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Majority of the adult type esophageal stricture cases occur because of deliberate ingestion of corrosive materials in a parasuicidal attempt while remaining group is accidental; only a minority of %3.7, were reported to be psychotic . In our case, we present a psychotic patient, who ingested a caustic material under the inşuence of her delusions and had a delusional perception of her intractable vomiting as supernatural beings infested her stomach. To emphasize the importance of meticulous evaluation of psychotic manifestations such as contents of delusions, which might be relevant to a general medical condition. The Case is a 37-year-old single, currently unemployed female, who has taken her drugs irregularly and had a şuctuating clinical course for 20 years and hospitalized thrice. On March 2013, she was monitored in our clinic for schizoaffective disorder. For the last three months, she has been avoiding eating, auto-inducing vomiting, thinking there were genies inside her. Before her admission to psychiatry, she had been evaluated by an internist for vomiting and a workup including endoscopy that revealed a patent lumen. She was started on PPI but couldn’t take her drugs orally and upon persistent complaints, presented to our clinic. She was cachectic and thought she needed to gain weight but did not want to feed the genies in her stomach, so had stopped eating food but ingested soap to cleanse her insides. On mental examination she had looseness of association and had occasional hallucinations during the interview. Her mood was irritable with an inappropriate affect and poor insight. In the ward, she had episodes of excitation, which involved self-induced vomiting and ingestion of soap. Upon persistence of her vomiting, she underwent another endoscopy, revealed corrosive stricture, which did not allow further passage of the endoscope. A piece of soap was extracted from the proximal end of the stricture. She was started on haloperidol decanoate and biperiden and referred to a gastroenterology unit for further treatment.
Discussion: Caustic injuries have serious long-term consequences, such as esophageal strictures and might have manifestations like dysphagia and vomiting. Differentiating delusions, organic conditions or bidirectional relationship between them is appeared to be an important subject. Two-factor approach according to which understanding the nature and genesis of any kind of delusion involves seeking answers to two questions; the first question is, “what has brought the delusional idea to mind in the first place?”. The second question is, “why is this idea accepted as true and adopted as a belief when the belief is typically bizarre and when so much evidence against its truth is available to the patient?” .
Conclusion: Considering this case, a detailed anamnesis including the content of delusions and necessary consultations should be made after precise psychiatric evaluation.