Management of Psychosis in the Setting of Binge Eating, Mania, and Extrapyramidal Side Effects

Psychosis is a mental disorder in which an individual exhibits a loss of contact with reality; this definition, however, often fails to convey the broadness and complexity behind the diagnosis. While studies agree that it is best practice to address psychosis by treating its underlying cause, manifestations of psychosis do vary widely and may be challenging to identify in some clinical scenarios, such as the one presented here. Binge eating in the setting of psychosis has been observed in instances where alterations of the gut microbiota in response to an eating disorder trigger psychotic episodes. However, instances in which the manifestation of psychosis itself is the catalytic factor for the presentation of a binge-eating event with aggression and delusions are seldom observed in the current medical literature. Of note, many of the drugs used to treat mental illness have been associated with regulating food intake. We aim to further expand on the association between psychosis, eating disorders, and management thereof in the setting of polypharmacy and undesired side effects. Here, we present the case and management of a 71-year-old male Hispanic patient with a significant history of mental illness who was admitted to the hospital due to acute gastroenteritis precipitated by binge eating during a psychotic episode.