Gastrointestinal symptoms suggested parasitic infections. Talkativeness, grandiosity and overactive symptoms suggested bipolar disorder. Multiorganic injuries, poor cognition and persistent behaviors might not be interpreted as bipolar disorders.
Dementia: The patient had poor cognition, confabulation and euphoria, which could be interpreted as chronic encephalopathy. The patient had diarrhea and seizures for 4 months, so the clinically reasonable deduction was that his encephalopathy had developed in the last several months. However, he had been eating raw food with a parasitic infection risk for 8 years, so his changes in eating behavior could not be explained by dementia.
Delirium: Delirium is defined as nonspecific acute encephalopathy syndrome with consciousness, attention, thinking, memory, mental motor behavior, and sleep cycle disorder [
7]. Delirium is usually transient, lasting for a maximum of 4 weeks and persisting for 6 months in only a few patients. This patient had severe and complex physical diseases, cardiac surgery, and mental disorders, which made the patient prone to delirium. However, after his physical condition stabilized during follow-up, the patient still had poor cognition and euphoria. This is better explained by chronic encephalopathy rather than delirium. However, the agitation described during the first consultation may have partly been caused by delirium.
Klüver-Bucy syndrome: Heinrich
Klüver and Paul Bucy described a dramatic behavioral syndrome that includes hyperorality, placidity, hypermetamorphosis, dietary changes, altered sexual behavior, and visual agnosia, in monkeys after bilateral temporal lobectomy in 1937. It is now thought to be caused by disturbances of the temporal portions of the limbic networks that interface with multiple cortical and subcortical circuits to modulate emotional behavior and affect [
8]. Subcortical infarction and inflammation of the brain might cause
Klüver-Bucy syndrome, which might support episodes of docility but not hyperactivity.
Schizoaffective disorder: The patient had delusions of grandeur and affective symptoms; however, no sufficient symptoms met the diagnostic criteria for schizophrenia.