Ceftriaxone and Infection in First Episode Adolescent Psychosis

Abstract

Chief Complaint and Presenting ProblemJ . is a 16-year-old adolescent boy in tenth grade referred to adolescent inpatient service after several months of progressive withdrawal that culminated in marked decrease in speech and activity, and refusal to leave his room. J. was referred from home to a local emergency department by mobile crisis services, and then transferred to an adolescent inpatient unit for admission. History of Present IllnessMother reported an uneventful history, denying recent or past psychiatric symptoms for psychotic, mood, developmental, disruptive behavior, impulse control, and anxiety disorders. Two years prior to admission, at age 14, J. was reported to have been shot in the lower extremity by a stray bullet; this injury resulted in a slow, unsteady, limping gait and chronic foot infection. As a result, J. was absent from school much of the year. Although he went out with his friends occasionally, he was reportedly not as active as he had been in the past. Neither J. nor his mother endorsed mood or posttraumatic anxiety symptoms for that time period. However, J. reported that he could not play basketball because of the injury. In addition, one year prior to admission his 25-year-old brother, who had in utero transmission of HIV, died of AIDS related complications. J. acknowledged he was sad, elaborating no further.Mother, who was HIV positive, reported that she had been increasingly ill beginning around the time of J.'s brother's death as a result of renal failure, which had required frequent dialysis, clinic visits, and hospitalizations. J. acknowledged worrying about her, especially when she was in the hospital. Her last discharge was two months prior to the beginning of his increasing withdrawal. During her hospitalizations J. stayed with an aunt, where he had to function with a higher level of independence than usual. He was required to take care of various daily needs himself, and take trains to come into the city. His aunt, who seems reliable, reported he was doing well, without decrease in functioning. As J. was not a reliable historian due to psychosis, and his mother provided sparse history, possibly due to her own illness and losses, this was helpful in establishing the beginning of the current syndrome.In this context, mother reported that J. had been acting normally until about four months prior to admission, when one day, without explanation, he stopped attending school. Within a month he was no longer leaving the apartment, and over the last several weeks he was refusing to leave his room. During this period J. was reported to be withdrawn and less communicative, as he rarely responded to direct questions. He ate and drank when his mother brought him food, but not much.Upon questioning, J. acknowledged hearing voices but would not disclose any details. He denied visual hallucinations, olfactory hallucinations, ideas of reference, and mood and anxiety symptoms. He admitted to smoking marijuana in the past but was unable to provide details. He denied suicidal or homicidal ideat...