Abstract
The patient was 53-year old woman who had been found to have valvular heart disease at the age of 20. She had suffered from schizoaffective disorder since the childbirth at the age of 28 and had been admitted to a mental hospital for eighteen years. After leaving the hospital, she had not consulted a doctor for two years. She was admitted to our mental hospital in July, X (age 48) because of psychomotor excitement and auditory hallucination with acute pulmonary edema due to severe heart failure. After admission she was making a transient recovery by treatment with medication. But she had recurrent attacks of pulmonary edema associated with psychomotor excitement in spite of taking cardiotonics and antipsychotics in high doses. In June, X+5,she was attacked with cardiogenic shock along with severe heart failure, which was followed by psychomotor excitement. After two days she recovered from the coma by treatment with cardiotonics and diuretics but the clouding of consciousness lasted for about three months. An EEG showed low voltage Θ waves in all leads and the MRI revealed ischemic change in cerebral cortex and white substance after about two weeks of the shock. However, she was slowly improving in intelligence and activities of daily living. For months after the shock, she was making a recovery from the severe heart failure and clouding of consciousness. She was taking no antipsychotics with no psychomotor excitement and auditory hallucination, and continued to be in good general condition.
