May 1, 2025: NEJM CPC - A 27-Year-Old Man with Abnormal Behaviors, Confusion, and Seizures

Overview

A 27-Year-Old Man with Abnormal Behaviors, Confusion, and Seizures

 

Description: 

This Case Records of the MGH for the New England Journal of Medicine is a clinicopathological conference about an adult who presented with abnormal behaviors and who developed a seizure while in the acute psychiatry service. A differential diagnosis will be presented, and the diagnostic test will reveal the final diagnosis. 

Target Audience

This program is intended for Psychiatrists, Psychologists, General and Family Practice Physicians, Psychiatric Nurses, Physician Assistants, Nurse Practitioners, and Social Workers.

Learning Objectives

Upon completion of the activity, participants will be able to:

  1. Create a differential diagnosis of a young patient with bipolar affective disorder and chronic lithium exposure presenting with abnormal behaviors and seizures.
  2. Apply deductive reasoning and clinicopathologic confirmation exercises.
  3. Describe the diagnostic tests that reveal the patient's final diagnosis.
  4. Describe the treatment and management considerations of the final diagnosis.

SPEAKER(S)

Case Presenter: Paavani Reddy, MD
   Psychiatry Resident

Differential Diagnosis: Nadia Quijije, MD
   MGH Department of Psychiatry

Clinical Impression and Management: Caitlin Adams, MD
  MGH Department of Psychiatry

Radiology: Pedram Heidari, MD
   MGH Department of Radiology

Medical management: Michelle Rengarajan, MD
   MGH Department of Medicine

Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of McLean Hospital and Massachusetts General Hospital. McLean Hospital is accredited by the ACCME to provide continuing medical education for physicians.

    McLean Hospital designates this Enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  • 1.00 Nursing Contact Hours

    Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.

    This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 1.00 contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.

  • 1.00 Social Workers

    The Collaborative of NASW, Boston College, and Simmons College Schools of Social Work authorizes social work continuing education credits for courses, workshops, and educational programs that meet the criteria outlined in 258 CMR of the Massachusetts Board of Registration of Social Workers

    This program has been approved for 1.00 Social Work Continuing Education hours for relicensure, in accordance with 258 CMR. Collaborative of NASW and the Boston College and Simmons Schools of Social Work Authorization Number

  • 1.00 Participation

    This course allows other providers to claim a Participation Certificate upon successful completion of this course.

    Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credit™ associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credit™ may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.

  • 1.00 Psychologists CE Credit

    The Massachusetts General Hospital Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education for psychologists. The Massachusetts General Hospital Department of Psychiatry maintains responsibility for this program and its content.

    This offering meets the criteria for 1.00 Continuing Education (CE) credits per presentation for psychologists.

Registration opens: 
05/01/2025
Course closes: 
06/26/2025
Rating: 
0

Faculty

Authors:

Paavani Reddy, MD

Paavani is a 2nd year resident in the MGH/McLean Psychiatry Residency Program. She grew up in Cleveland, Ohio, and went to college and medical school in the Chicago area at Northwestern University. She is interested in early family mental health and consult-liaison psychiatry. She enjoys scouting dessert spots, as well as reading on the Esplanade.


Nadia Quijije, MD

Dr. Quijije obtained her medical doctorate from SUNY Downstate Health Sciences University, completed her psychiatric residency at the University of South Florida, a Consultation Liaison Fellowship at Massachusetts General Hospital, a Fellowship in Psychotherapy at the Boston Psychoanalytic Society and Institute (BPSI), and is currently in psychoanalytic training at BPSI. Dr. Quijije is a psychiatrist on the Acute Psychiatric Service, Consultation Liaison Psychiatry Service, and Ketamine Clinic at MGH and also has a private practice.


Caitlin Adams, MD

Caitlin Adams is an attending psychiatrist who completed a fellowship in CL psychiatry at MGH. She is currently working as an attending psychiatrist in the departments of Psychiatry and Neurology. She has built an embedded psychiatry clinic within the division of cognitive and behavioral neurology. Her clinical interests include diagnoses at the interface of medicine and psychiatry as well as at the interface of neurology and psychiatry. She currently serves as the Functional Neurological Disorder SIG Chair for the American Neuropsychiatric Association, is a founding member of the Functional Neurological Disorder Society, and was co-president of the Boston Society of Neurology, Neurosurgery, and Psychiatry from 2023-2024.


Pedram Heidari, MD

Pedram Heidari, MD, is a physician-scientist and nuclear radiologist at Massachusetts General Hospital (MGH) and Assistant Professor of Radiology at Harvard Medical School. He serves as the Service Chief of Nuclear Medicine and Molecular Imaging at MGH and Director of the MGH PET Core. Dr. Heidari’s work lies at the intersection of precision molecular imaging, radiopharmaceutical therapy (RPT), and translational oncology, with a focus on theranostic approaches to cancer care.

Dr. Heidari joined the MGH faculty in 2018. He has since built one of the largest radiopharmaceutical therapy programs in North America, integrating advanced dosimetry and AI-based imaging analysis into clinical workflows. His research focuses on the development and translation of novel radiotracers for imaging and therapy, with recent projects targeting tumor microenvironment markers, apoptosis, and immune modulation. He leads the "Bio-dosimetry" pillar of a major institutional initiative, evaluating biological surrogates of radiation response using PET imaging biomarkers.

Dr. Heidari has trained numerous clinical and research fellows and actively participates in national and international imaging consortia. He holds several NIH and foundation grants, has published extensively in high-impact journals, and serves on national grant review panels and editorial boards. Dr. Heidari’s leadership has positioned MGH as a hub for innovation in molecular imaging and radiotheranostics, fostering collaborations across academia and industry to drive forward the next generation of cancer diagnostics and therapies.


Michelle Rengarajan, MD

Dr. Rengarajan received a B.A. from the University of Chicago and an M.D. and Ph.D. from Stanford University. She completed her residency in Internal Medicine at Brigham and Women’s Hospital and her endocrinology fellowship at Massachusetts General Hospital. Dr. Rengarajan specializes in treating endocrine disorders, with a particular focus on thyroid disorders, endocrine autoimmunity, and immunotherapy toxicities. She is an attending in MGH Thyroid Associates and on the Severe Immunotherapy Complications team. Dr. Rengarajan conducts translational research on autoimmune endocrine diseases, such as Hashimoto’s thyroiditis, Graves' disease, and type 1 diabetes. She is additionally involved in clinical and translational research related to endocrinologic complications of cancer immunotherapy.


Case Organizer:

Daniel Restrepo, MD, FHM

Dr. Restrepo is a board-certified general internist and hospitalist in the Department of Medicine, a member of the Core Educator Faculty, and the Associate Program Director for Point-of-Care Ultrasound for the internal medicine residency program at the Massachusetts General Hospital, as well as an Assistant Professor of Medicine at Harvard Medical School. He additionally serves as the Associate Editor for the Case Records of the Massachusetts General Hospital in the New England Journal of Medicine (also known as the CPCs) and is the Co-Director of the Clinical Reasoning Curriculum for the MGH medical residents.

He graduated with a degree in biology from the University of Florida and attended medical school at the University of South Florida College of Medicine. He completed his internal medicine residency and later chief residency at Massachusetts General Hospital. His main interests lie in diagnostic reasoning, clinical and bedside teaching, as well as physical diagnosis and point-of-care ultrasound.

CE Information

Available Credit

  • 1.00 AMA PRA Category 1 Credit™

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of McLean Hospital and Massachusetts General Hospital. McLean Hospital is accredited by the ACCME to provide continuing medical education for physicians.

    McLean Hospital designates this Enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  • 1.00 Nursing Contact Hours

    Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.

    This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 1.00 contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.

  • 1.00 Social Workers

    The Collaborative of NASW, Boston College, and Simmons College Schools of Social Work authorizes social work continuing education credits for courses, workshops, and educational programs that meet the criteria outlined in 258 CMR of the Massachusetts Board of Registration of Social Workers

    This program has been approved for 1.00 Social Work Continuing Education hours for relicensure, in accordance with 258 CMR. Collaborative of NASW and the Boston College and Simmons Schools of Social Work Authorization Number

  • 1.00 Participation

    This course allows other providers to claim a Participation Certificate upon successful completion of this course.

    Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credit™ associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credit™ may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.

  • 1.00 Psychologists CE Credit

    The Massachusetts General Hospital Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education for psychologists. The Massachusetts General Hospital Department of Psychiatry maintains responsibility for this program and its content.

    This offering meets the criteria for 1.00 Continuing Education (CE) credits per presentation for psychologists.

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Accreditation

In support of improving patient care, MGH Institute of Health Professions is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

 

1.0 Physicians

MGH Institute of Health Professions designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.


1.0 Physician Associates/Assistants
AAPA Credit Designation Statement – Live

MGH Institute of Health Professions has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

 

AAPA Credit Designation Statement – Enduring Materials

MGH Institute of Health Professions has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until {Expiration Date). PAs should only claim credit commensurate with the extent of their participation.


1.0 Nursing

MGH Institute of Health Professions designates this activity for 1.0 contact hours for nurses. The American Academy of Nurse Practitioners Certification Board (AANPCB) accepts credit from organizations accredited by the ACCME and ANCC.


1.0 Pharmacists

This activity provides 1.0 contact hours of continuing education credit.

NOTE FOR PHARMACISTS: Upon closing of the electronic evaluation, IHP will upload the pharmacy-related continuing education information to the CPE Monitor within 60 days. Per ACPE rules, IHP does not have access nor the ability to upload credits requested after the evaluation closes. It is the responsibility of the pharmacist or pharmacy technician to provide the correct information [NABP ePID and DOB (in MMDD format)] in order to receive credit for participating in a CE activity.


1.0  Psychologists:

Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.0 CE credit.


1.0  Social Workers

 As a Jointly Accredited Organization, MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.0 clock hours for continuing education credits.

1.0 IPCE Credit

This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change.