![]() ![]() ![]() ![]() He smoked occasionally and drank socially he denied any other substance use. His relationships were harmonious and his life was free of significant stressors. X had no previous personal or family psychiatric history and no history of epilepsy, infectious diseases, or sleep or pain disorders. He was not too concerned about the hypersomnia, the odd behavior during sleep, or the newly reported sensation of having, imbedded in his back, four balls that further divided into smaller ones. Well-oriented and generally cooperative, he was euthymic, with intermittent attention and focus, and his main complaint was his unsteady gait. X was noted to be a thin, neatly dressed man, ambulating with his wife’s help. Other sleep-related disorders included hypersomnia, narcolepsy, sleep talking, and vivid dreams that the patient believed were real events. An Example of the Patient's Unusual Sleeping Postures After Mercury Poisoning aĪ The patient maintained awkward postures such as this one for 1 to 2 hours. Given the complexity of the case, the patient was transferred to a psychiatric teaching hospital, with diagnoses of pain somatoform disorder and sleep disorder, 5 months after the initial presentation.įIGURE 1. More remarkably, during supine sleep, his hands and feet were raised up in the air, and he maintained these awkward postures for 1 to 2 hours ( Figure 1). He had also started to have dizziness, nausea, ataxia, blurred vision, and further sleep problems-sleeping up to 15 hours a day, falling asleep during conversations or meals, and exhibiting pronounced sleep talking. X’s lower joint pain had disappeared, but the tremulous sensation in his limbs persisted. After physical examination, laboratory studies, an X-ray of the affected joints, and MRI of the brain and spine showed no obvious abnormalities, the emergency department referred the patient to a psychiatric hospital with a diagnosis of pain somatoform disorder.Īfter 2 months of psychopharmacotherapy that included duloxetine (60 mg/day) and mirtazapine (45 mg/day), Mr. Treatment with a nonsteroidal anti-inflammatory drug was ineffective. X,” a 42-year-old married taxi driver from Beijing, came to the emergency department with insomnia, a severe and constant burning sensation and pain in the lumbar spine, hip and knee joints, and soles of the feet, and a sense of tremor in his limbs. ![]()
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