Treatment refractory psychosis remitted upon treatment with continuous positive airway pressure: a case report

Patients refractory, or responding only partially, to antipsychotic drugs are common in clinical practise. Medical diseases can present with psychotic symptoms or add to a psychotic picture and should not be missed. We report on a patient with schizophrenia whose treatment refractory psychosis remitted upon treatment of her obesity-hypoventilation syndrome (OHS).

A 63-year-old women previously diagnosed with hebephrenic schizophrenia developed treatment resistant auditory hallucinations along with extreme daytime fatigue and obesity. She was eventually diagnosed with Pickwickian syndrome or OHS and received treatment with continuous positive airway pressure (CPAP). Restoring the patient's alveolar hypoventilation with nocturnal CPAP led to the complete remission of hallucinations.

We suggest that this case highlights an issue that might become more common in the future with increasing prevalence of overweight. Indeed, some atypical neuroleptics might even counteract their own therapeutic effect by inducing excessive weight gain that increases the risk for OHS. We recommend taking a careful sleep history in schizophrenic patients with obesity and to perform a polysomnography in suspect cases.