RESUMO
We report here the case of a hospitalized 11 year-old boy (YP) with a positive diagnosis of 'Childhood Onset Schizophrenia'. YP experienced verbal-auditory hallucinations, a delusion of alien control and hetero-aggressive behaviour. Antipsychotic drugs were unsuccessful and furthermore provoked severe acute dystonia. fMRI-guided rTMS applied over several cortical regions provided the means to reveal for the first time a functional dissociation between auditory-verbal hallucinations and agency. These results demonstrate the efficacy of rTMS for young patients suffering from drug-resistant hallucinations but they furthermore question the physiopathology of the hallucinatory process by suggesting that agency and hallucinations may be sub-served by different neural networks.
Assuntos
Transtornos Dissociativos/diagnóstico , Alucinações/diagnóstico , Esquizofrenia Infantil/complicações , Psicologia do Esquizofrênico , Estimulação Magnética Transcraniana/métodos , Mapeamento Encefálico , Criança , Transtornos Dissociativos/etiologia , Estimulação Elétrica , Alucinações/etiologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética/métodos , Masculino , Testes Neuropsicológicos , Oxigênio/sangue , Esquizofrenia Infantil/patologiaRESUMO
Although complex hallucinations are extremely vivid, painful symptoms in schizophrenia, little is known about the underlying mechanisms of multisensory integration in such a phenomenon. We investigated the neural basis of these altered states of consciousness in a patient with schizophrenia, by combining state of the art neuroscientific exploratory methods like functional MRI, diffusion tensor imaging, cortical thickness analysis, electrical source reconstruction and trans-cranial magnetic stimulation. The results shed light on the functional architecture of the hallucinatory processes, in which unimodal information from different modalities is strongly functionally connected to higher-order integrative areas.
Assuntos
Córtex Cerebral/fisiopatologia , Estado de Consciência/fisiologia , Alucinações/fisiopatologia , Percepção/fisiologia , Esquizofrenia Paranoide/fisiopatologia , Adulto , Algoritmos , Atrofia , Mapeamento Encefálico/métodos , Córtex Cerebral/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Dominância Cerebral/fisiologia , Eletroencefalografia/métodos , Lobo Frontal/fisiopatologia , Giro do Cíngulo/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional , Imageamento por Ressonância Magnética/métodos , Masculino , Rede Nervosa/fisiopatologia , Neurônios/fisiologia , Lobo Occipital/fisiopatologia , Tamanho do Órgão/fisiologia , Escalas de Graduação Psiquiátrica , Esquizofrenia Paranoide/psicologia , Processamento de Sinais Assistido por Computador , Software , Lobo Temporal/fisiopatologia , Estimulação Magnética Transcraniana/métodosRESUMO
Nowadays, catatonia is no more considered as a subtype of schizophrenia. Catatonia seems more frequently associated to mood disorders as well as general medical conditions. It is sometimes difficult to associate formally a medical etiology to this syndrome. But we found, in the literature, three groups of associated general medical conditions: neurological disorders, drug induced and toxic induced conditions, metabolic conditions. We present a prospective study of 12 clinical cases of catatonia due to general medical conditions we realized in the Consultation-Liaison Psychiatry Department of the University Hospital of LILLE (France) during a period of 5 months. We find coherent data with the literature. However, our results suggest that if medical conditions precipitate the catatonia syndrome, they are rarely its only etiology. We think that if somatic factors are co-morbid with psychiatric conditions they do not necessarily predominate as the target of treatment. The treatment of the catatonia must be a priority and remain symptomatic, to allow in parallel the specific treatment for the somatic disorder or the psychiatric disorder.