Behavioral addictions and psychosis

Abstract

M.K* is a 27-year-old, single, unemployed male that was driven to the Emergency Department by his foster father, four weeks ago with first episode of psychiatric symptoms of tactile hallucinations, auditory hallucinations of male and female voices making inappropriate sexual comments about him, persecutory delusions and delusions of control for the past five days. M.K is a daily cannabis user of 0.5-1g use for the past 2 years and has 5.5 pack year smoking history. M.K also reports having a pornography and masturbation addiction for 2 years with marked intrusive thoughts of sexual nature the past week. M.K has no medical or psychiatric history. Recent stressor was moving out of foster father’s house 8 days ago. The symptoms led to significant impact at work which he has quit since then. On presentation, M. K showed partial insight into his third person running commentary hallucinations but believed adamantly that he was being watched, followed and controlled. He reported hearing his female neighbour stating that he has sexual interest in animals and later heard his manager making pedophilic allegations on him. M.K was so distressed, he quit work and isolated himself in his room. He reported poor concentration and lack of appetite for the past week. M.K describes his baseline mood to have “always been not the greatest” and denied anhedonia, fatigue, or sleep changes. He denied thoughts of self- harm, harm to others or suicidal ideation. Four weeks following inpatient, referral to HBCT and cannabis abstinence has shown improvement in psychiatric symptoms with absence of hallucinations, however, there has been increased symptoms of anxiety with “panic attacks”. M.K’s biological mother is reported to have history of substance misuse and sister with depressive symptoms. He continues to withdraw from society with increased time spent indoors gaming and shows emotional dependence on foster father.