Resistant Schizoaffective Disorder in a Patient with Psoriasis and Hypophysitis: A Case Report of the Interaction Between Psychosis and Chronic Systemic Inflammation

Schizoaffective disorder is a complex psychiatric condition that often requires specialized treatment, particularly when resistant to standard therapies. Comorbidities like chronic inflammatory diseases can complicate the diagnosis, suggesting shared pathophysiological mechanisms. This case study examines the role of chronic systemic inflammation in psychiatric disorders, focusing on a patient with treatment-resistant schizoaffective disorder, psoriasis, and hypophysitis. The 40-year-old male patient, admitted for psychopathological decompensation, was initially treated with clozapine, which was effective but discontinued due to severe sialorrhoea. He was then switched to olanzapine, showing continued improvement in his psychiatric symptoms and good tolerability. Following optimization of antipsychotic treatment, the patient’s delusional thoughts diminished, verbalization stopped, and associated distress reduced. Interestingly, the psoriatic lesions also improved. This case highlights the potential connection between severe, treatment-resistant psychosis, endocrine dysfunction caused by hypophysitis, and psoriasis, suggesting that chronic systemic inflammation may be a shared underlying factor. The overlap between these conditions underscores the importance of considering inflammation’s role in psychiatric illnesses and emphasizes the need for an interdisciplinary approach when managing psychosis with somatic comorbidities.