Choroidal fissure cyst (CFC), an intracranial space-occupying mass, is often incidentally identified and generally regarded not to present with overt clinical signs. The concurrence of space-occupying lesions with psychotic disorders have been reported in numerous cases; however, to the best of our knowledge, co-occurrent CFC and schizophrenia have not been published before in the literature. Electroconvulsive therapy (ECT) has been frequently considered relatively contraindicated in patients with spaceoccupying lesions in the brain; nevertheless, in the last few years, increased numbers of studies encourage clinicians to treat drugresistant psychiatric patients with ECT. Here we present 21-year-old male patient, who has been diagnosed with antipsychoticresistant schizophrenia with a coincidental CFC who have been clinically improved by bilateral and modified nine sessions of ECT. It is recommended to be deliberate if ECT will be applied to the patients with intracranial mass on the treatment phase. ECT may cause some side effects by increasing intracranial pressure on the patients, including rupture of cystic lesions. However, recent publications stated that ECT could be used safely in cysts, which do not cause edema or intracranial pressure increase. Our patient has not been presented any intracranial pressure signs nor neurological deficits. This report supports the safety and efficacy of ECT in the treatment of psychiatric disorders accompanied by intracranial structural lesions; nevertheless, all the risks ought to be taken into account cautiously when ECT becomes an issue for the psychiatric patients with intracranial mass and the opinion of neurosurgeons should be taken with calculating the benefit-loss ratio.

Peripheric edema could be caused by various medical conditions as well as pharmacologic agents such as antihypertensives, nonsteroidal antiinflamatory drugs, endocrine agents and immunotherapies. Olanzapine is an atypical antipsychotic that is widely prescribed for the treatment of schizophrenia and bipolar affective disorder. Most common adverse reactions of olanzapine are weight gain, postural hypotension, constipation, dizziness, akathisia, sedation. Peripheral edema was reported as an infrequent side effect, which affected 3% of the olanzapine treated patients. In this report, we aim to draw attention of psychiatrists on this rare adverse effect by presenting a 56-year-old case, who applied to our hospital with severe depressive and obsessive-compulsive symptoms and hospitalized because of suicide risk. Before psychiatric admission, he wasn’t taking any medication. He was diagnosed as major depression with psychotic features and obsessive-compulsive disorder. He was started on olanzapine 10 mg/day, quetiapine 300 mg/day and fluoxetine 40 mg/day. Two weeks after initiation of olanzapine, he was found to have bilateral pedal edema without ulceration and temperature change but minimal redness was observed. He had no history suggestive of cardiac, renal and liver dysfunction or allergic reaction against to any drug that could explain his existing edema. Possible medical conditions which may cause edema were ruled out by laboratory tests and physical examination. Olanzapine was stopped immediately and the therapy was modified to risperidone 1 mg/day. After discontinuation of olanzapine, edema was gradually resolved within two weeks. Because olanzapine associated edema has been seen rarely, it could be overlooked by psychiatrists in comparison to its more common side effects. Although it shows self-limited and benign course, patients may feel discomfort and their compliance to treatment may decrease. Also, it may interfere with differential diagnosis of other medical conditions which may cause edema. In conclusion, we suggest that patients should be observed carefully for edema during olanzapine treatment.