Commentary: Diagnostic and Treatment Issues in Psychosis

The 3 cases presented in this issue highlight challenges in evaluating and treating patients with psychotic symptoms. The first case involved the rare but debilitating condition of periodic catatonia, the second case involved the use of intranasal oxytocin to augment an antipsychotic for a patient with worsening psychotic symptoms (and a prior diagnosis of schizophrenia) in the postpartum period, and the third case involved auto-enucleation (often referred to as "Oedipism"), a violent form of self-mutilation, in a patient presenting with first-episode schizophrenia. These case reports reinforce the need to consider a wide differential diagnosis before initiating treatment. Understanding the broad spectrum with which psychotic symptoms can present, or rare presentations of more common conditions, can help clarify the diagnosis and guide treatment, and hopefully help prevent or reduce future self-harm or violence, psychotic episodes, and hospitalizations.