Long-Term Comorbid Neuropsychiatric Sequelae of Hypoxia at Birth

Perinatal hypoxia due to obstetric complications has been known to cause neurodevelopmental impairments in infants and children. The severity of the impairments and recovery depends on the degree of hypoxia. There have been some studies which focuses on understanding the effects of perinatal hypoxia on cognitive and behavioral functioning like attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), learning disorders, or aggression. Although the studies have investigated the effects in children, there are very few studies done to explore perinatal hypoxia, causing any neuropsychiatric outcomes in adults.  This is a case of a 38-year-old man who presented to psychiatry as a referral for depression by neurology. He saw neurology for intractable migraine resistant to all treatment for the last year. The brain imaging was read as normal with minor small vascular changes. During our assessment, he reported depression and passive suicidal ideation, which began since he was diagnosed with migraines. His developmental history was significant for perinatal asphyxia and learning difficulties. Growing up, he reported severe irritability, impulsivity, and risk-taking behaviors but became stable when he was in his late twenties. His past psychiatric management was unclear. He was seeing an outpatient therapist when he visited our clinic. We diagnosed him with an unspecified mood disorder, tried prozac, and then gabapentin with some effect. Before we could explore further medication trials with topamax, his care had to be transferred to other psychiatrists, and we could not obtain further details of his outcome.  Based on our case, we concluded there is a need for further research focused on the effects of perinatal hypoxia on certain brain areas as a cause of neuropsychiatric symptoms in adults.