About

Michael P. Greenage, DO, is an Assistant Professor at the Virginia Tech Carilion School of Medicine. His professional role involves contributing to medical education and research within the institution. Specific details about his research focus, background, or key contributions are not provided in the available page text.

Selected publications

• Non-Catatonic Mutism as a Presentation of Psychosis: A Case Study

  Psychopharmacology Bulletin · 2026-03-09

  articleOpen accessSenior author

  Objective: To describe a rare case of non-catatonic mutism as the primary presentation of psychosis in a patient with complex comorbidities, highlighting diagnostic differentiation and antipsychotic response. Methods: Case report of a 47-year-old female with bipolar II disorder, post-traumatic stress disorder, polysubstance use, and homelessness presenting with intermittent mutism. Diagnostic evaluation included clinical history, Bush-Francis Catatonia Rating Scale (BFCRS), and exclusion of alternative etiologies. Treatment involved antipsychotics with legal authorization. Results: BFCRS score of 3 ruled out catatonia. Mutism resolved with haloperidol 4 mg daily after initial olanzapine failure, with no overt psychotic symptoms. Integrated care addressed social determinants. Conclusions: Non-catatonic mutism may represent isolated psychosis, responsive to antipsychotics. Systematic evaluation is crucial in atypical presentations with psychosocial complexity.

  PublisherOA PDFDOI

• A Case of Clozapine Induced Mania-Like Symptoms in the Treatment of Schizophrenia

  Psychopharmacology Bulletin · 2025-08-12 · 1 citations

  articleOpen accessSenior author

  Clozapine is an atypical antipsychotic and is the drug of choice for treatment-resistant schizophrenia. Unlike other atypical antipsychotics which are known to occasionally cause symptoms of mania or hypomania, clozapine has been shown to be effective at symptom reduction during manic episodes in treatment-resistant bipolar disorder and is generally well tolerated in those severe mood disorders. To our knowledge, there is only one other reported case of potential clozapine-induced mania. In this case report and review, we present a 47-year-old caucasian male with a well-established history of schizophrenia who was voluntarily admitted to an inpatient psychiatric unit for paranoia and auditory hallucinations. The patient had trialed multiple antipsychotics prior to the current hospitalization, with the exception of clozapine. To our knowledge, this is the second case report of manic-like symptoms that may be secondary to clozapine.

  PublisherOA PDFDOI

• A Unique Delusion with Depression in Early Stage of Neurocognitive Disorder Due to Vascular Disease: Considerations for Clinicians

  Psychopharmacology Bulletin · 2025-08-12

  reviewOpen access

  As global aging becomes more prominent, neurocognitive disorders (NCD) incidence has increased. Patients with NCD usually have an impairment in one or more cognitive domains, such as attention, planning, inhibition, learning, memory, language, visual perception, and spatial or social skills. Studies indicate that 50-80% of these adults will develop neuropsychiatric symptoms (NPS), such as apathy, depression, anxiety, disinhibition, delusions, hallucinations, and aberrant motor behavior. The progression of NCD and subsequent NPS requires tremendous care from trained medical professionals and family members. The behavioral symptoms are often more distressing than cognitive changes, causing caregiver distress/depression, more emergency room visits and hospitalizations, and even earlier institutionalization. This signifies the need for early identification of individuals at higher risk of NPS, understanding the trajectory of their NCD, and exploring treatment modalities. In this case report and review, we present an 82-year-old male admitted to our facility for new-onset symptoms of depression, anxiety, and persecutory delusions. He has no significant past psychiatric history, and his medical history is significant for extensive ischemic vascular disease requiring multiple surgeries and two episodes of cerebrovascular accident (CVA). On further evaluation, the patient was diagnosed with major NCD, vascular subtype. We discuss differential diagnoses and development of NPS from NCD in order to explain the significance of more thorough evaluation by clinicians for early detection and understanding of NCD prognosis.

  PublisherOA PDFDOI

• Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa

  Case Reports in Psychiatry · 2019-03-26 · 3 citations

  articleOpen accessSenior author

  INTRODUCTION: Parkinson's disease (PD) is a complex disease that is often treated with dopaminergic medications such as carbidopa-levodopa and now with innovative interventions such as deep brain stimulation (DBS). While PD frequently presents with depression and apathy, research must elucidate whether its treatment modalities have an additive or synergistic effect that can lead to an increased suicide risk. DBS has been associated with depression, behavioral changes, and suicidality while dopaminergic treatment has also been shown to cause behavioral changes such as hypersexuality and impulsivity. Considering the now frequent practice of utilizing both DBS and carbidopa-levodopa to treat PD, it is crucial to understand how to properly manage PD patients who are displaying this overlap in symptomology. CASE REPORT: A 56-year-old Caucasian male with a 6-year diagnosis of PD who was being treated with high dose carbidopa-levodopa and left DBS of the ventral intermediate nucleus (VIM) presented after a suicide attempt. The patient was found to be severely depressed and had exhibited behavioral changes in the weeks leading up to the attempt. Imaging was performed to assess positional changes of DBS and carbidopa-levodopa dosage adjusted while under close observation in the inpatient unit. The patient was started on fluoxetine to treat the depressive symptoms and was eventually discharged with close monitoring. DISCUSSION: With PD and DBS being associated with behavioral changes and depressive symptoms and carbidopa-levodopa therapy being linked to behavioral changes such as impulsivity, it is important that these patients be closely monitored and research analyzes how these factors may interact and lead to an increased risk of suicide. Furthermore, when symptoms appear, a clear protocol must be established on managing these patients. We therefore recommend an approach that utilizes imaging to assess any changes in DBS placement, dose management of carbidopa-levodopa, and behavior monitoring in an inpatient setting.

  PublisherOA PDFDOI

• Postpartum Eclampsia Associated With Changes of Mood Symptoms

  The Primary Care Companion For CNS Disorders · 2016-04-20

  articleOpen accessSenior author

  Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.To the Editor: We present a case of a patient who had a relapse of her major depressive disorder after giving birth. Her presentation was complicated with selective mutism, catatonic features, and postpartum eclampsia. This case highlights the importance of careful monitoring on the psychiatry unit of postpartum patients as well as the necessity and importance of communication between psychiatry and other medical specialties.

  PublisherOA PDFDOI

• The Role of Anxiety and Emotional Stress as a Risk Factor in Treatment-Resistant Hypertension

  Current Atherosclerosis Reports · 2010-12-30 · 24 citations

  review1st authorCorresponding
  PublisherDOI

Labs

• Psychiatry and Behavioral MedicinePI