Síntomas psicóticos y consumo de bebidas energizantes: reporte de caso / Psychotic symptoms and consumption of energy drinks: case report

RESUMEN: El consumo de bebidas energizantes y su rápida expansión ha creado preocupación desde el punto de vista científico y comunitario. Estas son bebidas que contienen cafeína como su principio activo más común. Se presenta el caso de un paciente sin antecedentes psiquiátricos con presentación clínica de síntomas psicóticos tras incremento del consumo de bebidas energizantes. Se realiza una revisión de literatura existente sobre otros casos de aparición de psicosis tras el consumo de estas bebidas en personas sin y con antecedentes psiquiátricos, así como casos en que predomina la presentación de otros síntomas psiquiátricos con la finalidad de discutir el impacto clínico. El consumo de bebidas energizantes podría representar un problema de salud pública mundial debido a los posibles efectos adversos graves y aún poco estudiados en la salud física y mental.

ABSTRACT The consumption of energy drinks and their rapid expansion has created concern from a scientific and community point of view. These are drinks that contain caffeine as their most common active ingredient. We present the case of a patient with no psychiatric history with clinical presentation of psychotic symptoms after increased consumption of energy drinks. A review of existing literature is carried out on other cases of the appearance of psychosis after the consumption of these beverages in people without and with a psychiatric history, as well as cases in which the presentation of other psychiatric symptoms predominates in order to discuss the clinical impact. The consumption of energy drinks could represent a global public health problem due to the possible serious and still little studied adverse effects on physical and mental health.

Quiste aracnoideo (Galassi Tipo II) y síntomas neuropsiquiátricos: a propósito de un caso / Arachnoid Cyst (Galassi Type II) and neuropsychiatry symptoms: about a case

INTRODUCCIÓN: un quiste aracnoideo es originado de la alteración de una de las membranas de la meninges (aracnoides), de predominio en la fosa craneal media; es una patología poco común que cause síntomas y si ocurren, se pueden presentar manifestaciones neuropsiquiatrías. OBJETIVO: exponer los datos clínicos; y la metodología diagnóstica y terapéutica. CASO: presentamos una paciente femenina de 24 años de edad; sin antecedentes personales médicos psiquiátricos y médicos no psiquiátricos conocidos, quien presenta una historia con un mes de evolución de síntomas psicóticos y cambios conductuales. Se le realizo CAT cerebral simple y luego una resonancia magnética cerebral contrastada para definir el tamaño del quiste aracnoideo, por los posibles síntomas neuropsiquiátricos encontrados. Por medio de exámenes de laboratorios, estudios electrofisiológicos (electroencefalograma), neuroimágenes y evaluación clínica. Se decide presentar las características clínicas encontradas de la paciente quien requirió manejo con antipsicóticos, benzodiacepinas y estabilizador del humor con gradual mejoría de sus sintomatologías de ingreso (agitación psicomotora y psicosis).

INTRODUCTION: an arachnoid cyst is caused by the alteration of one of the membranes of the meninges (arachnoid), predominantly in the middle cranial fossa; It is an uncommon pathology that causes symptoms and if they occur, neuropsychiatric manifestations may take place. OBJECTIVE: expose the clinical data; and the diagnostic and therapeutic methodology. CASE: we present a 24-year-old female patient; with no personal history of psychiatric and known non-psychiatric medical records, whom presents a story with a month of evolution of psychotic symptoms and behavioral changes. A simple cerebral CAT was performed and then a cerebral magnetic resonance imaging with contrast to define the size of the arachnoid cyst, due to the possible neuropsychiatric symptoms found. Through laboratory tests, electrophysiological studies (electroencephalogram), neuroimaging and clinical evaluation. It was decided to present the clinical characteristics of the patient who required management with antipsychotics, benzodiazepines and mood stabilizer with gradual improvement of her admission symptoms (psychomotor agitation and psychosis)

Living frisbees: riesgos de patologías mentales en niños y niñas expuestos a thc durante su gestación / Living frisbees: risks of mental pathologies in boys and girls exposed to thc during their pregnancy

La Cannabis sativa es una planta que contiene componentes psicoactivos (principalmente tetrahidrocannabinol) y actualmente corresponde a la droga ilícita más consumida a nivel mundial. Además, desde el área de la salud mental, ha habido un creciente interés en evaluar la relación entre el consumo de marihuana y el desarrollo de trastornos mentales. En este contexto, considerando tanto este creciente aumento en su consumo a nivel mundial y el interés por conocer si está involucrada en la patogénesis de patologías de la esfera psiquiátrica, es clave analizar qué posibles riesgos de desarrollar patologías mentales presentan aquellos niños expuestos al tetrahidrocannabinol durante la gestación. A partir de esta situación, el objetivo de este FRISBEEs es determinar si los niños/as expuestos a THC durante su gestación tienen un mayor riesgo de patologías mentales, en comparación a aquellos niños no expuestos durante su gestación. Los materiales y métodos utilizados para responder esta pregunta fueron obtenidos a partir de una búsqueda bibliográfica en dos bases de datos, donde se analizó la evidencia disponible, y se seleccionó el estudio primario titulado "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring", ya que era el que más se aproximaba a poder responder nuestra pregunta clínica. Este se analizó de forma crítica, llegando al resultado de que el estudio no fue concluyente en establecer una asociación entre el uso de cannabis y síntomas psicóticos. Como conclusión, dado que no se pudo llegar a establecer una asociación entre el uso de cannabis y el desarrollo de patologías mentales, se debería realizar más investigación sobre el tema dado la magnitud del consumo de cannabis a nivel mundial, para así poder llegar a conclusiones clínicas basadas en la evidencia y poder dar recomendaciones clínicas a las pacientes embarazadas.

Cannabis sativa is a plant that contains psychoactive components (mainly tetrahydrocannabinol) and currently corresponds to the most widely consumed illicit drug worldwide. In addition, from the area of mental health, there has been a growing interest in evaluating the relationship between marijuana use and the development of mental disorders. In this context, considering both this growing increase in its consumption worldwide and the interest in knowing if it is involved in the pathogenesis of pathologies in the psychiatric sphere, it is essential to analyze what possible risks of developing mental pathologies present those children exposed to tetrahydrocannabinol during gestation. Based on this situation, the objective of this FRISBEEs is to determine whether children exposed to THC during their pregnancy have a greater risk of mental pathologies, compared to those children not exposed during their pregnancy. The materials and methods used to answer this question were obtained from a bibliographic search in two databases, where the available evidence was analyzed, and the primary study entitled "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring ", as he was the closest to answering our clinical question. This was critically analyzed, reaching the result that the study was not conclusive in establishing an association between the use of cannabis and psychotic symptoms. In conclusion, given that it was not possible to establish an association between the use of cannabis and the development of mental pathologies, more research should be carried out on the subject given the magnitude of cannabis use worldwide, in order to reach conclusions. evidence-based clinics and to be able to give clinical recommendations to pregnant patients

Psicosis secundaria a meningioma: revisión a propósito de un caso / Secondary psychosis due to meningioma: review about a case

Resumen Los meningiomas son los tumores primarios más frecuentes del sistema nervioso central, tienden a ser benignos y de lento crecimiento. Pueden ser asintomáticos o incluso manifestarse únicamente con síntomas psiquiátricos, incluyendo un cuadro psicótico. No existen estudios clínicos controlados randomizados que estudien la relación entre meningioma y cuadros psicóticos. La evidencia disponible se basa en series y reportes de casos. Existe una relación entre la magnitud del edema perilesional y la presencia de síntomas psicóticos. Por otra parte, el tamaño de la lesión o su localización neuroanatómica específica tendrían menor relevancia. La resección quirúrgica de la lesión, en conjunto con el manejo psiquiátrico adecuado, usualmente conduce al cese de la sintomatología psicótica. En la evaluación de pacientes con síntomas psicóticos se debe tener un elevado índice de sospecha, en particular en cuadros de reciente inicio, con manifestaciones atípicas o resistentes al tratamiento. En estos casos se recomienda un estudio con neuroimágenes. Este artículo presenta el caso de una paciente evaluada en nuestro hospital diagnosticada con un meningioma frontal izquierdo de gran tamaño, que presentó sintomatología psicótica secundaria, y se expone una revisión bibliográfica actualizada de esta asociación.

Meningiomas are the most frequent central nervous primary tumors, which tend to be benign and present a slow growth. They may be asymptomatic or present clinically just with psychiatric symptoms including a psychotic state. There are no clinical randomized controlled trials that study the relationship between meningioma and a psychotic episode. Available evidence is based on case reports and series. There is a relationship between the magnitude of perilesional edema and the presence of psychotic symptoms. On the other hand, the size of the tumor or its specific neuroanatomic location would have less relevance. Surgical resection of the tumor associated with psychiatric management usually leads to the cessation of psychotic symptoms. In the assessment of patients with psychotic symptoms, there must be a high index of suspicion, particularly in first psychotic episodes, atypical manifestations and resistance to treatment. In these cases, a neuroimaging study is recommended. This article presents the case of a patient evaluated in our hospital and diagnosed with a large left frontal meningioma with secondary psychotic symptoms, and an updated bibliographic review of this association is presented.

Encefalitis límbica: clínica, patogenia y problemas diagnósticos / Limbic encephalitis: clinic, pathogenesis and diagnostic problems

La encefalitis límbica es una enfermedad infrecuente y potencialmente grave, que puede o no ser paraneoplásica y se caracteriza por déficit de la memoria reciente, alteraciones psiquiátricas y convulsiones. De origen autoinmunitario, está asociada a anticuerpos séricos e intratecales contra antígenos neuronales intracelulares y de superficie, con especial afectación de zonas límbicas. En este artículo se revisan aspectos históricos y epidemiológicos, patogenia, síndromes más frecuentes y mejor delimitados, histopatología y estudios complementarios. Se repasan también las dificultades del diagnóstico diferencial y la necesidad de descartar siempre un tumor subyacente. La detección de autoanticuerpos neuronales es importante para el diagnóstico, la planificación terapéutica y el pronóstico. La inmunoterapia y, si corresponde, el tratamiento de la neoplasia son cruciales para lograr una recuperación neurológica sustancial. La encefalitis límbica es una entidad probablemente subdiagnosticada, con un pronóstico más favorable si se trata de forma temprana. El actual conocimiento de su patogenia puede además aportar claridad para la mejor comprensión de otros síndromes neurológicos y psiquiátricos que puedan compartir mecanismos autoinmunitarios, como algunos trastornos psicóticos y epilepsias farmacorresistentes. (AU)

Limbic encephalitis is a rare and potentially serious disease, which may or may not be paraneoplastic and is characterized by recent memory deficits, psychiatric disturbances and seizures. Of autoimmune origin, it is associated with serum and intrathecal antibodies against intracellular and surface neuronal antigens, with special involvement of limbic areas. This article reviews historical and epidemiological aspects, pathogenesis, more frequent and better defined syndromes, histopathology and complementary studies. The difficulties of differential diagnosis and the need to always rule out an underlying tumor are also reviewed. Detection of neuronal autoantibodies is important for diagnosis, therapeutic planning and prognosis. Immunotherapy and, if appropriate, neoplasm treatment, are crucial to achieve substantial neurological recovery. Limbic encephalitis is probably an underdiagnosed entity, with a more favorable prognosis if treated early. The current knowledge of its pathogenesis may also provide clarity for a better understanding of other neurological and psychiatric syndromes that may share autoimmune mechanisms, such as some psychotic disorders and drug-resistant epilepsies. (AU)

A experiência enigmática na psicose: os fenômenos elementares à luz da teoria do significante / L'expérience énigmatique dans la psychose: les phénomènes élémentaires à la lumière de la théorie du signifiant / La experiencia enigmática en la psicosis: los fenómenos elementales a la luz de la teoria del significante / The enigmatic experience in psychosis: the elementary phenomena in the light of theory of significant

O conhecimento dos fenômenos elementares é uma ferramenta valiosa no diagnóstico e tratamento da psicose. Lacan reexamina essa noção psiquiátrica com base nos estudos de Benveniste e Jakobson sobre os shifters. Conforme será demonstrado, o resultado desse diálogo foi a formulação da experiência enigmática na psicose, na qual aparece a possibilidade original de uma enunciação sem enunciador. Apesar de exceder os limites do que é aceitável como válido pela linguística, a consequência da investigação lacaniana é situar de forma defintiva a causalidade da psicose no campo da linguagem e não no registro biológico. Além disso, a compreensão dos dois tempos lógicos da experiência enigmática permite isolar um princípio, do qual se deduz uma reorganização dos fenômenos elementares em dois tipos: xenopáticos e de autorreferência.

La connaissance des phénomènes élémentaires est un important outil tant pour le diagnostic que pour le traitement de la psychose. Lacan analyse cette notion psychiatrique à partir des études de Benveniste et Jakobson à propos des shifters. Tel qu'il sera démontré, le résultat de ce dialogue a été la formulation de l'expérience énigmatique dans la psychose, où il surgit la possibilité originelle d'une énonciation sans énonciateur. Malgré l'extrapolation des limites de l'acceptable du point de vue de la linguistique, la conséquence de l'investigation lacanienne a été la possibilité de situer d'une manière définitive la causalité de la psychose dans champ du langage, et non pas dans le registre biologique. Par ailleurs, la compréhension des deux temps logiques de l'expérience énigmatique lui a permis d'isoler un principe, a partit duquel se déduit une réorganisation des phénomènes élémentaires selon deux types: xénopathiques et d'autoréférence.

El conocimiento de los fenómenos elementales es una valiosa herramienta en el diagnóstico y tratamiento de la psicosis. Lacan reexamina esta noción psiquiátrica basado en los estudios de Benveniste y Jakobson sobre los shifters. Como se demostrará, el resultado de este diálogo fue la formulación de la experiencia enigmática en la psicosis, donde aparece la posibilidad única de una enunciación sin enunciador. A pesar de superar los límites de lo que es aceptable como válido por la lingüística, la consecuencia de la investigación lacaniana es poner definitivamente la causalidad de la psicosis en el campo del lenguaje, y no en el registro biológico. Además, la comprensión de los dos tiempos lógicos de la experiencia enigmática permitió aislar un principio de que lo se puede deducir una reorganización de los fenómenos elementales en 2 tipos: xenopaticos y de autorreferencia.

The knowledge of the elementary phenomena is a valuable tool for diagnosis and treatment of psychosis. Lacan reexamines this psychiatric notion based on Benveniste`s and Jakobson`s studies on the shifters. As will be shown, the result of this dialogue was the formulation of the enigmatic experience on psychosis, where appears the unique possibility of an enunciation without enunciator. Despite exceeding the limits of what is acceptable as valid by linguistics, the consequence of Lacan's research is situate in a definitive way the causality of psychosis in the field of language, and not in the biological register. In addition, understanding the two logical times of the enigmatic experience allows to isolate a principle from which is deduced a reorganization of the elementary phenomena into 2 types: xenopathic and self-reference.

Two Siblings with Adolescent/Adult Onset Niemann-Pick Disease Type C in Korea

Niemann-Pick disease, type C (NP-C), is caused by NPC1 or NPC2 gene mutations. Progressive neurological, psychiatric, and visceral symptoms are characteristic. Here, we present cases of a brother (Case 1) and sister (Case 2) in their mid-20s with gait disturbance and psychosis. For the Case 1, neurological examination revealed dystonia, ataxia, vertical supranuclear-gaze palsy (VSGP), and global cognitive impairment. Case 2 showed milder, but similar symptoms, with cortical atrophy. Abdominal computed tomography showed hepatosplenomegaly in both cases. NPC1 gene sequencing revealed compound heterozygote for exon 9 (c.1552C>T [R518W]) and exon 18 (c.2780C>T [A927V]). Filipin-staining tests were also positive. When a young patient with ataxia or dystonia shows VSGP, NP-C should be considered.

Onset of psychosis at age 81? With regard to frontal lobe syndromes / Psicose inaugural aos 81 anos? A propósito das síndromes do lobo frontal

When the frontal lobe of the brain is affected important behavioral changes may occur mainly at the level of executive functioning, i.e., planning, decision-making, judgment and self-perception. However, the behavioral changes may be of different nature with marked indifference and apathy. We report a clinical case of an 81-year-old patient with sudden onset of behavioral changes that were initially interpreted as an acute confusional episode of infectious etiology, but actually they were due to an ischemic lesion in the frontal lobe.

O lobo frontal, quando afetado, pode provocar alterações importantes do comportamento, principalmente na função executiva: planejamento, tomada de decisões, juízo e autopercepção. Contudo, as alterações podem ser de outra natureza, caracterizando-se por marcada indiferença e apatia. É relatado aqui o caso de uma paciente de 81 anos, com alterações súbitas do comportamento, que foram interpretadas inicialmente como um quadro confusional agudo de natureza infecciosa, mas que se mostraram provocadas por uma lesão isquêmica na região frontal.

Correlative factors for organic psychotic symptoms in patients following traumatic brain injury / 法医学杂志

OBJECTIVE@#To investigate the correlative factors for organic psychotic symptoms following traumatic brain injury (TBI).@*METHODS@#In the current study, 391 subjects who had undergone forensic identification of the organic mental disorders due to TBI were included, both the demographic and post-traumatic information collected. The relevant data were statistically analyzed in those confirmed as organic psychotic syndrome according to Chinese Classification of Mental Disorders 3rd version (CCMD-3).@*RESULTS@#Fifty-two subjects (13.3%) were identified as organic psychotic symptoms. The chi-square test showed that the detectable organic psychotic symptoms were associated with the marriage status, damage nature, injury severity and treatment, and the multivariate logistic regression analysis revealed good fitness of treatment and injury severity with the regression model (OR = 0.044, 95% CI: 0.017-0.114; OR = 2.145, 95% CI: 1.201-3.832, respectively).@*CONCLUSION@#The risks of organic psychotic symptoms following TBI can be involved in the alternative of craniotomy for the cases with trauma and moderate brain injury.

Formal Thought Disorder and language impairment in schizophrenia / Alteração formal do pensamento e prejuízo da linguagem na esquizofrenia

Schizophrenia is a psychiatric illness in which disorders of thought content are a prominent feature. The disruption of normal flow of thought, or “Formal Thought Disorder” (FTD), has been traditionally assessed through the content and form of patients’ speech, and speech abnormalities in schizophrenia were considered as a by-product of the disruption in conceptual structures and associative processes related to psychosis. This view has been changed due to increasing evidence that language per se is impaired in schizophrenia, especially its semantic, discursive, and pragmatic aspects. Schizophrenia is currently considered by some authors as a “language related human specific disease” or “logopathy”, and the neuroanatomical and genetic correlates of the language impairment in these patients are under investigation. Such efforts may lead to a better understanding about the pathophysiology of this devastating mental disease. We present some current concepts related to FTD as opposed to primary neurolinguistic abnormalities in schizophrenia.

A esquizofrenia é uma doença psiquiátrica na qual as alterações do conteúdo do pensamento são uma característica marcante. A ruptura do fluxo normal de pensamentos, ou “Alteração Formal do Pensamento” (AFP) é acessada através da forma e conteúdo da fala do paciente. Alterações de fala e linguagem em esquizofrênicos eram consideradas como consequentes à ruptura de seus sistemas conceituais e processos associativos relacionados à psicose. Esta visão alterou-se pelo aumento nas evidências de comprometimento primário da linguagem na esquizofrenia, especialmente em seus aspectos semânticos, discursivos e pragmáticos. A esquizofrenia é atualmente considerada por alguns autores como uma “doença humana específica relacionada à linguagem”, ou “logopatia”. Os correlatos neuroanatômicos e genéticos do prejuízo linguístico nestes pacientes estão sendo investigados. Estes esforços podem levar à maior compreensão da fisiopatologia desta grave doença mental. Nesta revisão, apresentamos conceitos atuais sobre AFP e sua diferenciação das anormalidades linguísticas primárias na esquizofrenia.

Síntomas psicóticos, paranoides y catatónicos como debut de enfermedad de Cushing en una paciente con síndrome de Turner: reporte de caso y revisión de la literatura / Psicotic, paranoid and catatonic symptoms as Cushing disease onset in a Turner syndrome patient: case report and literature revision

It is known that hipercortisolism and overactivity of the Hypotalamus pituitary adrenal axis are associated to psiquiatric diseases presentation. In patients with Cushing syndrome, mood disorders are common, also psicosis cases also are present during the disease. But, the presence and mostly the onset with a episode of catatonic psicosis is unusual. The cortisol excess produce structural damage in the Central Nervous System, reversible and irreversible, specially in the hypocampus. We show the case of a young woman with previous diagnostic of Turner syndrome, karyotype 45 X0, who presented a psychiatric episode caracterized for depresive psicotic symptoms and posteriorly a catatonic state as an unusual form of Cushing disease onset. This patient presented health improvement after pituitary resection. There is not evidencia that Turner syndrome influes over this unusual form of presentation.

Se conoce que el hipercortisolismo y la sobreactividad del eje hipotálamo pituitario adrenal están asociados a la presentación de enfermedades psiquiátricas. En pacientes con síndrome de Cushing son frecuentes los trastornos del ánimo aunque también se presentan casos de psicosis durante el curso de la enfermedad. Sin embargo es inusual la presencia y más aún el debut con un cuadro de psicosis catatónica. El exceso de cortisol produce daño estructural en el sistema nervioso central tanto reversible como irreversible, especialmente en el hipocampo. Presentamos el caso de una paciente mujer joven con diagnóstico previo de síndrome de Turner, cariotipo 45 X0, quien presentó un cuadro psiquiátrico caracterizado por síntomas depresivos psicóticos y posteriormente catatonia como forma inusual de debut de enfermedad de Cushing y presentó mejoría posterior a la resección de la pituitaria. No se tiene evidencia que el síndrome de Turner influya sobre esta rara forma de presentación.

MRKH syndrome: Psychological disturbances and suicide.

The Mayer- Rokitansky-Küster-Hauser (MRKH) syndrome has been known to be associated with psychological abnormalities. However, hardly any case has been reported of suicide by an individual suffering from such syndrome, as per the author‘s knowledge. A 19 year old female was brought to Safdarjung hospital mortuary for post mortem examination. After eliciting a detailed history from the relatives of the deceased, going through the previous investigation reports and after post mortem examination it was confirmed that the deceased was suffering from MRKH syndrome. The mental stress associated with the diseased state resulted in the female committing suicide by ingesting some unknown substance. Emotional support forms the basis of treatment in such cases. Surgical treatment is also employed in some cases so as to help them lead normal sexual life. This paper deals with the pathology and psychological profile of the patient suffering from this syndrome and the therapeutic options that may be considered to ameliorate the stress associated with the disease.