{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:18:51Z","timestamp":1777504731079,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010875","name":"amgen canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010875","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Kidney Health Dis"],"published-print":{"date-parts":[[2020,1]]},"abstract":"\n Rationale:<\/jats:title>\n New-onset psychosis in an immunosuppressed patient post-kidney transplantation (KT) is a diagnostic challenge. A broad differential diagnosis merits consideration; however, an approach to this differential diagnosis remains to be outlined in the literature. Also, when and how to modify the maintenance immunosuppressive regimen remains a significant area of controversy.<\/jats:p>\n <\/jats:sec>\n \n Presenting concerns:<\/jats:title>\n A 23-year-old male, known for X-linked Alport syndrome for which he had undergone KT 1 year prior, presented with a 1-week history of disorganized speech, bizarre behavior, religious delusions, and visual hallucinations.<\/jats:p>\n <\/jats:sec>\n \n Diagnoses:<\/jats:title>\n After ruling out infectious, metabolic, autoimmune, and structural causes, immunosuppressant medications were changed from tacrolimus to cyclosporine. The patient did not improve after this change, and a second opinion consultation with a transplant psychiatrist led to a diagnosis of primary first-episode psychosis, later refined to bipolar disorder type I.<\/jats:p>\n <\/jats:sec>\n \n Interventions:<\/jats:title>\n The patient was started on risperidone, which led to a significant improvement in his symptoms.<\/jats:p>\n <\/jats:sec>\n \n Outcomes:<\/jats:title>\n Twelve months after discharge, his mood and behavior had returned to baseline on aripiprazole, bupropion, and citalopram. However, he developed acute allograft rejection, prompting a change from cyclosporine back to tacrolimus, with stability of his mental state and graft function.<\/jats:p>\n <\/jats:sec>\n \n Teaching points:<\/jats:title>\n This report offers learners an extensive and organized differential diagnosis to the work up of psychosis post kidney transplantation. A complete history, with input from collateral sources, and a systematic approach to the differential diagnosis, are crucial and should not be overshadowed by the risk of immunosuppressant-related neurotoxicity. We underscore the importance of multi-disciplinary management and comprehensive psychosocial assessment and re-assessment to refine the diagnosis. We also report the successful re-introduction of tacrolimus once the diagnosis of a primary psychiatric disorder is confirmed. Finally, we offer a simplified approach that can aid in distinguishing between a primary psychiatric diagnosis versus tacrolimus-associated psychosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/2054358120947210","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T07:18:22Z","timestamp":1596525502000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["New-onset Psychosis in an Immunosuppressed Patient With Kidney Transplantation: An Educational Case Report"],"prefix":"10.1177","volume":"7","author":[{"given":"Benjamin","family":"Mappin-Kasirer","sequence":"first","affiliation":[{"name":"Faculty of Medicine, McGill University, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-0598","authenticated-orcid":false,"given":"Shaifali","family":"Sandal","sequence":"additional","affiliation":[{"name":"Research Institute of the McGill University Health Centre, Montreal, QC, Canada"},{"name":"Nephrology Division, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,8,4]]},"reference":[{"key":"bibr1-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1111\/nep.12419"},{"key":"bibr2-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2012.07.010"},{"key":"bibr3-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1017\/S1461145705006279"},{"issue":"6","key":"bibr4-2054358120947210","first-page":"3175","volume":"23","author":"Eidelman BH","year":"1991","journal-title":"Transplant Proc"},{"issue":"6","key":"bibr5-2054358120947210","first-page":"3105","volume":"23","author":"Fung JJ","year":"1991","journal-title":"Transplant Proc"},{"key":"bibr6-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1021\/tx970071k"},{"key":"bibr7-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1016\/S0014-2999(99)00247-2"},{"key":"bibr8-2054358120947210","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2018.1409"},{"key":"bibr9-2054358120947210","doi-asserted-by":"publisher","DOI":"10.4084\/mjhid.2014.014"},{"key":"bibr10-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2011.12.007"},{"key":"bibr11-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.12.018"},{"key":"bibr12-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31829584e0"},{"key":"bibr13-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e3181dbbb7d"},{"key":"bibr14-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13127"},{"key":"bibr15-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2016.08.010"},{"key":"bibr16-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000069268.63375.4A"},{"key":"bibr17-2054358120947210","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199410273311702"},{"key":"bibr18-2054358120947210","first-page":"926395","volume":"2013","author":"Bersani G","year":"2013","journal-title":"Case Rep Psychiatry"},{"key":"bibr19-2054358120947210","doi-asserted-by":"publisher","DOI":"10.4103\/0970-258X.261183"}],"container-title":["Canadian Journal of Kidney Health and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2054358120947210","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2054358120947210","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2054358120947210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:23:29Z","timestamp":1777389809000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2054358120947210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":19,"alternative-id":["10.1177\/2054358120947210"],"URL":"https:\/\/doi.org\/10.1177\/2054358120947210","relation":{},"ISSN":["2054-3581","2054-3581"],"issn-type":[{"value":"2054-3581","type":"print"},{"value":"2054-3581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]},"article-number":"2054358120947210"}}