RESUMEN
Objectives: Xylazine is an alpha-2 agonist increasingly prevalent in the illicit drug supply. Our objectives were to curate information about xylazine through social media from People Who Use Drugs (PWUDs). Specifically, we sought to answer the following: 1) what are the demographics of Reddit subscribers reporting exposure to xylazine? 2) is xylazine a desired additive? and 3) what adverse effects of xylazine are PWUDs experiencing? Methods: Natural Language Processing (NLP) was used to identify mentions of "xylazine" from posts by Reddit subscribers who also posted on drug-related subreddits. Posts were qualitatively evaluated for xylazine-related themes. A survey was developed to gather additional information about the Reddit subscribers. This survey was posted on subreddits that were identified by NLP to contain xylazine-related discussions from March 2022 to October 2022. Results: 76 posts mentioning xylazine were extracted via NLP from 765,616 posts by 16,131 Reddit subscribers (January 2018 to August 2021). People on Reddit described xylazine as an unwanted adulterant in their opioid supply. 61 participants completed the survey. Of those that disclosed their location, 25/50 (50%) participants reported locations in the Northeastern United States. The most common eoute of xylazine use was intranasal use (57%). 31/59 (53%) reported experiencing xylazine withdrawal. Frequent adverse events reported were prolonged sedation (81%) and increased skin wounds (43%). Conclusions: Among respondents on these Reddit forums, xylazine appears to be an unwanted adulterant. PWUDs may be experiencing adverse effects such as prolonged sedation and xylazine withdrawal. This appeared to be more common in the Northeast.
RESUMEN
OBJECTIVES: 'Pseudoneurotic schizophrenia' was a diagnostic term coined in the 1940s by Hoch and Polatin. It described a subgroup of patients who presented with prominent anxiety symptoms, which masked a latent psychotic disorder. Pseudoneurotic schizophrenia as a diagnostic entity has fallen out of clinical use. METHODS: Described herein is a case that meets the Hoch and Polatin definition of pseudoneurotic schizophrenia. RESULTS: The history of the concept is reviewed and a discussion is given of why it was forgotten. CONCLUSION: The concepts that underlie the diagnostic entity of pseudoneurotic schizophrenia remain relevant to current practice. Recent findings in patients with an emerging psychotic disorder lend modern support to the idea that schizophrenia may present with significant neurotic symptoms.
