Psychotic Cannabis Withdrawal: A Clinical Case.

Cannabis use has been associated with several psychiatric comorbidities and there appears to be a dose-response relationship between the intensity and duration of its use and the risk of psychosis. More commonly, acute episodes of cannabis induced-psychosis manifest immediately following exposure, are precipitated after the use of large amounts of cannabis, resolve with abstinence, and are of shorter duration than those observed with primary psychotic disorders. Cannabis withdrawal symptoms usually manifest when heavy, prolonged consumption of this substance is interrupted or significantly reduced. The withdrawal syndrome may include sympathetic autonomic hyperactivity, irritability, anxiety, sleep disturbance, and reduced appetite. On the other hand, cases of psychosis induced by cannabis withdrawal are rare. In this case, we present a 32-year-old healthy woman without personal or family psychiatric history who showed a heavy and continued consumption of cannabis since she was 10 years old, without developing any psychiatric symptoms. However, recently she experienced two brief psychotic episodes with disorganized behavior and persecutory delusions, both episodes happening a week after discontinuing cannabis consumption.

No sonographer, no radiologist: New system for automatic prenatal detection of fetal biometry, fetal presentation, and placental location.

Ultrasound imaging is a vital component of high-quality Obstetric care. In rural and under-resourced communities, the scarcity of ultrasound imaging results in a considerable gap in the healthcare of pregnant mothers. To increase access to ultrasound in these communities, we developed a new automated diagnostic framework operated without an experienced sonographer or interpreting provider for assessment of fetal biometric measurements, fetal presentation, and placental position. This approach involves the use of a standardized volume sweep imaging (VSI) protocol based solely on external body landmarks to obtain imaging without an experienced sonographer and application of a deep learning algorithm (U-Net) for diagnostic assessment without a radiologist. Obstetric VSI ultrasound examinations were performed in Peru by an ultrasound operator with no previous ultrasound experience who underwent 8 hours of training on a standard protocol. The U-Net was trained to automatically segment the fetal head and placental location from the VSI ultrasound acquisitions to subsequently evaluate fetal biometry, fetal presentation, and placental position. In comparison to diagnostic interpretation of VSI acquisitions by a specialist, the U-Net model showed 100% agreement for fetal presentation (Cohen's κ 1 (p<0.0001)) and 76.7% agreement for placental location (Cohen's κ 0.59 (p<0.0001)). This corresponded to 100% sensitivity and specificity for fetal presentation and 87.5% sensitivity and 85.7% specificity for anterior placental location. The method also achieved a low relative error of 5.6% for biparietal diameter and 7.9% for head circumference. Biometry measurements corresponded to estimated gestational age within 2 weeks of those assigned by standard of care examination with up to 89% accuracy. This system could be deployed in rural and underserved areas to provide vital information about a pregnancy without a trained sonographer or interpreting provider. The resulting increased access to ultrasound imaging and diagnosis could improve disparities in healthcare delivery in under-resourced areas.

[First Psychotic Episode in a Patient with DiGeorge Syndrome and Selective Mutism]. / Primeiro Episódio Psicótico em Doente com Síndrome de DiGeorge e Mutismo Seletivo.

DiGeorge Syndrome is a group of diseases caused by a microdeletion, and some of its most frequent symptoms are those related with development and behavior. We present the case of a female patient with DiGeorge Syndrome and selective mutism since childhood, evaluated for the first time in a psychiatry consultation at the age of 18 for inaugural psychotic symptomatology. We describe the psychopathology, the diagnostic investigation, the treatment, and the clinical evolution. In the future, it will be important to better characterize patients with this syndrome who present psychiatric disease.

A síndrome de DiGeorge consiste num conjunto de doenças causadas por uma microdeleção, sendo alguns dos seus sintomas mais frequentes os ligados ao desenvolvimento e ao comportamento. Apresentamos o caso clínico de uma doente com síndrome de Di-George e história de mutismo seletivo desde a infância, avaliada pela primeira vez em consulta de psiquiatria aos 18 anos de idade por sintomatologia psicótica inaugural. Descrevemos a psicopatologia, o estudo realizado, o tratamento instituído e a evolução clínica. No futuro será importante uma melhor caraterização da abordagem dos doentes com esta síndrome que apresentam perturbação psiquiátrica.