Spongiform leukoencephalopathy unveiled in an autopsy of a drug abuser

ABSTRACT Toxic leukoencephalopathy (TLE) is a rare neurological debilitating and fatal condition. It has been previously associated with exposure to leukotoxic offenders such as chemotherapy, cranial radiation, certain drugs, and environmental factors. Currently, it is a commoner white matter syndrome resulting from increased substance abuse, classically by inhaled heroin and other opioids. Herein, we report a case of fatal TLE unveiled in an autopsy of a drug abuser. A 24-year-old male was found dead on the roadside. A day before, he was located in a state of delirium. In this case, the autopsy findings and histopathology characteristics of cerebral cortex involvement particularly directed to speculate the heroine as the principal offender.

Características y complicaciones de la intoxicación aguda por cocaína Un estudio transversal en un servicio de urgencias de Colombia / Characteristics and complications of acute cocaine intoxication A cross-sectional study in an emergency room in Colombia

Resumen Introducción: el consumo de cocaína se ha incrementado y con ello el número de consultas a urgencias y hospitalizaciones por intoxicación aguda. El objetivo fue describir las características y complicaciones de los pacientes intoxicados por cocaína que acudieron al servicio de urgencias de un hospital de alta complejidad de Colombia. Método: estudio de corte transversal. Se incluyeron pacientes atendidos durante 2016 y 2019 con intoxicación por cocaína, según historia clínica y test de cocaína positivo y sin enfermedad de base que afectara directamente la supervivencia. Se describieron las características sociodemográficas y clínicas y se estimó la mortalidad y prevalencia de complicaciones. Resultados: se incluyeron 159 pacientes, en su mayoría hombres, con bajo nivel educativo y mediana de edad de 31 años. La mortalidad fue 3.8%. La prevalencia de lesión renal aguda (LRA) fue de 29.6% (IC95% 22.6-37.3%), 8.8% (IC95% 4.3-14.3%) para insuficiencia hepática aguda (IHA), 4.4% (IC95% 1.8-8.9%) para infarto agudo de miocardio (IAM) y 4.4% (IC 95% 1.8-8.9%) para ataque cerebrovascular (ACV). Los niveles elevados de fosfocreatinquinasa (CPK) fueron encontrados con valores mayor a mil en 80% de pacientes con LRA, 100% de IHA, y en 50% de ACV. Conclusión: la intoxicación aguda por cocaína produce alteraciones multiorgánicas principalmente renales y hepáticas, que pueden ser por daño directo y también posiblemente por daño muscular reflejado en la elevación de CPK. Esto puede indicar la necesidad de vigilancia estricta de esta enzima y su investigación como variable pronóstica. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2256).

Abstract Introduction: the use of cocaine has increased, and, with it, the number of emergency room visits and hospitalizations due to acute intoxication. The objective was to describe the characteristics and complications of patients with cocaine intoxication who were seen in the emergency room of a tertiary care hospital in Colombia. Materials and methods: a cross-sectional study. Patients seen from 2016 to 2019 with cocaine intoxication, according to the medical chart and a positive cocaine test, and with no underlying diseases which would directly affect survival, were included. The sociodemographic and clinical characteristic were described, and the mortality and prevalence of complications were estimated. Results: a total of 159 patients were included, mostly males, with a low educational level and a median age of 31 years. The mortality was 3.8%. The prevalence of acute kidney injury (AKI) was 29.6% (95%CI 22.6 - 37.3%), 8.8% (95%CI 4.3 - 14.3%) for acute liver failure (ALF), 4.4% (95%CI 1.8 - 8.9%) for acute myocardial infarction (AMI) and 4.4% (95% CI 1.8-8.9%) for cerebrovascular accident (CVA). Elevated creatine phosphokinase (CPK) levels were found to be greater than 1,000 in 80% of patients with AKI, 100% of those with ALF, and 50% of those with CVA. Conclusion: acute cocaine intoxication causes multiple organ dysfunction, mainly of the kidneys and liver, which may be due to direct injury and possibly also due to muscle damage reflected in the elevated CPK. This could indicate the need for strict monitoring of this enzyme and research of its use as a prognostic variable. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2256).

Family members' experiences of caring for a relative with substance-induced psychosis disorder

Background: When there is a lack of resources in the community to support deinstitutionalisation,family members of a relative diagnosed with substance-induced psychosis disorder (SIPD) are the most affected and vulnerable. Nevertheless, family members' care is still largely unacknowledged in the mental health sector in low- and middle-income countries. Furthermore, no prior research could be found on family members' experiences caring for a relative with SIPD in Giyani, Limpopo province, South Africa. Objectives: To explore and describe family members' experiences caring for a relative with SIPD. Method: The study employed a qualitative research design using interpretative phenomenological analysis as the research method. Telephonic interviews were conducted and analysed. Eight family members were selected to participate in the study using a purposive sampling technique. Results: The analysis of data led to the emergence of the following themes: family members experienced caring for a relative with SIPD as a destabilising responsibility; they experienced acceptance and support from significant others and the community and solace in prayer. Participants also expressed they experienced a need for support from government structures in order to care for a relative with SIPD. Conclusion: The study's findings highlighted the family members' experiences of caring for a relative with SIPD and the role of the family, community and government structures in caring for an individual with SIPD. It is evident from the challenges experienced that the family members need external interventions to develop healthy coping strategies. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by promoting effective coping amongst family members caring for a relative with SIPD.

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.

The Psychiatric Effects of Cannabis / 생물치료정신의학

With the recent legalization of recreational cannabis in Canada and 11 states of the U.S., the interest surrounding cannabis use is increasing. However, many people and even clinicians in Korea do not have exact knowledge about the psychiatric consequences of cannabis use. In this narrative review, the characteristics of cannabis, the endocannabinoid system, and the psychiatric consequences of cannabis use were provided. Cannabis contains more than 80 cannabinoids in the native plant. Psychotropic properties of Δ-9-tetrahydrocannabinol and cannabidiol are most well studied. The two main receptors are cannabinoid-1 receptor and cannabinoid-2 receptor. Several endocannabinoids, such as anandamide and 2-arachidonoylglycerol, act on the receptors as the endogenous ligands. Cannabis influences mood, cognitive functions, and psychomotor functions in acute phase responses, increasing the odds ratio for motor vehicle crashes. Long-term cannabis use is associated with various psychotic outcomes, including the development of schizophrenia, although there is interindividual variability. Cannabis adversely influences learning, memory, and attention. More frequent, persistent, and earlier onset cannabis use is associated with greater cognitive impairment. The chronic cognitive effects of cannabis are complex and controversial. Cannabis has addictive potential, and cannabis use disorder is common. Clinicians should have evidence-based knowledge about the consequences of cannabis use and communicate accurate information about cannabis use and its associated risks to the public.

Psychotic Disorder Induced by Appetite Suppressants, Phentermine or Phendimetrazine: A Case Series Study

OBJECTIVES: A retrospective case series study was conducted to investigate the clinical characteristics of psychotic disorders induced by appetite suppressants, phentermine and phendimetrazine. METHODS: A retrospective electronic medical record review identified 5 admitted patients who had psychotic symptoms after taking phentermine or phendimetrazine. Clinical information was reviewed and summarized in each case. RESULTS: Hallucinations were reported in all cases, including auditory, visual, olfactory and somatic hallucinations. After discontinuation of phentermine or phendimetrazine, the symptoms rapidly improved with low dose of antipsychotics. Patients tended to have less prominent negative symptoms and higher insight into illness, and often showed depressive mood. These clinical characteristics were similar to psychosis induced by amphetamines. Two patients developed stimulant use disorder while using phentermine. CONCLUSIONS: These findings call for awareness of the risks associated with use of appetite suppressants. Prescription of phentermine or phendimetrazine should be accompanied by close monitoring of mental status, and suspicion for substance/medication-induced psychotic disorder.

4-bromo-2, 5-dimetoxifeniletilamina (2CB) un riesgo en nuestro medio: serie de casos / The risk of 2, 5-dimethoxy-4-bromophenylethylamine (2C-B): Case series / 4-bromo-2, 5-dimetoxifeniletilamina (2CB) um risco em nosso meio: série de casos

En Medellín, la prevalencia de consumo de drogas en el último año es del 3.6% y es el grupo de edad más predominante entre los 19 y 29 años. Sin embargo, hay un subregistro relevante sobre el consumo de las nuevas drogas que son vendidas como alternativas legales a las drogas clásicas de abuso. El objetivo de este reporte es mostrar tres casos que muestran las complicaciones cardiovasculares, neurológicas y musculares asociadas con 4-bromo-2,5-dimetoxifeniletilamina (2CB), sustancia conocida en Colombia desde 2007. El consumo de 2CB está en aumento y es prioritario que los profesionales de la salud reconozcan sus riesgos.

The prevalence of drug consumption in Medellin over the last year was 3.6%, where the principal age group was between 19 and 29 years. The phenomenon of the consumption of new drugs being sold as legal alternatives to the classic drugs of abuse has been greatly underreported. The objective of this report is to show three cases with muscular, neurological, and cardiovascular complications associated with 2,5-dimethoxy-4-bromophenylethylamine (2C-B), a substance known in Colombia since 2007. The consumption of 2C-B is on the rise and must become a priority for health professionals due to the risks involved.

Em Medellín, a prevalência de consumo de drogas no último ano é de 3.6% e é o grupo de idade mais predominante entre os 19 e 29 anos. Porém, há um sub-registro relevante sobre o consumo das novas drogas que sao vendidas como alternativas legais às drogas clássicas de abuso. O objetivo deste relatório é mostrar três casos que mostram as complicações cardiovasculares, neurológicas e musculares associadas com 4-bromo-2,5-dimetoxifeniletilamina (2CB), substância conhecida na Colômbia desde 2007. O consumo de 2CB está em aumento e é prioritário que os profissionais da saúde reconheçam seus riscos.

Diagnóstico erróneo de psicosis inducida por cocaína en una persona con esquizofrenia y masticadora de hojas de coca / Cocaine-induced psychosis as a misdiagnosis in a patient with schizophrenia and coca leavechewing

En el Perú existe una elevada prevalencia de trastornos por consumo de estimulantes y aunque no existen estadísticas precisas, puede asumir se la ocurrencia de múltiples casos de psicosis inducida por el consumo declorhidrato de cocaína o pasta básica de cocaína. Por otro lado, la masticación de hojas de coca constituye partedel acervo cultural e histórico de un gran segmento de la población peruana. A propósito de un caso de confusión diagnóstica (un cuadro de esquizofrenia en un paciente masticador de hojas de coca diagnosticado erróneamente como psicosis inducida por cocaína, en base a la positividad de un examen de metabolitos urinarios de dichasustancia) revisamos razonablemente la bibliografía correspondiente al cuadro clínico de psicosis inducida por consumo de cocaína, su diagnóstico diferencial con otras psicosis, y las características de las pruebas de laboratorio para la detección de cocaína y sus derivados. Concluimos recomendando un mayor conocimiento e información respecto a los fenómenos asociados al consumo de la hoja de coca y de la cocaína, por parte del personal de salud, a fin de prevenir confusiones diagnósticas como la del caso aquí reportado.

In Peru, there is a high prevalence of stimulant use disorders and thus, although no accurate statistics are available, multiple cases of psychoses induced by cocaine hydrochloride and cocaine paste intake may occur. Moreover, chewing of dry coca leaves is part of the cultural and historical heritage of a large segment of the Peruvian population. On the basis of a case of psychiatric misdiagnosis (a primary schizophrenic psychosis in a chewer of coca leaves, misdiagnosed as cocaine-induced psychosis based on an positive test of urinary cocaine metabolites), we review pertinent literature on the clinical presentation of cocaine-induced psychosis and its differential diagnosis with other psychoses, and the characteristics of the laboratory tests used for the detection of cocaine and its metabolites. As a conclusion, the suggestion is made that health and mental health workers should have more information and knowledge about the phenomena associated with the consumption of coca leaves and cocaine, in order to avoid misdiagnosis similar to the reported case.

The efficacy of treatment and prevention of vitamin E on haloperidol-induced tardive dyskinesia and its pos-sible mechanisms in rats / 中国神经精神疾病杂志

Objective To investigate the efficacy of treatment and prevention of VitE on vacuous chewing move-ments (VCMs) of haloperidol-induced tardive dyskinesia (TD) rats and serum levels of brain-derived neurotrophic fac-tor ( BDNF) and total antioxidant capacity ( TAC) , and to explore the possible mechanisms.Methods Thirty-two male Sprague-Dawley (SD) rats were randomly divided into TD, P-Vit E, T-Vit E and control group (n=8), receiving to-week treatment with Haloperidol (Hal)+NS, Hal+Vit E (medicated at the baseline), Hal+VitE (medicated at the fifth week) or normal saline (NS), respectively.VCM was evaluated at each week.ELISA and spectrophotometer were used to detect the serum levels of BDNF and TAC, respectively.Results The VCM score of both TD group and T-Vit E group increased at the 2nd weekend, reached the peak at the 5th weekend.VCM score of T-Vit E group declined gradually at the 6th weekend and was significantly lower than that in the TD group [(6.5 ±3.3) vs.(27.9 ±5.8), P0.05) at the 10th weekend.There was no significant difference in VCM score between P-Vit E group and control group for ten weeks(P>0.05).At the 10th weekend, serum BDNF [(6.9 ±1.0) pg/mL] and TAC [(11.9 ±3.2) U/mL] levels of TD group were significantly lower than those of the controls [BDNF (8.6 ±2.5) pg/mL, TAC (18.2 ±5.5) U/mL] and T-Vit E group [BDNF (8.7 ±2.0) pg/mL, (18.6 ±5.9) U/mL] (P0.05).Conclusions Vit E may relieve and prevent VCM in TD model rats though alleviation of free radical damage.

Psicosis inducida por fármacos antituberculosos: un caso asociado a cicloserina / Antituberculosis drug-induced psychosis: a case associated with cycloserine

Nuestro país posee una alta prevalencia e incidencia de casos de tuberculosis (para el año 2012 se registró una morbilidad de 105,2 casos por 100 000 habitantes).En el tratamiento de esta patología pueden desencadenarse numerosas reacciones adversas de índole heterogénea, siendo preponderantes las neuropsiquiátricas, por la polifarmacia antibiótica requerida y otros posibles factores de riesgo del usuario. A partir de un caso de psicosis desencadenada por cicloserina en un paciente con tuberculosis multidrogorresistente, revisamos la literatura pertinente y recomendamos la ponderación individualizada del retiro de la medicación desencadenante del efecto adverso, respecto a la necesidad de mantener la cobertura antibiótica imprescindible y adecuada.

Our country has a high prevalence of tuberculosis (morbidity in year 2012 was 105,2 cases per 100 000 people). In the treatment of this disease, a high number of diverse drug-related side-effects, with prevalent neuropsychiatric type, can be developed, because of the antibiotic polypharmacy required and other possible risk factors. From a case of cycloserine-induced psychosis, in a patient with multidrug-resistant tuberculosis, we review the relevant literature and recommend individualized consideration on the withdrawal of the side-effect trigger medication versus the need to maintain the essential and appropriate antibiotic coverage.