2026 Volume 2 Issue 1 Pages 367-372
Background: Psychiatric symptoms may be associated not only with neurotransmitter abnormalities but also with physiological factors including energy metabolism, gut environment, and methylatio n-related pathways.
Case: A 27-year-old woman with psychotic disorder, mild intellectual disability, and premenstrual dysphoric disorder had premenstrual-limited psychomotor agitation and anxious distress. Auditory h allucinations, muttering, inappropriate smiling, and communication difficulties worsened premenstrua lly; reduced motivation appeared after menses onset. Response to antipsychotic medication and nut ritional supplementation was limited. Organic acid testing showed elevated arabinose, oxalate, and lactate with decreased aconitate, suggesting involvement of gut and mitochondrial metabolism.
Conclusion: After metabolic support, symptoms outside the premenstrual period decreased and anti psychotic use was reduced to premenstrual-only. Based on hair mineral findings, antioxidant and h epatic support was provided and agitation weakened. After nutritional intervention targeting methyl ation-related metabolism (5-methyltetrahydrofolate, methylcobalamin, trimethylglycine), premenstrual exacerbation disappeared and antipsychotic medication was discontinued; seven months except trans ient inappropriate smiling and agitation.
