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Resumen Antecedentes: El lupus eritematoso sistémico (LES) es una enfermedad auto inmunitaria crónica multisistémica con diversas manifestaciones clínicas. Siendo las mujeres la pobla ción vulnerable y con mayor afectación a nivel neurológico, al presentar mayor riesgo de convulsiones. Las manifestaciones neuropsiquiátricas ocurren en etapas tempranas de la enfermedad y del diagnóstico, ya que pueden presentarse junto con manifestaciones sistémicas o no. La frecuencia de manifestaciones neuropsiquiátricas en el lupus eritematoso sistémico se ha descrito del 14 al 75%, siendo las alteraciones cognitivas uno de los grandes síntomas a destacar1. La cual puede ir acompañada de trastornos afectivos de tipo depresión y ansiedad. Ya que la psicosis secundaria a LES se remarca por su baja prevalencia (10%)2, los estudios de laboratorio nos suelen orientar hacia el diagnóstico definitivo, siendo los anticuerpos ribosomales P los que se han relacionado más específicamente con la psicosis lúpica. La resonancia magnética es la prueba de elección y las lesiones cerebrales están dominadas por hiperintensidades de materia blanca en forma de punción3. En el siguiente reporte de caso, presentamos a una paciente de 20 años, la cual contaba con antecedentes de esteatosis hepática diagnosticado, diabetes tipo MODY y resección de ovario derecho por teratoma maduro de 9 años de evolución, pero sin antecedentes psiquiátricos de importancia para el momento de su valoración. Sin embargo, de forma aguda presentó un brote psicótico caracterizado por ideas delirantes de grandiosidad y referencia, así como alteraciones conductuales, cognitivas y afectivas. Por las que tuvieron que acudir a hospital de 3er nivel durante el periodo de contingencia sanitaria en el 2020. Tras el antecedente de presentar infección por SARS-CoV-2 tres meses antes de su patología neuropsiquiátricas. Se sospechó en síntomas neurológicos secundarios a infección por COVID-19, así como patología psiquiátrica aislada. Por lo que se realizó abordaje de estudio de primer brote psicótico, diagnosticándose lupus eritematoso sistémico con manifestaciones neuropsiquiátricas. El tratamiento se basó en un bolo de metilprednisolona y antipsicóticos, luego modificada por terapia con corticoesteroides orales y antipsicótico de depósito. Conclusión: El lupus eritematoso sistémico con manifestaciones neuropsiquiátricas es una presentación poco frecuente del padecimiento, por la amplia variación en la aparición de este, los pacientes con síntomas psiquiátricos en contexto de hospital general deben de ser tomados en cuenta para abordajes extensos4. De la misma forma, el tener este conocimiento del caso podrá ampliar nuestro conocimiento sobre las complicaciones de esta patología reumatológica. Y una de sus complicaciones más graves como la psicosis lúpica para poder realizar un mejor abordaje del primer brote psicótico en hospitales generales, donde la valoración de un especialista puede ser más complicada para mejorar las condiciones médicas de estos pacientes.
Abstract Background: Systemic lupus erythematosus is a chronic multisystemic autoimmune disease with diverse clinical manifestations. Women are the most vulnerable population and have the greatest neurological involvement with a higher risk of seizures. Neuropsychiatric manifestations occur in early stages of the disease and diagnosis since they can occur together with systemic manifestations or not. The frequency of neuropsychiatric manifestations in systemic lupus erythematosus has been described from 14 to 75%; being cognitive alterations one of the major symptoms to highlight. Which, in the same way can be accompanied by affective disorders such as depression and anxiety. Since psychosis, secondary to SLE, stands out for its low prevalence (10%), laboratory studies usually guide us towards a definitive diagnosis, being ribosomal P antibodies the ones that have been more specifically related to lupus psychosis. MRI is the test of choice and brain lesions are dominated by punctate white matter hyperintensities. In the following case report, we present a 20-year-old patient who had a history of diagnosed hepatic steatosis, MODY type diabetes and resection of the right ovary for mature teratoma of 9 years of evolution; but with no psychiatric history of importance at the time of her evaluation. However, she acutely presented a psychotic outbreak characterized by delusions of grandiosity and reference; as well as behavioral, cognitive, and affective alterations. For which she had to go to a 3rd level hospital during the period of health contingency in 2020. After a history of SARS-CoV-2 infection three months before her neuropsychiatric pathology, neurological symptoms secondary to COVID-19 infection were suspected, as well as isolated psychiatric pathology. Therefore, a study approach of the first psychotic outbreak was performed, diagnosing systemic lupus erythematosus with neuropsychiatric manifestations. Treatment was based on a bolus of methylprednisolone and antipsychotics; later modified by therapy with oral corticosteroids and depot antipsychotic. Conclusion: Systemic lupus erythematosus with neuropsychiatric manifestations is an infrequent presentation of the disease, because of the wide variation in its appearance, patients with psychiatric symptoms in a general hospital setting should be considered for extensive approaches. In the same way, having this knowledge of this case may broaden our knowledge about the complications of this rheumatologic pathology. And one of its most serious complications such as lupus psychosis to be able to make a better approach to the first psychotic outbreak in general hospitals, where the assessment of a specialist can be more complicated.
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Abstract Introduction: Schizophrenia commonly appears during adolescence or early adulthood, when young people change their habits and start a new social life. Stigma about this disease delays its diagnosis and treatment. While avoiding medical treatment, neuronal losses may occur and the disease may worsen. Schizophrenia may be sending signals to the person, but she or he may not have noticed them. However, mood alterations could already be happening. Schizophrenia is toxic to the brain and with the passage of time, more neuronal losses may occur, which diminish the performance of the brain. Fragmentary thinking affects cognitive processes that may affect behavior and emotions. An early diagnosis makes it possible for medications and therapies to combat the symptoms and brain damage, hence, increasing the quality of life of the patient. Development: All recent studies have found that schizophrenia appears in the families of patients with schizophrenia in early adulthood (EIA), unlike the families of community controls. Adoption and twin studies suggest that genetic factors greatly increase the risk of developing schizophrenia. The diagnosis is based on overt changes in his or her behavior and interrupted thinking in the examination of the mental state. Cognitive delays are common in early-onset schizophrenia. There are deficits in memory, executive functioning, attention and global deficiencies. Children who subsequently develop schizophrenia often have premorbid problems with verbal reasoning, working memory, attention and processing speed. Cognitive impairment usually occurs at the onset of the disease. Premorbid abnormalities are evident in mthe majority of young people who develop schizophrenia. Common premorbid difficulties include social isolation, behavioral disorders, academic difficulties, speech and language problems, and cognitive delays. Because schizophrenia in young people often has an insidious onset, the gradual development of psychotic symptoms in a child with premorbid language delays and social isolation may be difficult to recognize. The diagnosis, according to the Diagnostic Manual of Mental Disorders (DSM 5), should include two or more of the following symptoms: delusions, hallucinations, disorganized speech, very disorganized or catatonic behavior, negative symptoms. Discussion: The majority of children who report having hallucinations do not meet the criteria for schizophrenia. Normative childhood experiences, including overactive imagination and vivid fantasies, can be misinterpreted as psychosis. Distinguishing formal thought disorder from developmental disorders that affect speech and language function can be a challenge for the clinician. Several environmental risk factors have been associated with the development of schizophrenia but the use of new methods for the detection of genes and anatomical alterations opens the door for the development of new theories. Neuroimaging studies are still limited and cannot yet provide information on brain activity at the molecular level. The relatively small sample sizes, few longitudinal studies and scant population studies in the field remain our only direct access to the living brain. Conclusions: Further studies in schizophrenia beginning in childhood will give us the opportunity to understand it better and will help develop new theories and lines of research regarding neurodevelopmental abnormalities. Unfortunately, the follow-up of a significant number of patients with this disease is difficult since the cases are scarce. Another complication for this kind of studies is the difficulty in making a diagnosis due to the superimposed symptoms with other mental disorders. It will always be of great importance to maintain a good relationship with parents and caregivers, bearing in mind that stigma and discrimination are often associated with the use of mental health services. We must be respectful and sensitive to gender, sexual orientation, disability, socioeconomic status, age and other background information of the patients to achieve a greater attachment to the therapy and improve prognosis. Currently, the origin of schizophrenia is uncertain, and we still do not have a specific study for its diagnosis, therefore, adequate staff training will continue to be the key in this scenario.