RESUMO
BACKGROUND: Deep brain stimulation (DBS) is emerging as a promising tool in the treatment of refractory obsessive-compulsive disorder (OCD) but the search for the best target still continues. This issue is especially relevant when particularly resistant profiles are observed in some patients, which have been ascribed to individual responses to DBS according to differential patterns of connectivity. As patients have been implanted, new dilemmas have emerged, such as what to do when the patient does not respond to surgery. CASE PRESENTATION: Here we describe a 22-year-old male with extremely severe OCD who did not respond to treatment with DBS in the nucleus accumbens, but who did respond after explanting and reimplanting leads targeting the ventral capsule-ventral striatum region. Information regarding the position of the electrodes for both surgeries is provided and possible brain structures affected during stimulation are reviewed. To our knowledge this case is the first in the literature reporting the removal and reimplantation of DBS leads for therapeutical benefits in a patient affected by a mental disorder. CONCLUSION: The capability for explantation and reimplantation of leads should be considered as part of the DBS therapy reversibility profile in resistant mental disorders, as it allows application in cases of non-response to the first surgery.
Assuntos
Estimulação Encefálica Profunda , Núcleo Accumbens/cirurgia , Transtorno Obsessivo-Compulsivo , Reoperação/métodos , Estriado Ventral/cirurgia , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Remoção de Dispositivo/métodos , Eletrodos Implantados , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/cirurgia , Escalas de Graduação Psiquiátrica , Técnicas Estereotáxicas , Resultado do Tratamento , Adulto JovemRESUMO
Se realizó un estudio descriptivo y transversal de 44 lactantes ingresados por escabiosis en el Hospital Infantil Norte Dr. Juan de la Cruz Martínez Maceira de Santiago de Cuba, durante el primer trimestre del 2007. La investigación reveló que los niños y niñas de 0 - 2 y 3 - 5 meses fueron los más afectados por esa enfermedad cutánea, pero predominantemente los varones. Las lesiones prevalecieron en plantas, palmas y glúteos, sobre todo las clasificadas como vesiculopustulosas. Las abuelas y las madres constituyeron las fuentes de transmisión y el tratamiento prescrito se correspondió con el grado de afectación presentada.
A descriptive and cross-sectional study in 44 infants with scabies admitted to Dr. Juan de la Cruz Martínez Maceira Northern Children Hospital of Santiago de Cuba was conducted during the first trimester of 2007. The investigation revealed that infants between 0 - 2 and 3 - 5 months were the most affected by this skin disorder, predominating the male sex. The lesions prevailed in soles, palms and buttocks, mainly those classified as vesiculopustular. Mothers and grandmothers constituted the transmission sources, and treatment was in correpondence with the degree of involvement.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Escabiose/prevenção & controle , Escabiose/terapia , Escabiose/transmissão , Sarcoptes scabiei , Dermatopatias , Estudos Transversais , Epidemiologia DescritivaRESUMO
CONTEXTO: Dificuldades interpessoais, instabilidade afetiva, distorções da relação médico-paciente e respostas imprevisíveis às intervenções são características centrais aos transtornos de personalidade que são encontradas tanto em pacientes jovens, como em adultos idosos. RELATO DE CASO: Encontra-se aqui descrito um caso de transtorno de personalidade em paciente de 68 anos de idade, com transtorno de personalidade do tipo histriônica e outras comorbidades psiquiátricas. CONCLUSÃO: Transtorno de personalidade é um diagnóstico raramente aventado no tratamento psiquiátrico no paciente idoso de difícil manejo. Deve-se nestes casos fazer uma investigação mais aprofundada do funcionamento da personalidade, pois a presença e a severidade do transtorno de personalidade têm implicações no plano da assistência de ambos os tratamentos psicológico e farmacológico.
CONTEXT: Interpersonal difficulties, affective instability, distortions of the clinician-patient relationship, and unpredictable responses to clinical interventions, are characteristics found in older adults as well as in younger patients with personality disorders. CASE REPORT: We report the case of a 68 years old patient with histrionic personality disorder and other psychiatric comorbidities. CONCLUSION: Personality disorders are frequently overlooked in the diagnostic workout of complex psychogeriatric syndromes, and require a comprehensive assessment of personality traits. The correct identification of personality disorders and their subtypes is critical for planning the therapeutic approach, including pharmacotherapy and psychological management.