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She developed cardiogenic shock requiring vasopressors and inotropic support with transfer to critical care. Brain MRI confirmed cardioembolic infarcts, resolving on repeat imaging at 8\u2009weeks. Electroencephalograms normalised following clinical improvement. Extensive autoimmune, infectious and toxicological investigations were unrevealing. Psychotic symptoms resolved in parallel with cardiac stabilisation and did not recur following antipsychotic discontinuation. At follow-up, she demonstrated sustained psychiatric remission without medication. This case underscores the importance of systematic medical evaluation in first-episode psychosis and the risks of premature diagnostic closure.<\/jats:p>","DOI":"10.1136\/bcr-2026-274214","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:25:21Z","timestamp":1789147521000},"page":"e274214","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute psychosis unmasking severe non-ischaemic cardiomyopathy with biventricular thrombosis and cardioembolic cerebral infarcts"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0803-1138","authenticated-orcid":false,"given":"Bushra","family":"Elhusein","sequence":"first","affiliation":[{"name":"Department of Psychiatry, London Health Sciences Centre, London, Ontario, Canada"},{"name":"Psychiatry, University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0999-6924","authenticated-orcid":false,"given":"Rashma","family":"Khan-Kisitu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, London Health Sciences Centre, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Hofkirchner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, London Health Sciences Centre, London, Ontario, Canada"},{"name":"Psychiatry, University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"2026091110251780000_19.9.e274214.1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/wps.21292","article-title":"How common is secondary psychosis? 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