ABSTRACT
BACKGROUND: Neuropsychiatric sequelae are the predominant long-term disability after traumatic brain injury (TBI). This study reports a case of late-onset social anxiety disorder (SAD) following TBI. CASE REPORT: A patient that was spontaneous and extroverted up to 18-years-old started to exhibit significant social anxiety symptoms. These symptoms became progressively worse and he sought treatment at age 21. He had a previous history of traumatic brain injury (TBI) at age 17. Neuroimaging investigations (CT, SPECT and MRI) showed a bony protuberance on the left frontal bone, with mass effect on the left frontal lobe. He had no neurological signs or symptoms. The patient underwent neurosurgery with gross total resection of the lesion and the pathological examination was compatible with intradiploic haematoma. CONCLUSIONS: Psychiatric symptoms may be the only findings in the initial manifestation of slowly growing extra-axial space-occupying lesions that compress the frontal lobe from the outside. Focal neurological symptoms may occur only when the lesion becomes large. This case report underscores the need for careful exclusion of general medical conditions and TBI history in cases of late-onset SAD and may also contribute to the elucidation of the neurobiology of this disorder.
Subject(s)
Anxiety Disorders/etiology , Brain Injuries/psychology , Frontal Lobe/physiopathology , Intracranial Hemorrhage, Traumatic/diagnosis , Intracranial Hemorrhage, Traumatic/psychology , Anxiety Disorders/diagnosis , Frontal Lobe/surgery , Humans , Intracranial Hemorrhage, Traumatic/surgery , Male , Neuroimaging , Surveys and Questionnaires , Time Factors , Treatment Outcome , Young AdultABSTRACT
Animal and human studies indicate that cannabidiol (CBD), a major constituent of cannabis, has anxiolytic properties. However, no study to date has investigated the effects of this compound on human pathological anxiety and its underlying brain mechanisms. The aim of the present study was to investigate this in patients with generalized social anxiety disorder (SAD) using functional neuroimaging. Regional cerebral blood flow (rCBF) at rest was measured twice using (99m)Tc-ECD SPECT in 10 treatment-naïve patients with SAD. In the first session, subjects were given an oral dose of CBD (400 mg) or placebo, in a double-blind procedure. In the second session, the same procedure was performed using the drug that had not been administered in the previous session. Within-subject between-condition rCBF comparisons were performed using statistical parametric mapping. Relative to placebo, CBD was associated with significantly decreased subjective anxiety (p < 0.001), reduced ECD uptake in the left parahippocampal gyrus, hippocampus, and inferior temporal gyrus (p < 0.001, uncorrected), and increased ECD uptake in the right posterior cingulate gyrus (p < 0.001, uncorrected). These results suggest that CBD reduces anxiety in SAD and that this is related to its effects on activity in limbic and paralimbic brain areas.
Subject(s)
Anti-Anxiety Agents/pharmacology , Anxiety Disorders/drug therapy , Cannabidiol/pharmacology , Adult , Anxiety/diagnostic imaging , Anxiety/physiopathology , Anxiety Disorders/diagnostic imaging , Anxiety Disorders/physiopathology , Brain/diagnostic imaging , Brain/drug effects , Brain/physiopathology , Cerebrovascular Circulation/drug effects , Cross-Over Studies , Double-Blind Method , Humans , Male , Placebos , Psychiatric Status Rating Scales , Regional Blood Flow/drug effects , Tomography, Emission-Computed, Single-Photon , Young AdultABSTRACT
We report the case of an adult male patient with Tourette syndrome, self-injurious behavior and depression, refractory to conventional treatment, and whose symptoms remitted after electroconvulsive therapy. Serial Technetium 99m-Ethyl-Cysteinate-Dimer single photon emission tomographies were applied, before, during, and after electroconvulsive therapy. The neural substrates of this treatment process were further analyzed by woxel-wise subtracted single photon emission tomography images.
