A Literature Review Examining Virtual Reality Exposure Therapy for Individuals Diagnosed With Social Anxiety Disorder.

ABSTRACT: Social anxiety disorder (SAD) is a specific subtype of anxiety disorder where individuals experience uncomfortable social situations that induce anxious feelings including nervousness and panic. Computer technology has been applied in interventions for many mental health disorders. We aim to understand and explore the use of virtual reality exposure therapy (VRET) to treat adults with SAD. We conducted a literature search using relevant mesh keywords in PubMed and PsycINFO. Six studies met inclusion criteria in our final qualitative synthesis review. Results showed a significant reduction in SAD symptom severity based on primary measures in all studies, suggesting that VRET is an effective option in treating SAD. Studies have shown the success of VRET in formats such as a single-user implementation, one-session treatment, and self-training intervention. In conclusion, VRET is effective in reducing SAD symptoms. The limitations of most studies included a small sample size and weak ecological validity. Future research can examine VRET with a more extensive clinical sample and broader social behaviors.

Cannabis-Induced Malignant Catatonia: A Medical Emergency and Review of Prior Case Series.

Few case reports of catatonia associated with cannabis use are reported. Here, we describe a case of a 35-year-old African American male who developed malignant catatonia following heavy cannabis use. The patient was brought to the emergency department (ED) for altered mental status, hypertension, and erratic behavior. Before his ED presentation, he was smoking cannabis in heavy amounts, confirmed by positive urine toxicology in ED. Initial lab results showed leukocytosis, elevated creatine phosphokinase (CPK) levels. Head CT scans without contrast, including cerebrospinal fluid (CSF) analysis, were nonsignificant. In ED, the patient was agitated, combative, mute, and rigid. He was sedated using 2 mg of intramuscular (IM) midazolam. Psychiatric consultation services suspected catatonia, and the patient scored 12 points on Bush-Francis Catatonia Rating Scale (BFCRS). Although the patient's symptoms responded to 2 mg of IM lorazepam, the patient later relapsed, became tachycardic with blood pressure fluctuations, and his repeat BFCRS score was 18. At this point, the patient was diagnosed as having malignant catatonia, and his lorazepam dosage was increased up to 6 mg IM per day. After a few days of waxing and waning of his symptoms, he finally started to show constant improvement and gradually reduced his symptoms. Our case highlights the first-ever reported case of malignant catatonia associated with cannabis use.