RESUMEN
A 44-year-old male with no known past medical history but a known history of daily synthetic marijuana use presented to the emergency department after two witnessed seizures. The patient was admitted to the neurology service, where he was worked up with an MRI with epilepsy protocol and an EEG. During admission, the patient was admitted to daily synthetic marijuana use. He did note that he had started to decrease the amount of mojo he used daily in an attempt to stop. His last use was at 9 am the day of his admission. He was trying to decrease his use; his girlfriend of difficulty word-finding noted periods. Synthetic marijuana (SM) or "mojo" use has been increasing in the past decade for two reasons; It is considered an herbal product and has been legal. A withdrawal syndrome of SM use has been characterized chiefly as tachycardia, irritation, anxiety, and mood swings. These withdrawal symptoms are usually seen with chronic use. Some early results in the literature also show that SM use can lead to functional and structural neuronal changes. This manuscript discusses a case of a first on-set seizure as a possible withdrawal symptom in chronic SM use.
RESUMEN
With emerging information about the potential for morbidity and reduced life expectancy with long-term use of opioids, it is logical to evaluate nonopioid analgesic treatments to manage pain states. Combinations of drugs can provide additive and/or synergistic effects that can benefit the management of pain states. In this regard, tetrahydrocannabinol (THC) and cannabidiol (CBD) modulate nociceptive signals and have been studied for chronic pain treatment. Psilocybin, commonly known as "magic mushrooms", works at the serotonin receptor, 5-HT2A. Psilocybin has been found in current studies to help with migraines since it has a tryptamine structure and works similarly to triptans. Psilocybin also has the potential for use in chronic pain treatment. However, the studies that have looked at alternative plant-based medications such as THC, CBD, and psilocybin have been small in terms of their sample size and may not consider the demographic or genetic differences in the population because of their small sample sizes. At present, it is unclear whether the effects reported in these studies translate to the general population or even are significant. In summary, additional studies are warranted to evaluate chronic pain management with alternative and combinations of medications in the treatment of chronic pain.
RESUMEN
The monoamine hypothesis of depression attributes the symptoms of major depressive disorders to imbalances of serotonin, noradrenaline, and dopamine in the limbic areas of the brain. The preferential targeting of serotonin receptor (SERT) by selective serotonin reuptake inhibitors (SSRIs) has offered an opportunity to reduce the range of these side effects and improve patient adherence to pharmacotherapy. Clozapine remains an effective drug against treatment-resistant schizophrenia, defined as failing treatment with at least two different antipsychotic medications. Patients with schizophrenia who display a constellation of negative symptoms respond poorly to antipsychotic monotherapy. Negative symptoms include the diminution of motivation, interest, or expression. Conversely to the depressive symptomology of interest presently, supplementation of antipsychotics with SSRIs in schizophrenic patients with negative symptoms lead to synergistic improvements in the function of these patients. Fluvoxamine is one of the most potent inhibitors of CYP1A2 and can lead to an increase in clozapine levels. Similar increases in serum clozapine were detected in two patients taking sertraline. However, studies have been contradictory as well, showing no such increases, which are worrying. Clinicians should be aware that clozapine levels should be monitored with any coadministration with SSRIs.