Type 2 diabetes mellitus is a highly prevalent chronic disease. In patients with comorbid psychiatric disorders, insulin may become a means of suicide due to its potentially lethal effects when overdosed. Continuous glucose monitoring (CGM) systems have proven effective for glycemic control, but their role in suicide prevention is less explored. We report the case of a 68-year-old woman with type 2 diabetes, borderline personality disorder, and major depressive disorder, who attempted suicide by injecting 90 units of lispro insulin and ingesting 12 tablets of lorazepam. The patient's daughter, monitoring her mother's glucose levels via CGM, detected a sudden hypoglycemic drop and intervened promptly, preventing a fatal outcome. The patient was treated in the emergency department with intravenous dextrose and supportive care, was later admitted to the ICU, and followed by psychiatric evaluation and pharmacological adjustments. Her psychiatric treatment plan was modified to reduce central nervous system depressants and reinforce outpatient psychiatric follow-up. At a one-month follow-up, the patient reported clinical improvement, denied suicidal ideation, and remained under psychiatric care. This case underscores the utility of CGM not only for glycemic control but also as an emergency detection tool in high-risk psychiatric patients, emphasizing the value of integrating digital health with psychiatric monitoring and family support.

Metoclopramide is a commonly used antiemetic associated with extrapyramidal side effects, including akathisia. Although typically mild, severe presentations may mimic neurologic emergencies. We present an 81-year-old male with chronic obstructive pulmonary disease (COPD) admitted for respiratory syncytial virus (RSV) pneumonia who developed acute severe akathisia after a single dose of metoclopramide. The episode began with acute back pain followed by marked restlessness and nonrhythmic movements with preserved awareness, favoring a toxic-metabolic process over seizure. Laboratory evaluation revealed transient lactic acidosis (6.3 mmol/L), further confounding the diagnosis. Despite treatment with diphenhydramine and lorazepam, symptoms progressed, requiring intensive care unit (ICU) transfer due to worsening agitation and decreased awareness. Symptoms resolved completely within 24 hours. This case highlights the importance of recognizing medication-induced akathisia, which can mimic a seizure and lead to escalation of care, particularly in elderly patients with concurrent infection.

Pulmonary embolism (PE) is a potentially life-threatening condition that may occur in patients receiving antipsychotic medication. Several studies have shown an increased risk of venous thromboembolism (VTE) associated with the use of antipsychotics, particularly during the first weeks or months of treatment. However, very early onset of VTE within hours of treatment initiation has been rarely reported. We present the case of a 69-year-old woman who developed acute pulmonary embolism within a few hours after initiation of psychopharmacological treatment for a psychotic episode. Due to acute agitation, the patient received olanzapine, quetiapine, levomepromazine, and lorazepam. The patient had no known predisposing risk factors for VTE. Shortly after begin of psychopharmacological treatment she presented with deterioration of her general condition, soporous, hypotensive, tachycardic and with reduced oxygen saturation. PE was suspected clinically and confirmed by computed tomography pulmonary angiography. After diagnosis, PE was successfully treated with anticoagulation. This case is notable for the unusually rapid development of VTE, occurring within hours rather than the typically reported days to weeks. It underscores the need for heightened clinical vigilance even in the very early phase of antipsychotic therapy and in patients without risk factors for VTE.

Hemichorea associated with non-ketotic hyperglycemia (HC-NH) is a rare neurological complication and is also considered a specific complication of diabetes. Its exact pathogenesis remains unclear. We report a case of a 79-year-old female patient with HC-NH. Her primary clinical presentation included involuntary movements in the right limbs that began 3 days prior to admission. These movements worsened during emotional agitation and could be accompanied by insomnia but resolved after falling asleep. Imaging studies revealed no significant intracranial lesions on CT. MRI showed hyperintensity on T1-weighted images (T1WI) in the left globus pallidus and putamen and slightly lower signal intensity on T2-weighted imaging (T2WI). Fingerstick glucose monitoring during hospitalization showed only mild elevation, and urine ketones showed negative results. Treatment included glucose control, tiapride, Trihexyphenidyl, and haloperidol for choreiform movements, along with lorazepam to alleviate anxiety and tension. The patient showed slight improvement, and choreiform movements markedly diminished 3 months after discharge. This case demonstrates that blood glucose levels may not be markedly elevated at the onset of HC-NH, potentially leading to delayed or misdiagnosis. Additionally, symptom control may not achieve optimal results in the short term. Therefore, early diagnosis and treatment are crucial for the prognosis of this condition.

Benzodiazepines are commonly prescribed psychotropic drugs with anxiolytic, sedating, hypnotic, and anticonvulsant effects. They impair saccadic eye movements in prosaccade tasks, particularly peak velocity, but the extent of the effects on different saccadic parameters remains unclear. Therefore, we conducted a systematic review and meta-analyses on the effects of different benzodiazepines on peak velocity (k (number of included studies) = 30, kES (number of included effect sizes) = 45, N (number of participants) = 444), latency (k = 12, kES = 17, N = 221) and amplitude gain (k = 5, kES = 8, N = 113). Furthermore, we performed meta-analyses and dose-dependent meta-regressions of lorazepam effects on peak velocity (k = 13, kES = 19, N = 257) and latency (k = 8, kES = 12, N = 187). We found a robust and large effect on peak velocity (standardised mean change (SMCC)) = -1.064, 95% CI (confidence intervals) [-1.287, -0.84]), a less consistent, medium sized effect on latency (SMCC = 0.706, 95% CI [0.285, 1.127]), and a medium sized, but non-significant, effect on gain (SMCC = -0.581, 95% CI [-1.226, 0.064]). These findings confirm the sensitivity of saccadic eye movements to modulation of gamma-aminobutyric acid (GABA) through benzodiazepines and point to the peak velocity in particular as a biomarker for sedative effects in pharmacological research in healthy adults.

Myxedema psychosis or "myxedema madness" is a rare, treatable, but potentially fatal neuropsychiatric manifestation of severe hypothyroidism. This case report presents a 46-year-old, unemployed, childless woman with progressive deterioration of her health over the last six months, including progressive lethargy, social withdrawal, poor intake, irritability, sound sensitivity, auditory hallucinations, urine and fecal incontinence, and complete neglect of personal hygiene. She had undergone total thyroidectomy and parathyroidectomy for which she was on levothyroxine, which she had discontinued. On physical examination, she was disoriented, having disorganized thinking, false belief of having cancer, fecal soiling, non-pitting edema of the lower limbs, and rigidity of the upper and lower limbs. Laboratory investigations showed hypoglycemia, hypokalemia, hypophosphatemia, severe hypothyroidism, and low morning cortisol. The CT scan of the brain revealed symmetrical calcification of bilateral basal ganglia, thalami, right corona radiata, and bifrontal subcortical white matter. She was started on levothyroxine, hydrocortisone, and aripiprazole. On day 16, she developed catatonic features, for which she was treated with lorazepam and aripiprazole, resulting in gradual improvement.

Background/Objectives: While standard antiemetic regimens have evolved, breakthrough symptoms and anticipatory nausea persist. Lorazepam has historically been used as an adjunct, yet a comprehensive re-evaluation of its efficacy across historical trials is lacking. This study provides a synthesis of clinical evidence to re-evaluate the adjunctive therapeutic value of lorazepam, potentially addressing persistent gaps in emesis control, such as anticipatory and refractory symptoms. Methods: Following PRISMA guidelines, we analyzed eight randomized controlled trials (n = 864) published between 1989 and 1997. Primary endpoints included complete and improved responses for emesis and nausea. Results: Eight trials (n = 864), published between 1989 and 1997, met the inclusion criteria. Lorazepam-containing regimens significantly increased the complete response rate for overall emesis (OR = 1.55; 95% CI, 1.12-2.14; p = 0.008) and improved the response rate (OR = 1.50; 95% CI, 1.03-2.19; p = 0.04). Subgroup analysis of acute emesis showed consistent benefits (complete response OR = 1.77; 95% CI 1.23-2.55; p = 0.002). Nausea control also favored lorazepam, although the differences were not statistically significant. Sedation was more frequent with lorazepam (RR = 2.67; 95% CI 1.54-4.63), although no serious adverse events were reported. Conclusions: By revisiting decades of clinical evidence, this meta-analysis confirms that lorazepam provides a significant therapeutic advantage in controlling chemotherapy-related vomiting, particularly during the acute phase. While its direct efficacy alongside modern agents like NK1 receptor antagonists remains to be fully elucidated, the anxiolytic and amnestic properties of lorazepam remain a potential adjunct for managing complex CINV profiles. Careful dose titration is necessary to balance efficacy with sedation.