What is the treatment plan for constant nausea, brain fog, or memory loss with afternoon episodes of psychosis?

Hello doctor,

I am a 26-year-old woman who is five feet two inches and weigh 137 pounds, but last year I weighed 170 pounds. This is going to be a rather long story, but I feel as though all of the information is pertinent. For the ease of telling my story, as well as the ease of understanding it, I have broken down my symptoms into stages. I suffered from the onset and worsening of depression, anxiety, and concentration. My weight went from 140 pounds to 185 pounds, steadily gaining weight regardless of diet or exercise routine. At age 22, what appeared to be cystic acne started on my face, chest, and back of my neck. I have prescribed various antibiotics until we found one that worked well without making me excessively drowsy. I reached out to my doctor, who diagnosed me with anxiety disorder. For the past three years, I have been taking medicines for anxiety.

Stage 1: Constant nausea:

I woke up feeling nauseous. I cannot explain it other than to say that it felt different than motion sickness or nausea associated with a virus. I vomited once and felt slightly better, but the nausea never disappeared. It would get worse when I would try to eat, getting so bad that I could not even force myself to eat. This new appetite loss felt aggressive rather than passive. I also started suffering from a multitude of gastrointestinal ailments, including alternating bouts of constipation and diarrhea, in addition to bloating and gas, which was new for me. Nausea ceased after I started a gluten-free diet, which happened on the same day as my first psychotic break.

Stage 2: Brain fog or memory loss:

This is the stage for which I will have the hardest time describing. Regardless of whether or not I was medicated, I would catch myself staring at blank screens or blank pieces of paper, thinking about nothing. The brain fog took away everything that made me feel competent, which caused the depression to worsen. The brain fog continued to get worse, eventually including being unable to find words I wanted to speak in the middle of a conversation. I was unable to solve problems with more than one variable, which is a problem for me. An interesting side effect of the brain fog episode was that it made me much more talkative. I have no memories from last summer. I do not even recognize most of the pictures on my phone from the summer. I have always had a pretty decent photographic memory, so this revelation of not saving any memories terrified me.

Stage 3: Psychosis:

I am not sure what happened, but unable to control my emotions. The slightest aggravation would set me off into a screaming match or crying spell, accompanied by pale skin, fever, puffy eyelids, sweating, and chills. One night, a small disagreement with my boyfriend caused me to feel so much rage with additional suicidal thoughts first occurrence that I checked myself into the hospital because I was worried about harming myself or someone else. This happened twice. Both times, the incident was written up as acute psychosis caused by a stress reaction.

Stage 4: Afternoon episodes:

After the first occurrence of psychosis, I started noticing a pattern of when my symptoms showed up. These afternoon episodes begin sometime around 11:30 AM to 12:30 PM and typically last six hours. These episodes started with a sudden change in perceived temperature, usually involving multiple waves of chills and goosebumps. Then I would notice my mood drop significantly, with the color in my face going with it. I felt like my blood pressure and temperature were rising. My heart would start beating fast, hard, or both. I had sudden shortness of breath, which manifested as a panic attack about two weeks early. For no reason, I would start crying and crying hard for hours. Generally, by 9.00 PM, it would wear off, and I would feel relatively normal with my appetite back briefly. I am now taking Propranolol 60 mg for tachycardia, and the afternoon episodes have lessened in severity. However, Propranolol does cause me to occasionally have a break from reality. I have attached a log of symptoms from an unmedicated day while I wore a Holter monitor. This is the most recent log I have. Every doctor I have seen would like to write this off as an anxiety disorder, but this feels physical in origin. I am hoping to see if I may be able to gain any other insight.

Hello doctor,

Thank you for the reply.

I do get some joint stiffness but in the late afternoon and evening rather than the morning. I have not paid much attention to how long it lasts, but it normally goes away once I get up and walk around a bit. When I do have joint stiffness, I get a strong urge to crack all my joints out of nowhere. I have been prescribed Propranolol about three weeks ago after describing one of the afternoon episodes to my doctor. That was my thought as well, which is why I requested to be tested for Celiac disease, and the results came back negative. I also started taking multivitamins around the time that I switched to a gluten-free diet. I added a calcium supplement when the metabolic panel came back with a low calcium level. I will be requesting a gastroenterologist referral during my next visit. I have seen a psychiatrist in the past, but I do not have one now. I was referred to a psychiatrist three years ago for the diagnosis of anxiety. I also spoke with two different psychiatrists during my hospital stay. During the second hospital visit, I was still actively in an episode, crying uncontrollably, when I spoke to the psychiatrist. He told me that he had never seen anyone in a state I was in while still being lucid and rational. Kindly help.

Hello doctor,