastic apnea syndrome; ophthalmologic examination showed
maxilla, and relative mandibular prognathism (Figure 1). that the actual visual acuity based on international
The subsequent examination revealed that the muscle standard vision chart was 0.12 for the right eye

Volume 1 Issue 1 (2023) 2 https://doi.org/10.36922/jcbp.0405