Acidente crotálico seguido por primeiro episódio psicótico: um folclore clínico / Rattlesnake bite accident followed by first psychotic episode: a clinical folklore / Accidente crotálico seguido de primer episodio psicótico: un folclore clínico

Introdução: Acidentes ofídicos são doenças negligenciadas e constituem uma parcela importante da morbidade de pessoas em idade produtiva que vivem em zonas rurais. A maior parte dos seus efeitos a curto prazo é amplamente conhecida, especialmente aqueles de natureza clínica; no entanto, ainda se observa lacuna importante do conhecimento das consequências a longo prazo de tais agravos, notadamente as de ordem psíquica. Este artigo relata um caso de adoecimento mental subsequente a um acidente crotálico e gera reflexões de âmbito cultural e fisiopatológico a respeito das sequelas de tais eventos. Apresentação do caso: Trata-se de adolescente residente no interior baiano que foi vítima de mordedura por cascavel e teve necessidade de hospitalização em unidade de terapia intensiva. Observou-se que, mesmo após melhora clínica, iniciou com sintomas psicóticos prodrômicos e progrediu para piora mental grave, que culminou em internação psiquiátrica e diagnóstico de esquizofrenia no decorrer dos meses seguintes. Conclusões: Nota-se, neste caso, correlação direta entre esses dois eventos; mas, em razão da escassez de trabalhos científicos que abordem tais questões, depreende-se que é preciso investigar e estudar com maior profundidade possíveis associações entre acidentes crotálicos e psicoses.

Introduction: Snakebites are neglected diseases and constitute an important part of the morbidity of working-age people who live in rural areas. Most of their short-term effects are widely known, especially those of a clinical nature; however, there is still an important gap in the knowledge of the long-term consequences of such injuries, notably those of a psychotic nature. This article aims to report a case of mental illness subsequent to a rattlesnake bite accident and generate cultural and pathophysiological reflections regarding the consequences of such events. Case presentation: An adolescent residing in the interior of the state of Bahia was bitten by a rattlesnake and required hospitalization in an intensive care unit. It was observed that even after clinical improvement, the case started with prodromal psychotic symptoms and progressed to severe mental deterioration that culminated in psychiatric hospitalization and diagnosis of schizophrenia over the following months. Conclusions: In this case, there was a direct correlation between these two events, but because of the scarcity of scientific works that address such issues, it is necessary to investigate and study in greater depth possible associations between snakebite accidents and psychoses.

Introducción: Las mordeduras de serpientes son enfermedades desatendidas y constituyen una parte importante de la morbilidad de las personas en edad laboral que viven en zonas rurales. La mayoría de sus efectos a corto plazo son ampliamente conocidos, especialmente los de carácter clínico; sin embargo, todavía existe un importante vacío en el conocimiento de las consecuencias a largo plazo de este tipo de lesiones, en particular las de carácter psíquico. Este artículo tiene como objetivo informar un caso de enfermedad mental posterior a un accidente crotálico y generar reflexiones culturales y fisiopatológicas sobre las consecuencias de tales eventos. Presentación del caso: Se trata de un adolescente residente en el interior de Bahía que fue mordido por una serpiente cascabel y requirió hospitalización en unidad de cuidados intensivos. Se observó que, aún después de la mejoría clínica, comenzó con síntomas psicóticos prodrómicos y progresó a un deterioro mental severo que culminó con hospitalización psiquiátrica y diagnóstico de esquizofrenia en los meses siguientes. Conclusiones: En este caso, existe una correlación directa entre estos dos eventos pero, debido a la escasez de trabajos científicos que aborden tales cuestiones, parece necesario investigar y estudiar con mayor profundidad posibles asociaciones entre accidentes crotálicos y psicosis.

Frecuencia de trastornos mentales y sus características sociodemográficas en pacientes con COVID-19 ingresados en un hospital psiquiátrico de Lima Metropolitana

Introducción. La descripción de las características y los diagnósticos de pacientes psiquiátricos con COVID-19 durante la pandemia ha sido poco descrito en el Perú. Objetivo. Describir la frecuencia de diagnósticos psiquiátricos y sus características sociodemográficas en pacientes con prueba antigénica positiva a COVID-19 en un hospital psiquiátrico peruano durante julio 2020 a julio 2021. Métodos. Se realizó un estudio descriptivo basado en la revisión de 100 historias clínicas de pacientes entre 18 y 70 años. Las variables estudiadas fueron el diagnóstico de ingreso y variables sociodemográficas como edad, sexo, nivel académico, ocupación, días de estancia. Resultados. Los diagnósticos más frecuentes fueron esquizofrenia, trastornos esquizotípicos y trastornos de ideas delirantes (49%) y los trastornos del humor (37%). El 66% pertenecía a los niveles socioeconómicos más bajos y el 60% eran pacientes continuadores. El mes de abril de 2021 presentó la mayor cantidad de ingresos (n=15). Conclusión. Durante un año de observación en tiempos de emergencia sanitaria por la COVID-19, ingresaron a un hospital psiquiátrico de referencia 100 pacientes con diagnóstico psiquiátrico que además tuvieron infección por SARS-CoV-2, la mayoría de estos pacientes tuvieron trastornos psicóticos.

Introduction. The description of the characteristics and diagnoses of psychiatric patients with COVID-19 during the pandemic has been poorly described in Peru. Objective. To describe the frequency of mental disorders and the associated sociodemographic characteristics of patients with a positive antigen test for COVID-19 in a peruvian psychiatric hospital from July 2020 to July 2021. Methods. For this descriptive study we analyzed 100 medical records of patients between 18 and 70 years old. The variables studied were the diagnosis according to ICD-10 and sociodemographic features such as age, gender, educational status, employment, days of admission. Results. The most common diagnoses were "Schizophrenia, schizotypal disorders and delusional disorders" (49%) and "mood disorders" (37%), 66% belonged to the lowest socioeconomic levels and 60% were recurrent patients. The month of April 2021 presented the highest number of admissions (n=15). Conclusion. In a year of observation during the COVID-19 outbreak, 100 patients with psychiatric diagnosis who also had SARS-CoV-2 infection were admitted to a reference psychiatric hospital, most of these patients had psychotic disorders.

Behavioral or neuropsychiatric symptoms of Alzheimer's disease: from psychopathology to pharmacological management / Sintomas comportamentais ou neuropsiquiátricos da doença de Alzheimer: psicopatologia e abordagem terapêutica

Abstract Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of "mild behavioral impairment", the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.

Resumo Sintomas neuropsiquiátricos ou comportamentais de demência envolvem uma série de condições, como ansiedade, depressão, apatia, psicose e agitação, frequentemente observadas em indivíduos com demência. Embora esses sintomas não sejam necessários para o diagnóstico da doença de Alzheimer, estão presentes em todas as fases ou estágios da doença, contribuindo negativamente para o declínio cognitivo, comprometimento funcional e sobrecarga do cuidador. Os sintomas neuropsiquiátricos têm sido conceituados não apenas como fatores de risco, mas também como marcadores clínicos de progressão da doença de Alzheimer. O construto "comprometimento comportamental leve", correlato comportamental do comprometimento cognitive leve, tem sido proposto nesse contexto. Os primeiros passos na abordagem dos sintomas comportamentais da doença de Alzheimer envolvem definir os alvos-terapêuticos e investigar potenciais causas ou fatores agravantes. Após intervir nesses fatores, abordagens não farmacológicas constituem a primeira linha de intervenção. Depois da otimização do tratamento anticolinesterásico, terapias farmacológicas específicas (por exemplo, antidepressivos, antipsicóticos) podem ser consideradas, levando-se em conta potencias efeitos colaterais.

Ejercicio físico como intervención en personas en alto riesgo clínico de psicosis: revisión narrativa / Physical exercise as an intervention in people at clinical high-risk for psychosis: A narrative review

El constructo de alto riesgo clínico de psicosis ha favorecido la investigación en la neurobiología de los estadios previos a la psicosis, así como también en intervenciones preventivas. Se trata de personas jóvenes que presentan síntomas psicóticos de menor intensidad o de menor frecuencia en un tiempo determinado, o bien tienen antecedentes genéticos de trastornos psicóticos sumados a un deterioro significativo del funcionamiento. Las escasas intervenciones existentes para esta población cuentan con un bajo nivel de evidencia. La actividad y el ejercicio físico han demostrado ser parte de la terapia de múltiples trastornos psiquiátricos, mientras que el sedentarismo sería un factor favorecedor de la psicosis. Efectivamente, las personas en alto riesgo clínico de psicosis presentan un peor estado físico asociado a mayor sedentarismo y hábitos de vida poco saludables. Se ha propuesto que el ejercicio genera un efecto biológico positivo sobre el hipocampo y las áreas circundantes, regiones que estarían involucradas en la fisiopatología de la psicosis. Algunos estudios experimentales han mostrado una disminución en la sintomatología psicótica en pacientes en alto riesgo clínico de psicosis que han seguido pautas de ejercicio físico. También dan cuenta de cambios morfofuncionales en estructuras cerebrales. Si bien existen barreras para la implementación de esta intervención, se trata de una intervención segura y factible. Es necesario realizar una mayor cantidad de estudios experimentales de una escala mayor para medir su eficacia, generando evidencia científica que permita eventualmente integrar el ejercicio físico a las guías de práctica clínica como una recomendación sistemática.

The concept of clinical high risk for psychosis has favored research in the neurobiology of the stages prior to psychosis, as well as in preventive interventions. This group is made up of young people with: (1) psychotic symptoms of less intensity or less frequency during a brief time or having genetic history of psychotic disorders associated to a significant deterioration in functioning. The few existing interventions for this population have a low level of evidence. Physical activity and exercise have been shown to be part of the therapy for multiple psychiatric disorders, while a sedentary lifestyle would be a factor that favors psychosis. Indeed, people in clinical high risk for psychosis present a worse physical condition associated with a greater sedentary lifestyle and unhealthy habits. It has been proposed that exercise generates a positive biological effect on the hippocampus and surrounding areas, regions that would be involved in the pathophysiology of psychosis. Some experimental studies have shown a decrease in psychotic symptoms in patients with clinical high risk for psychosis who have followed physical exercise guidelines, as well as morphofunctional changes in brain structures. Although there are barriers to the implementation of this intervention, it is safe and feasible. It is necessary to conduct a greater number of experimental studies on a larger scale to measure its efficacy, generating scientific evidence that will eventually allow physical exercise to be included in clinical practice guidelines as a systematic recommendation for clinical high risk for psychosis.

Catatonía: revisión narrativa de su desarrollo histórico, diagnóstico, fisiopatología y terapéutica / Catatonia: A narrative review of its historical development, diagnosis, pathophysiology, and therapeutics

Inicialmente la catatonía fue un componente clínico de algunas formas de esquizofrenia, pero la evidencia básica y epidemiológica demuestra su vinculación con múltiples cuadros somáticos y psiquiátricos. Se describen y analizan conceptos clínicos, etiológicos, fisiopatológicos y terapéuticos actuales respecto a la catatonía. Se realizó una revisión narrativa amplia de artículos publicados en MEDLINE/PubMed. El diagnóstico es clínico y puede apoyarse en exámenes complementarios, pero existen instrumentos psicométricos con distinto énfasis clínico. Los subtipos más validados son el inhibido y el excitado. Se asocia mayormente a patologías somáticas, neurológicas, afectivas, psicóticas y del espectro autista. En su fisiopatología se han estudiado factores genéticos relacionados con los oligodendrocitos. Algunos hallazgos señalan un desbalance en la neurotransmisión y densidad de receptores de GABA y dopamina, hecho concordante con su función en las vías motoras y la respuesta terapéutica con benzodiacepinas. Asimismo, se ha analizado la actividad glutamatérgica, desde el modelo fisiopatológico de la encefalitis autoinmune. Las vías córtico-corticales y córtico-subcorticales tendrían un rol central, incluyendo estructuras como las cortezas orbitofrontal y temporal, núcleos basales y tronco encefálico, involucradas en la toma de decisiones, regulación emocional, almacenamiento, planificación y elaboración motora. Las principales líneas terapéuticas son las benzodiacepinas y la terapia electroconvulsiva. Otras intervenciones estudiadas son el zolpidem, antipsicóticos, estabilizadores del ánimo, moduladores glutamatérgicos y estimulación magnética transcraneal. Los nuevos hallazgos neurobiológicos discuten los preceptos nosológicos y terapéuticos, renovando el ciclo en la conceptualización de la catatonía. Se destaca el componente afectivo del síndrome psicomotor y el rol de las intervenciones que apunten a su modulación.

Catatonia was initially a clinical presentation of certain types of schizophrenia, but basic and epidemiological evidence has demonstrated its association with multiple somatic and psychiatric conditions. We describe and discuss current clinical, etiological, pathophysiological, and therapeutic concepts regarding catatonia. We conducted a broad narrative review of articles published in MEDLINE/PubMed. The diagnosis is clinical and can be supported by additional tests, but there are psychometric instruments with different clinical focus. The most validated subtypes are inhibited and excited catatonia. It is mostly associated with somatic, neurological, affective, psychotic, and autistic spectrum disorders. Genetic factors related to oligodendrocytes have been studied in its pathophysiology. Some findings point to an imbalance in neurotransmission and density of GABA and dopamine receptors, consistent with their function in motor pathways and therapeutic response with benzodiazepines. Likewise, glutamatergic activity has been analyzed from the pathophysiological model of autoimmune encephalitis. The cortico-cortical and cortico-subcortical pathways would have a central role, including structures such as the orbitofrontal and temporal cortex, basal nuclei, and brainstem, involved in decision-making, emotion regulation, storage, planning, and motor processing. The main therapeutic lines are benzodiazepines and electroconvulsive therapy. Other interventions studied are zolpidem, antipsychotics, mood stabilizers, glutamatergic modulators, and transcranial magnetic stimulation. New neurobiological findings challenge nosological and therapeutic precepts, renewing the cycle in the conceptualization of catatonia. We highlight the affective component of the psychomotor syndrome and the role of interventions aimed at its modulation.

Quemaduras en el contexto de un trastorno psicótico compartido en un centro de referencia colombiano: reporte de caso

Introducción: El trastorno psicótico compartido se caracteriza por la aparición de síntomas psicóticos en personas que tienen un vínculo afectivo estrecho con un sujeto que padece un trastorno mental; este caso es el primer reporte de lesiones por quemaduras en el contexto de este trastorno. Caso: Se trata de una pareja joven, con un patrón similar de quemaduras causadas por el contacto con una plancha. Las lesiones son el resultado de la agresión causada por un familiar de uno de ellos, que presentaba síntomas psicóticos relacionados con el espectro de esquizofrenia no diagnosticado previamente. Conclusiones: El impacto de esta afección abarca los componentes social, físico y psicológico y requiere un tratamiento multidisciplinario y un alto índice de sospecha diagnóstica.

Introduction: Shared paranoid disorder is characterised by the development of psychotic symptoms in people who have a close affective bond with a subject suffering from a mental disorder. This case is the first case of burn injuries reported in the context of this disorder. Case: We describe a young couple, with a similar pattern of burns caused by contact with Paranoid disorders a griddle. The injuries are the result of the aggression caused by a relative of one of them, who presented psychotic symptoms, related to the previously undiagnosed spectrum of schizophrenia. Conclusions: The impact of this condition encompasses social, physical and psychological components, requiring multidisciplinary management and a high index of diagnostic suspicion.

Influence of glutathione-related genetic variants on the oxidative stress profile of Mexican patients with psychotic disorders

Objective: The clinical trajectories of patients with psychotic disorders have divergent outcomes, which may result in part from glutathione (GSH)-related high-risk genotypes. We aimed to determine pharmacokinetics of clozapine, GSH levels, GSH peroxidase (GPx) activity, gene variants involved in the synthesis and metabolism of GSH, and their association with psychotic disorders in Mexican patients on clozapine monotherapy and controls. Methods: The sample included 75 patients with psychotic disorders on clozapine therapy and 40 paired healthy controls. Plasma clozapine/N-desmethylclozapine, GSH concentrations, and GPx activity were determined, along with genotyping of GCLC and GSTP1 variants and copy number variations of GSTP1, GSTT1, and GSTM1. Clinical, molecular and biochemical data were analyzed with a logistic regression model. Results: GSH levels were significantly reduced and, conversely, GPx activity was higher among patients than controls. GCLC_GAG-7/9 genotype (OR = 4.3, 95%CI = 1.40-14.31, p = 0.019) and hetero-/homozygous genotypes of GCLC_rs761142 (OR = 6.09, 95%CI = 1.93-22.59, p = 0.003) were found to be risk factors for psychosis. The genetic variants were not related to clozapine/N-desmethylclozapine levels or metabolic ratio. Conclusions: GCLC variants were associated with the oxidative stress profile of patients with psychotic disorders, raising opportunities for intervention to improve their antioxidant defenses. Further studies with larger samples should explore this proposal.

Correlation between rosacea and neuropsychiatric diseases / 中华皮肤科杂志

Rosacea is a chronic recurrent inflammatory skin disease that mainly occurs on the face. A large number of studies have confirmed that rosacea is related to a variety of systemic diseases, including neuropsychiatric diseases such as anxiety, depression, migraine, Alzheimer′s disease and Parkinson′s disease. This review summarizes research progress in the correlation between rosacea and neuropsychiatric diseases, as well as the underlying mechanisms.

Schizoaffective Disorder: How long does it take to diagnose? A case report / Transtorno Esquizoafetivo: Quanto tempo leva para diagnosticar?: "relato de caso"

Introduction: It is reported a case of a 57-year-old woman with multiple psychiatric hospitalizations, during which different diagnostic hypotheses and therapeutic procedures were proposed. Case report: After analyzing the patient's clinical records, the medical team proposed a diagnosis of Schizoaffective Disorder. This disorder presents a high risk of recurrent hospitalizations and high costs associated with therapeutic and follow-up withdrawal, yet there is limited data to assess the post-discharge critical periods. Final considerations: Further research in this area is required to adopt effective therapeutic strategies, reduce the probability of hospital admissions, improve prognosis, and lessen associated financial costs.

Introdução: é relatado o caso de uma mulher de 57 anos com múltiplas hospitalizações psiquiátricas, durante as quais diferentes hipóteses diagnósticas e terapêuticas associadas foram propostas. Relato do caso: Após análise dos registos clínicos, a equipa médica propôs o diagnóstico de Perturbação Esquizoafetiva. Esta Perturbação apresenta um elevado risco de re-internamento, para além do custo associado ao abandono do seguimento clínico e terapêutico. Porém, não existem dados suficientes que avaliem os períodos pós-alta. Consideracoes finais: Portanto, tornam-se necessárias pesquisas mais amplas na área para adotar estratégias terapêuticas eficazes, reduzir a probabilidade de re-internamento, melhorar o prognóstico e minimizar os custos financeiros associados.

Quiste aracnoideo (Galassi Tipo II) y síntomas neuropsiquiátricos: a propósito de un caso / Arachnoid Cyst (Galassi Type II) and neuropsychiatry symptoms: about a case

INTRODUCCIÓN: un quiste aracnoideo es originado de la alteración de una de las membranas de la meninges (aracnoides), de predominio en la fosa craneal media; es una patología poco común que cause síntomas y si ocurren, se pueden presentar manifestaciones neuropsiquiatrías. OBJETIVO: exponer los datos clínicos; y la metodología diagnóstica y terapéutica. CASO: presentamos una paciente femenina de 24 años de edad; sin antecedentes personales médicos psiquiátricos y médicos no psiquiátricos conocidos, quien presenta una historia con un mes de evolución de síntomas psicóticos y cambios conductuales. Se le realizo CAT cerebral simple y luego una resonancia magnética cerebral contrastada para definir el tamaño del quiste aracnoideo, por los posibles síntomas neuropsiquiátricos encontrados. Por medio de exámenes de laboratorios, estudios electrofisiológicos (electroencefalograma), neuroimágenes y evaluación clínica. Se decide presentar las características clínicas encontradas de la paciente quien requirió manejo con antipsicóticos, benzodiacepinas y estabilizador del humor con gradual mejoría de sus sintomatologías de ingreso (agitación psicomotora y psicosis).

INTRODUCTION: an arachnoid cyst is caused by the alteration of one of the membranes of the meninges (arachnoid), predominantly in the middle cranial fossa; It is an uncommon pathology that causes symptoms and if they occur, neuropsychiatric manifestations may take place. OBJECTIVE: expose the clinical data; and the diagnostic and therapeutic methodology. CASE: we present a 24-year-old female patient; with no personal history of psychiatric and known non-psychiatric medical records, whom presents a story with a month of evolution of psychotic symptoms and behavioral changes. A simple cerebral CAT was performed and then a cerebral magnetic resonance imaging with contrast to define the size of the arachnoid cyst, due to the possible neuropsychiatric symptoms found. Through laboratory tests, electrophysiological studies (electroencephalogram), neuroimaging and clinical evaluation. It was decided to present the clinical characteristics of the patient who required management with antipsychotics, benzodiazepines and mood stabilizer with gradual improvement of her admission symptoms (psychomotor agitation and psychosis)

El impacto de la resiliencia en la esquizofrenia: una revisión sistemática cualitativa / The impact of resilience in Schizophrenia: a qualitative systematic review

Resumen Introducción: la resiliencia ha sido definida como la resistencia frente a experiencias psicosociales adversas. Tiene un rol importante en varios trastornos mentales, asociándose, por ejemplo, a la severidad en el trastorno depresivo mayor y a la calidad de vida en el trastorno afectivo bipolar. La esquizofrenia es un trastorno mental severo que destaca por producir dificultades en múltiples dominios de la vida y una alta morbimortalidad. El objetivo de esta revisión fue sintetizar la evidencia disponible acerca de la importancia de la resiliencia en la esquizofrenia. Métodos: se realizó una búsqueda en las bases de datos PubMed, LILACS y SciELO, seleccionando artículos en inglés y español, que incluyeran personas con esquizofrenia y midieran la resiliencia. Veinticinco artículos cumplieron los criterios de inclusión. Resultados: las personas con esquizofrenia tenían una menor resiliencia que sujetos sanos (9 estudios). El nivel de resiliencia se asoció inversamente con los síntomas negativos (3 estudios), síntomas positivos (1 estudio), depresión (4 estudios), desesperanza (3 estudios) y suicidio (1 estudio). Por otro lado, la resiliencia se asoció positivamente con la calidad de vida (5 estudios), funcionalidad (4 estudios) y salud física (2 estudios). En dos estudios se evaluaron intervenciones orientadas a potenciar la resiliencia de pacientes con esquizofrenia, mostrando resultados poco concluyentes. Discusión: es llamativa la escasa literatura que aborda el tema de la resiliencia en esquizofrenia. Los hallazgos de la presente revisión sitúan a la resiliencia como un factor determinante de la evolución y expresión clínica de esta enfermedad.

Introduction: resilience has been defined as the resistance to adverse psychosocial experiences. It has an important role in various mental disorders, being associated, for example, with the severity in major depressive disorder and the quality of life in bipolar affective disorder. Schizophrenia is a severe mental disorder that stands out for causing difficulties in multiple domains of life and high morbidity and mortality. The objective of this review was to synthesize the available evidence about the importance of resilience in schizophrenia. Methods: a search of the PubMed, LILACS and SciELO databases was performed, selecting articles in English and Spanish that included patients with schizophrenia and measured resilience. Twenty-five articles met the inclusion criteria. Results: patient with schizophrenia had less resilience than healthy subjects (9 studies). Resilience levels were inversely associated with negative symptoms (3 studies), positive symptoms (1 study), depression (4 studies), hopelessness (3 studies), and suicide (1 study). On the other hand, resilience was positively associated with quality of life (5 studies), functionality (4 studies) and physical health (2 studies). In two studies, interventions aimed at enhancing the resilience of patients with schizophrenia were evaluated, showing inconclusive results. Discussion: there is a striking limited literature that address the topic of resilience in schizophrenia. The findings of the present review place resilience as a determining factor in the evolution and clinical expression of this disease.

Relações entre o uso de anfetaminas e sintomas psicóticos: uma revisão sistemática / Relations between the use of amphetamines and psychotic symptoms: a systematic review

Anfetaminas são substâncias com ações no sistema nervoso central e periférico com potencial de causar dano intenso e de desencadear sintomas psicóticos (delírios, alucinações). Esta revisão procurou identificar trabalhos com informações essenciais para a compreensão das relações entre o uso dessas substâncias por indivíduos e o desenvolvimento de quadros psicóticos, tanto transitórios, ocorridos apenas durante o uso, quanto persistentes durante e após o período de abstinência, ou evoluindo para transtornos primários, como a esquizofrenia. Através de busca em dois bancos de dados foi possível selecionar as referências que supriram os objetivos. Diversas pesquisas buscaram desvendar os mecanismos de ação dessas drogas, e as bases neurológicas, bioquímicas, fisiológicas e moleculares dos transtornos psicóticos, procurando evidências das ligações entre as três situações citadas anteriormente, e similaridades significativas entre os quadros foram identificadas, incluindo em exames de neuroimagem e análises de quadros clínicos, além de comprovações estatísticas. Contudo, futuros estudos são necessários para esclarecer alguns aspectos desse tema e melhorar classificação etiológica, clínica e diagnóstica, além do manejo desses pacientes. [au]

Amphetamines are substances which act in the central and peripheral nervous system, with potential to cause intense damage and initiate psychotic symptoms (delusions, hallucinations). This review had as it's objetive identifying works with essential informations in order to understand the relations between the use of these substances by individuals and the development of psychotic conditions, both transient, happening only during use, and persistent, during and after abstinence, or when evolving to primary disorders, like schizophrenia. Through research in two databases, it was possible to select references that fullfilled the goals. Different researches sought to unravel the action mechanisms of these drugs, and the neurologicsl, biochemical, physiological and molecular bases of psychotic disorders, looking for evidence of connections between the three situations described previously, and significant similatities between the conditions were identified, including in neuroimaging exams and analysis of clinical presentations, besides statistical evidence. However, future studies are necessary to clarify some aspects of this topic and improve the etiological, clinical and diagnostic classification, plus the treatment of these patients. [au]

Psychotic disorders in the diagnostic stability of a Portuguese ward - Diagnostic retrospective analysis / Trastornos psicóticos en la estabilidad diagnóstica de un barrio portugués - Análisis retrospectivo diagnóstico

ABSTRACT Objectives: Psychiatric diagnosis is based on clinical manifestations, resulting from patients' internal state, their life situation, the evolution of their condition and the response to our interventions. There are currently few objective data which help to establish the diagnosis which is why this is based on diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM defines entities by their diagnostic stability, however there are several causes of variability as categorised by Spritzer et al. (1987): subjects variance (changing in patients), occasions variance (different episodes), information variance (new information) and observation variance (different interpretations). This paper aims to determine the diagnostic stability of patients with Psychotic Disorders among patients readmitted to our Psychiatric Unit. Methods: Retrospective analysis of the diagnoses of patients with Psychotic Disorders who had been readmitted to our unit. We analysed data from the last 12 years - 5422 admission episodes with 507 patients with a relevant diagnosis in this period. Results: Psychiatric diagnosis does evolve over time, nevertheless some diagnostic groups show a relatively significant stability over time - Bipolar Disorder and Schizophrenia with 69% and 77% stability, respectively. Diagnosis such as Depressive Psychosis and Drug-induced psychosis show a significantly lower stability (8% and 21%, respectively). Conclusions: Knowing our own reality can make us aware that a cross-sectional view of patients can be insufficient and only time can determine a clear diagnosis. This study may help us to understand how psychotic disorders evolve.

RESUMEN Objetivos: El diagnóstico psiquiátrico se basa en las manifestaciones clínicas, consecuencia del estado interno del paciente, de su situación vivencial, de la evolución de su enfermedad y de la respuesta a nuestras intervenciones. Actualmente, existen pocos datos objetivos que ayudan a establecer el diagnóstico por lo que éste se basa en criterios diagnósticos como el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM). La DSM define diagnósticos por su estabilidad, sin embargo, existen varias causas de variabilidad caracterizadas por Spritzer et al. (1987): variación en el sujeto (cambio en el paciente), variación ocasional (diferentes episodios), variación en la información (nueva información) y variación en la observación (diferentes interpretaciones). Este trabajo pretende evaluar la estabilidad diagnóstica de los pacientes con Trastornos Psicóticos reinternados en nuestro internamiento psiquiátrico. Métodos: Análisis retrospectivo de los diagnósticos de los pacientes con Trastornos Psicóticos con reingresos en nuestro servicio. Se analizaron datos de los últimos 12 anos - 5422 admisiones con 507 pacientes con diagnóstico de interés en ese período. Resultados: El diagnóstico psiquiátrico se altera con el tiempo, sin embargo, algunos grupos revelan una mayor estabilidad a lo largo del tiempo - Perturbación Afectiva Bipolar y Esquizofrenia con el 69% y el 77%, respectivamente. Los diagnósticos como la depresión psicótica y la psicosis tóxica, revelan una estabilidad significativamente menor (8% y 21% respectivamente). Conclusiones: Conocer nuestra realidad nos hace conscientes de que una mirada transversal a los enfermos puede ser insuficiente y sólo el tiempo puede determinar un diagnóstico claro. Este trabajo puede ayudarnos a entender cómo evolucionan las enfermedades psicóticas.

Reporte de un caso fatal de encefalitis autoinmunitaria asociada a teratoma ovárico / Report of a fatal case of autoimmune encephalitis associated with an ovarian teratoma

INTRODUCCIÓN: El teratoma del ovario es el tumor de células germinales más frecuente. Entre sus complicaciones se describen algunos síndromes paraneoplásicos, como la encefalitis por anticuerpos contra el receptor N-metil-D-aspartato (NMDA). CASO CLÍNICO: Mujer de 22 años sin antecedentes de importancia que consulta por cuadro clínico de 4 días de evolución caracterizado por síntomas psiquiátricos y un episodio convulsivo. Se considera un cuadro de meningoencefalitis y se indica manejo antibiótico de amplio espectro y antiviral. Ante el deterioro se sospecha una encefalitis autoinmunitaria, se identifica un tumor anexial en los estudios imagenológicos compatible con teratoma y se confirma el diagnóstico con el hallazgo de anticuerpos NMDA en el líquido cefalorraquídeo. A pesar de su resección y manejo sistémico, fallece a los 5 meses. DISCUSIÓN: La encefalitis autoinmunitaria asociada a un teratoma es inusual, pero es una complicación que debe sospecharse como diagnóstico de exclusión. La mayoría tienen un pronóstico favorable, aunque hasta una cuarta parte de los casos puede asociarse a daño irreversible en la corteza del hipocampo e incluso la muerte, principalmente cuando el diagnóstico y el tratamiento son tardíos. CONCLUSIONES: Este caso es un reto clínico que representa un vacío en la evidencia actual, puesto que no existe un estándar de manejo de los teratomas. Se propone que, una vez diagnosticado un teratoma, se realice una cistectomía ovárica. Son necesarios más estudios para validar esta recomendación.

INTRODUCTION: The ovarian teratoma is the most common cell germ tumor. Some paraneoplastic syndromes have been described, including the anti-N-methyl-D-aspartate (NMDA) receptor encephalitis as part of its complications. CASE REPORT: A 22 years old female patient with no important medical history, consults due to an acute psychotic disorder and a convulsion. A meningoencephalitis was considered and broad-spectrum antibiotics and antivirals were started. Faced with deterioration, an autoimmune encephalitis is considered as well. Imaging studies revealed an ovarian teratoma and diagnosis was confirmed with antibodies against NMDA receptor in cerebrospinal fluid. Despite its resection and systemic management, the patient dies after 5 months. DISCUSSION: The autoimmune encephalitis associated with an ovarian teratoma is rare, its a complication that must be suspected as an exclusion diagnosis and most have a favorable prognosis, however up to a quarter of cases can be associated with irreversible damage to the hippocampal cortex and even death, mainly when late diagnosis and treatment are made. CONCLUSIONS: This case is a clinical challenge, no evidence is available since there is no standard for teratoma management. It is proposed that once a teratoma is diagnosed, an ovarian cystectomy is performed. Further studies are necessary to validate this recommendation.

Caligula: a neuropsychiatric explanation of his madness / Calígula: una explicación neuropsiquiátrica de su locura

ABSTRACT Gaius Julius Caesar Augustus Germanicus, better known as Caligula, (12 CE to 41 CE) was the third Roman emperor and ruled only four years. Throughout his life he experienced several traumatic events, and, in addition, historians mention some premorbid conditions that could cause him to become the monster that most historians know today. When Caligula was 25 years old, he suffered a near-fatal illness that turned his story around. One possible cause was lead poisoning due to the high consumption of wine, which contained lead, by Roman patricians. On the other hand, it is plausible that Caligula experienced epilepsy that began in childhood, later experienced status epilepticus in 37 CE, which triggered an epileptic psychosis with the consequent psychopathic and paranoid changes that led him to the madness noted by historians.

RESUMEN Gaius Julius Caesar Augustus Germanicus, mejor conocido como Calígula, (12 C.E. - 41 C.E.), fue el tercer emperador romano y gobernó durante apenas cuatro años. A lo largo de su vida, experimentó diferentes eventos traumáticos y, adicionalmente, algunos historiadores mencionan condiciones premórbidas que pudieron causar que se convirtiera en el monstruo que los historiadores conocen hoy. Cuando Calígula tenía 25 años, sufrió una enfermedad casi fatal que le dio un giro considerable a su historia. Una posible causa es intoxicación por plomo, debido al excesivo consumo de vino, el cual contenía considerables niveles de este metal. Por otro lado, es posible que Calígula cursara con crisis epilépticas de inicio en la infancia. Posteriormente, en el año 37 C.E. experimentara un estado epiléptico, el cual desencadenaría una psicosis epiléptica, dejando secuelas que iban a desencadenar la locura de la que muchos historiadores hablan.

Influencing factors for substance-induced psychotic disorders among adultsin Hebei Province / 预防医学

Objective@#To investigate the status and influencing factors of substance-induced psychotic disorders in residents over 18 years old in Hebei Province, and to provide evidence for the prevention and control of substance-induced psychotic disorders.@*Methods@#Using multi-stage stratified random sampling method, the permanent residents aged 18 years and over were selected from urban and rural areas in Hebei Province. The demographic data was collected, the 12-Item General Health Questionnaire ( GHQ-12 ) and eight risk factors about mental disorder questionnaire were used to find out mental disorders. The multivariate logistic regression model was conducted to analyze the influencing factor for substance-induced psychotic disorders. @*Results@#A total of 23 675 questionnaires were sent out, 20 884 were valid ( 88.20% ).The weighted lifetime prevalence rates of substance-induced psychotic disorders, alcohol-related disorders, sedatives/hypnotics/anti-anxiety disorders and other substance-induced psychotic disorders were 6.20%, 5.93%, 0.24% and 0.04%, respectively. Multivariate logistic regression analysis showed that age ( 35-<45, OR=1.582, 95%CI: 1.091-2.292; 45-<60, OR=2.185, 95%CI: 1.524-3.132; ≥60, OR=2.061, 95%CI: 1.422-2.986 ), males ( OR=10.832, 95%CI: 8.265-14.196 ), urban area (OR=1.431, 95%CI: 1.202-1.703 ), non-poor family ( OR=2.291, 95%CI: 1.652-3.177 ), physical diseases ( OR=2.028, 95%CI: 1.678-2.452 ) and genetic history ( OR=1.574, 95%CI:1.181-2.098 ) were the influencing factors for substance-induced psychotic disorders. @*Conclusion@#The lifetime prevalence of substance-induced psychotic disorders among residents aged 18 years and over in Hebei Province is 6.20%, which is mainly related to age, gender, region, family economic situation, physical disease history and genetic history.

Psicose na maternidade: um olhar psicanalítico a partir do filme "o estranho em mim" / Psychosis in motherhood: a psychoanalytic look from the film "the strange in me / Psicosis en maternidad: una mirada psicoanalítica de la película "das fremde in mir"

No puerpério produz-se uma transformação na mulher, que agora passa a ser também mãe. Esse é um momento de ambivalência, de gozo, mas também de sofrimento, expresso através dos transtornos do puerpério. A pesquisa desenvolvida insere-se na temática da psicopatologia materna e utilizou como palco para a análise a personagem Rebecca, da produção audiovisual "O Estranho em mim" (2008), que retrata a psicose na maternidade. Objetivou-se articular a literatura psicanalítica sobre a psicose, a partir de autores como Freud, Klein e Winnicott, para compreender a condição da personagem, a partir de uma revisão de literatura narrativa sobre o tema. Verificou-se a potência da perspectiva psicanalítica para o entendimento da vivência psicótica da personagem, enfatizando a importância dos cuidados primordiais e das relações primitivas do sujeito. O estudo também apontou a necessidade de pesquisas acerca da psicose na maternidade.

In the postpartum a change takes place in the woman who now also becomes a mother. This is a moment of ambivalence, of joy, but also of suffering, expressed as postpartum disorders. The theme of the research developed is the maternal psychopathology. An analysis of Rebecca, character of the audiovisual production "The stranger in me" (2008), which is facing a psychosis in motherhood, was done. The objective of this study was to articulate the psychoanalytical literature about psychosis, in the light of authors such as Freud, Klein and Winnicott, to understand Rebecca condition, through a narrative literature review about this theme. The adequacy of psychoanalytical perspective to understand Rebecca's psychotic experience in motherhood was verified, emphasizing the importance of primordial care and primitive relationships. The study also pointed the need for further research on the psychosis in motherhood.

En el puerperio hay una transformación en la mujer, que ahora también se convierte en madre. Este es un momento de ambivalencia, de alegría, pero también de sufrimiento, expresado a través de los trastornos del puerperio. La investigación desarrollada sobre el tema de la psicopatología materna se ha utilizado como escenario para el análisis del personaje Rebecca, de la producción audiovisual "Das Fremde in mir"(2008), que retrata la psicosis en la maternidad. El objetivo era articular la literatura psicoanalítica sobre psicosis, de autores como Freud, Klein y Winnicott, para comprender la condición del personaje, a partir de una revisión de la literatura narrativa sobre ese tema. La utilidad de la perspectiva psicoanalítica se quedó evidente para la comprensión de la experiencia psicótica del personaje, enfatizando la importancia del cuidado primordial y de las relaciones primitivas del sujeto. El estudio también señaló la necesidad de investigación sobre la psicosis materna.

Eating disorders and psychosis: a review and case report

SUMMARY INTRODUCTION: The interplay between eating disorders and psychosis is a challenging field to which little attention has been paid. Its study raises conceptual and methodological questions in both areas, making the diagnosis and management of patients difficult. Such questions are addressed and illustrated with a review and case report. METHODS: The authors present the case of a woman with Anorexia Nervosa and with comorbid Shared Psychotic Disorder, based on a literature review regarding the comorbidity between eating disorders and psychosis. The authors conducted a non-systematic review by searching the PubMed database, using the Mesh Terms "anorexia nervosa", "bulimia nervosa", "comorbidity" and "psychotic disorders". RESULTS: The findings suggest that studies on the subject are limited by issues regarding data on the prevalence of comorbidities, phenomenological aspects of eating disorders, and the interface and integration with psychotic symptoms. CONCLUSIONS: The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. In order to ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.

RESUMO INTRODUÇÃO: A interface entre perturbação do comportamento alimentar e psicose é um campo desafiador para o qual pouca atenção foi direcionada. O seu estudo levanta algumas questões conceituais e metodológicas em ambas as áreas, dificultando o diagnóstico e o manejo dos pacientes. Essas questões são abordadas e ilustradas neste trabalho com uma revisão e um relato de caso. MÉTODOS: Os autores apresentam o caso de uma mulher com anorexia nervosa e perturbação psicótica partilhada comórbida, com base numa revisão da literatura sobre a comorbilidade entre perturbação do comportamento alimentar e psicose. Os autores realizaram uma revisão não sistemática, por meio de pesquisa no banco de dados PubMed, utilizando os termos "anorexia nervosa", "bulimia nervosa", "comorbilidade" e "perturbações psicóticas". RESULTADOS: Os resultados sugerem que os estudos sobre o tema são limitados por questões inerentes a escassos dados sobre prevalência de comorbilidades, aspectos fenomenológicos das perturbações alimentares, e sua interface e integração com sintomas psicóticos. CONCLUSÕES: O caso apresentado ilustra as dificuldades no manejo de uma paciente com perturbação alimentar e psicose. A fim de garantir uma abordagem rigorosa dos sintomas psicóticos e alimentares, a avaliação do paciente deve focar o padrão de emergência dos sintomas, a sua fenomenologia, antecedentes clínicos e familiares e o seu status clínico.

Uso de cannabis en jóvenes hospitalizados por un primer episodio de psicosis: un estudio caso-control

Background: Cannabis use among young people in Chile has increased significantly in the last years. There is a consistent link between cannabis and psychosis. Aim: To compare cannabis use in patients with a first episode of psychosis and healthy controls. Material and Methods: We included 74 patients aged 20 ± 3 years (78% males) admitted to hospital with a first episode of psychosis and a group of 60 healthy controls aged 23 ± 4 years (63% males). Cannabis consumption was assessed, including age of first time use and length of regular use. Results: Patients with psychosis reported a non-significantly higher frequency of life-time cannabis use. Patients had longer periods of regular cannabis use compared with healthy subjects (Odds ratio [OR] 2.4; 95% confi-dence intervals [CI] 1.14-5.05). Patients also used cannabis for the first time at an earlier age (16 compared with 17 years, p < 0.0). The population attributable fraction for regular cannabis use associated with hospital admissions due to psychosis was 17.7% (95% CI 1.2-45.5%). Conclusions: Cannabis use is related to psychosis in this Chilean group of patients. This relationship is stronger in patients with early exposure to the drug and longer the regular use. One of every five admissions due to psychosis is associated with cannabis consumption. These data should influence cannabis legisla-tion and the public policies currently being discussed in Chile.

Características de pacientes con diagnóstico de primer episodio psicótico internados en un hospital universitario

RESUMEN Introducción: la esquizofrenia y otros trastornos psicóticos constituyen la mayor parte de los diagnósticos realizados en el Departamento de Emergencias y Admisión del Servicio de Psiquiatría del Hospital de Clínicas de la Universidad Nacional de Asunción, seguidos por los trastornos depresivos y los trastornos de ansiedad. Objetivo: determinar las características de los pacientes con diagnóstico de primer episodio psicótico, siendo esta información relevante en el contexto de la atención que pueda brindarse a los mismos y a la información epidemiológica que proporciona. Metodología: estudio observacional, descriptivo, con muestreo no probabilístico, temporalmente retrospectivo. Se incluyó las historias clínicas de pacientes del Servicio de Psiquiatría del Hospital de Clínicas, de ambos sexos, que hayan sido hospitalizados con síntomas de un primer episodio psicótico entre 2014 y 2019. Resultados: se analizaron las historias clínicas de 143 pacientes. El 62,8% era del sexo femenino. La edad media fue 31 ± 13 años. El 48,9% tenía historial de diagnósticos psiquiátricos en su familia. El 66,43% era de nivel económico medio, el 32,17% nivel bajo y el 1,4% nivel alto. El pensamiento desorganizado fue el síntoma más frecuente (86%) encontrado en el examen del estado mental. Conclusiones: la mayoría de los pacientes con diagnóstico de primer episodio psicótico provenía del Departamento Central de Paraguay, residía en zonas urbanas, era del sexo femenino, era de nivel económico medio, aproximadamente la mitad con antecedentes de trastornos mentales en la familia y presentaba casi dos meses de evolución de la enfermedad. El pensamiento (ideas delirantes), el afecto, la introspección, el humor, el lenguaje y la sensopercepción (alucinaciones) fueron los indicadores más frecuentemente alterados del examen mental.

ABSTRACT Introduction: Schizophrenia and other psychotic disorders make up the majority of diagnoses made in the Emergency and Admission Department of the Psychiatry Service of the "Hospital de Clínicas" of the National University of Asunción, followed by depressive disorders and anxiety disorders. Objective: The objective of the present study was to determine the characteristics of the patients diagnosed with a first psychotic episode. This information is relevant in the context of the care that can be provided to patients and the epidemiological information provided. Methodology: This was an observational, descriptive study, with non-probabilistic sampling, temporarily retrospective. The medical records of male and female patients of the Psychiatry Service of the "Hospital de Clínicas" who have been hospitalized with symptoms of a first psychotic episode were included. Results: The medical records of 143 patients were analyzed, 62.8% of them was female. The mean age was 31.5 ± 13.6 years, 48.9% had a history of psychiatric diagnoses in their family, 66.43% had medium economic level, 32.17% low level and 1.4% high level. distortion in thinking was the most frequent symptom (86%) found in the mental state exam. Conclusions: The majority of patients diagnosed with the first psychotic episode came from the Central Department of Paraguay, resided in urban areas, were female, had medium economic status, approximately half had a history of mental disorders in the family and had almost two months of disease evolution. Thought (delusions), affection, introspection, humor, language, and perception (hallucinations) were the most frequently altered indicators of the mental examination.