Schizophrenia, male in his 40’s -Fecal microbiota transplantation case report
Case presentation: Male in his 40s, schizophrenia
summary
He has been visiting a psychiatrist with a diagnosis of schizophrenia since he was about 20 years old, due to bullying in junior high and high school. He has hallucinations (auditory hallucinations), paranoia, and sleep disturbances, and takes psychiatric medication. After the transplantation (6 times course), he had a temporary feeling of heaviness, irritability, and fatigue, and after the 4th transplantation, the transplantation solution was changed. The patient improved by changing the transplantation solution after the fourth transplantation. At present, we diagnose that her mental condition has not changed after 6 transplants.Basic Information
| Patients : | 50s Male |
| Attending physician : | Medical Corporation Nizenkai Tanaka Clinic |
| Medical institution in charge of transplantation : | Medical Corporation Nizenkai Tanaka Clinic |
Information at the time of initial medical examination
| Disease name : | schizophrenia |
| At onset : | around 20 years old |
| Transplant Purpose: To | Depressive symptoms (mood swings) Irritability, tantrums Constipation Allergies (food, pollen, chemicals, etc.) |
| Chief complaint : | Auditory hallucinations, paranoia |
| Medications being taken : | Currently taking Sediel, Wipax, Valerin, Rivotril, Invega, Fenofibrate, Nexium, and Epadel |
| Medical history : | Allergies, childhood asthma |
| Background, family history, lifestyle, supplement use, etc : | Lives separately from his/her family. He goes to a work shop. He plays futsal once a week. He is fed rice, miso soup, fermented foods, and vegetables when he comes back to his parents’ house (from his mother). He has bowel movements every day. He smokes 15 cigarettes/day. He sometimes eats junk food such as cup noodles at night. |
Transplant Information
| Transplantation period: from | Transplantation period: from August 28, 2019 – October 8, 2019 |
| Number of transplants : | 6 times |
| Change from first transplant to end of transplant : |
| At the end of the third session, symptoms worsened (fatigue, irritability, and a feeling of heaviness), so the transplanted bacterial solution was changed. After that, the patient became calm, but did not recover well. 【1st transplantation questionnaire】 She had constipation and took Mg oxide (330) 3T for 3 minutes after every meal, and her stools became a little softer. She was irritable, so she took Rivotril the day before and had a hard time waking up this morning. ＜Doctor’s note＞⇒Mg oxide should not be excessive. 【2nd transplantation questionnaire】 Mood swings are the same. He tends to have a tendency to drag his mind back to the past. Today he has diarrhea. ＜Doctor’s note＞⇒ Train your mind to shut out the past. Blood test before FMT was fine. After discussion, it was decided to continue with the change of the bacterial solution. 【3rd transplantation questionnaire】 Feeling of breathlessness is getting stronger. Irritability. Tends to have insomnia at night. Bowel movements are improving. 【4th transplantation questionnaire】 The condition of her stools was better than before the FMT, and her atopy and asthma were also improving, but she became more irritable and felt heavy and heavy, and wanted to discontinue the FMT. 【5th transplantation questionnaire】 The day after the last FMT (2 weeks ago), she was feeling good, but after that, she became irritable and her fatigue became worse than ever. Even after exercise, he has a different lassitude than before. Constipation has improved compared to before. 【6th transplantation questionnaire】 After the last transplant, her mood is better than before. However, the day after she felt depressed, she took a homeopathic remedy to calm down, and her mood has been stable since then. Sometimes, he eats a nighttime meal and the next day becomes difficult. Her bowel movements are good. 【After the 6th transplantation】 Symptoms such as paranoia have not changed, but they are better than the first time. She has trouble sleeping and cannot get up until late in the morning. |
| Changes after completion of transplant : |
| Now following |
Evaluation and Discussion
| Transplant Evaluation : | No change |
| Pre- and post-transplant flora balance test changes : | In the second session, the intestinal flora balance has changed significantly compared to the first session. In the third visit, the diversity of intestinal flora has improved and symptoms are improving accordingly. |
| Blood test changes : | none in particular |
| POMS2 SCORE CHANGE : | Slightly worse than the first |
＜Intestinal flora balance before transplant data＞
＜Intestinal flora balance Post-transplant data＞
| His/her experience (from the questionnaire) : |
| Symptoms of paranoia remain the same, but may be better than they were at first. Sleep disturbances are still present (difficulty getting up in the morning). |
| Adverse events: No |
| Nothing |
| Transplant General Comments and Discussion : |
| No effect of transplantation was seen. The symptoms improved by changing the transplantation solution, although there was a temporary worsening of the disease. However, it cannot be said that it was more effective than before transplantation. |
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