RESUMEN
We present a case of acute alcohol-induced Korsakoff amnesia. A severe amnestic-confabulatory syndrome characterized the early clinical status. The initial neuropsychological tests demonstrated severe learning deficits plus impaired performance on many, but not all, tests of frontal lobe function. Single-photon emission CT (SPECT) at this stage showed hypoperfusion in the orbital and medical frontal regions and the medial diencephalic area. Four months later, the patient's amnesia remained but there was no confabulation. Repeat neuropsychological tests confirmed an ongoing severe amnesia, but performance on the frontal lobe tests now was normal. Repeat SPECT showed a return to normal perfusion in the frontal brain areas but little improvement in the medial diencephalic region. These findings along with data from the clinical literature suggest that confabulation results from dysfunction of orbital and a medial frontal cortex.
Asunto(s)
Trastorno Amnésico Alcohólico/fisiopatología , Adulto , Trastorno Amnésico Alcohólico/psicología , Circulación Cerebrovascular , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/fisiopatología , Diencéfalo/diagnóstico por imagen , Diencéfalo/fisiopatología , Femenino , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/fisiopatología , Humanos , Discapacidades para el Aprendizaje , Pruebas Neuropsicológicas , Compuestos de Organotecnecio , Oximas , Flujo Sanguíneo Regional , Exametazima de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Cocaine causes serious neurologic and neuropsychiatric complications. Cocaine-induced seizures are common and appear to be due to the local anaesthetic actions of this compound. Cocaine induced stroke has varied mechanisms. With ischemic stroke there is severe vasospasm induced by rises in brain catecholamines. These changes can persist for many weeks and can be demonstrated using single-photon emission computerized tomography (SPECT). In many patients with psychiatric symptoms such as psychosis or mania, SPECT demonstrates similar changes in cerebral blood flow. In fact, some of the psychiatric symptoms induced by cocaine may be due to decreases in cerebral blood flow. In cocaine abuse, treatment strategies based on decreasing cerebral vasospasm need to be developed.
Asunto(s)
Encéfalo/efectos de los fármacos , Cocaína/efectos adversos , Psicosis Inducidas por Sustancias , Tomografía Computarizada de Emisión de Fotón Único , Trastorno Bipolar/inducido químicamente , Encéfalo/patología , Encéfalo/fisiopatología , Catecolaminas/análisis , Catecolaminas/farmacocinética , Trastornos Cerebrovasculares/inducido químicamente , Femenino , Humanos , Masculino , Convulsiones/inducido químicamenteRESUMEN
A 35 year old married male who had previously had manic episodes twice, during winter months, was treated with intermittent lithium therapy between November and February of each year and was well for a period of five years. The case report and the findings are discussed to demonstrate the possibility of intermittent lithium therapy in some patients.
Asunto(s)
Trastorno Bipolar/tratamiento farmacológico , Litio/administración & dosificación , Adulto , Trastorno Bipolar/psicología , Diarrea/inducido químicamente , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Humanos , Litio/efectos adversos , Carbonato de Litio , Masculino , Estaciones del AñoRESUMEN
The influence of oral lithium on the concentration of red blood cell choline (Ch), lecithin, glycerophosphorylcholine (GPCh) and phosphorylcholine (PCh) was studied. The concentration of RBC Ch was significantly elevated and the concentration of lecithin, GPCh and PCh significantly depressed in 16 patients on oral lithium compared to 9 age-matched controls. We conclude that lithium markedly depletes the red blood cell of choline containing compounds including lecithin. These changes may be responsible for both the therapeutic efficacy and the toxicity of lithium.
Asunto(s)
Colina/sangre , Eritrocitos/efectos de los fármacos , Lípidos/sangre , Litio/farmacología , Administración Oral , Adulto , Eritrocitos/metabolismo , Glicerilfosforilcolina/sangre , Humanos , Litio/administración & dosificación , Persona de Mediana Edad , Fosfatidilcolinas/sangre , Fosforilcolina/sangreRESUMEN
A young male presented both Capgras syndrome and Folie à Deux. Both of his parents shared the same delusions with the patient. A dynamic explanation is provided for the simultaneous occurrence of both syndromes. The case report and the management of this patient may be of interest to clinicians.
Asunto(s)
Síndrome de Capgras/complicaciones , Trastornos Psicóticos/complicaciones , Trastorno Paranoide Compartido/complicaciones , Adulto , Síndrome de Capgras/psicología , Humanos , Masculino , Trastornos Neurocognitivos/complicaciones , Relaciones Padres-Hijo , Trastorno Paranoide Compartido/psicologíaRESUMEN
Three biological markers of affective disorders and response to desipramine were used to study the relationship of posttraumatic stress disorder (PTSD) to affective illness. Blunted TRH response and decreased REM latency in eight patients with PTSD occurred at frequencies similar to those that have been found in patients with major affective disorder. Pretreatment Hamilton Rating Scale for Depression and Beck Depression Inventory scale scores were elevated; scores after 4 weeks' treatment with desipramine revealed significant (p less than .05 and p less than .005, respectively) improvement. These findings support a link between PTSD and affective illness.
Asunto(s)
Trastorno Depresivo/diagnóstico , Desipramina/uso terapéutico , Sueño REM , Trastornos por Estrés Postraumático/diagnóstico , Tirotropina/sangre , Adulto , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/psicología , Diagnóstico Diferencial , Humanos , Masculino , Inventario de Personalidad , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/tratamiento farmacológico , Trastornos por Estrés Postraumático/psicología , Hormona Liberadora de TirotropinaRESUMEN
Three acutely psychotic patients with psychomotor excitement and agitation were rapidly sedated following intramuscular injections of 2.5 mg to 3 mg of midazolam. The use of midazolam, a short- and rapid-acting benzodiazepine preparation, in a psychiatric emergency room setting is discussed.
Asunto(s)
Midazolam/uso terapéutico , Agitación Psicomotora/tratamiento farmacológico , Trastornos Psicóticos/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Adulto , Servicios de Urgencia Psiquiátrica , Femenino , Humanos , Masculino , Trastornos Psicóticos/psicologíaRESUMEN
Agoraphobia, now a clinically accepted entity (DSM-III) was first described more than 100 years ago in the psychiatric literature. Recently, it has been considered a syndrome, with phobia, anxiety and depersonalization being the prominent symptoms. Its etiology is not clear and different schools of thought have given different explanations for its causation. Few reports of recent origin have have described a close association between the intake and/or discontinuation of pharmacologic agents and the onset of the syndrome. The agents implicated were the tricyclic group. Our report describes another "antidepressant," d-amphetamine, which when discontinued by our patient, was followed by the full syndrome of agoraphobia.
Asunto(s)
Agorafobia/etiología , Anfetamina , Trastornos Fóbicos/etiología , Síndrome de Abstinencia a Sustancias/psicología , Adulto , Agorafobia/psicología , Anfetamina/uso terapéutico , Femenino , Humanos , Obesidad/tratamiento farmacológico , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
The authors identified 46 cyclothymic probands from a random pool of 500 psychiatric outpatients and prospectively followed them over a 2-3 year period. They used 50 bipolar patients with a definite history of mania and 50 patients with personality disorders as control groups. Although 66% of the cyclothymic outpatients had previously received the diagnosis of hysteria or sociopathy, their pedigrees were similar to those seen in classical bipolar manic-depressive illness; furthermore, 44% of the cyclothymic group experienced brief hypomanic episodes while taking tricyclic drugs, and 35% developed full-blown hypomanic, manic, or depressive episodes during drug-free follow-up. The authors conclude that these findings provide evidence for a cyclothymic-bipolar spectrum.