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SAGE Open Medical Case Reports 2023Nicolau syndrome is a rare condition characterized by severe pain at the site of injection, leading to ulceration and necrosis of the local tissues. Its presentation is...
Nicolau syndrome is a rare condition characterized by severe pain at the site of injection, leading to ulceration and necrosis of the local tissues. Its presentation is usually acute. Nicolau syndrome is commonly seen in patients after intramuscular, intra-articular, or subcutaneous injections of non-steroidal anti-inflammatory drugs, antiepileptics, antipsychotics, antibiotics, antihistamines, and corticosteroids. Immediate diagnosis and management of this syndrome are of great importance. We herein report a rare presentation of Nicolau syndrome in a 36-year-old married male who suffered from paranoid schizophrenia for the past 3 years. The patient presented with dull pain, mild swelling, and necrotic ulceration over the injection site after receiving intramuscular fluphenazine. The patient underwent wound debridement and was given prophylactic antibiotics. Despite a wide range of therapeutic options for the management of Nicolau syndrome described in the literature, there exist limited guidelines for its management.
PubMed: 37440972
DOI: 10.1177/2050313X231180747 -
Annals of Agricultural and... Jun 2023The aim of the study was to evaluate the peripheral level of brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) during rehabilitation...
INTRODUCTION AND OBJECTIVE
The aim of the study was to evaluate the peripheral level of brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) during rehabilitation therapy, combined with neurofeedback in schizophrenic patients, and to investigate whether these biomarkers are related to psychopathological symptoms, changes in auditory evoked potentials (AEPs), and quantitative EEG (QEEGs) mapping.
MATERIAL AND METHODS
The study involved two groups of patients diagnosed with paranoid schizophrenia in partial remission who participated in a 3-month structured rehabilitation programme combined with neurofeedback (REH group) and a standard support group (CON group). The following parameters were assessed: BDNF and MMP-9 serum levels, AEPs, QEEGs, and psychopathological symptoms (PANSS).
RESULTS
A clinical improvement within the 3-month rehabilitation therapy course was correlated with the increase in BDNF and MMP-9 serum level. Despite the increase in BDNF and MMP-9 during the 3-month rehabilitation therapy, it was not possible to demonstrate any strong and significant correlation between the 2 examined neuropeptides. During the 3-month rehabilitation therapy, the theta waveform share reduction in QEEG, P50 latency reduction and amplitude increase correlated with PANSS Total and MMP-9 results.
CONCLUSIONS
All clinical (PANSS Positive, Negative, General, Total) and biochemical results (BDNF, MMP-9) of the REH group changed significantly over the 3-month period. Positive symptoms improved only in the CON group.
Topics: Humans; Brain-Derived Neurotrophic Factor; Matrix Metalloproteinase 9; Patients; Pilot Projects; Schizophrenia
PubMed: 37387382
DOI: 10.26444/aaem/163327 -
Schizophrenia Bulletin Sep 2023While the evolution of our modern concepts of mania and melancholia over the 19th century is relatively well-understood, no such clear narrative exists for the...
While the evolution of our modern concepts of mania and melancholia over the 19th century is relatively well-understood, no such clear narrative exists for the nonaffective psychotic syndromes that culminated in Kraepelin's concept of dementia praecox in 1899. These narratives were relatively distinct in Germany and France. An important milestone in the French literature is the 1852 essay by the alienist and polymath Charles Lasègue which contained the first detailed modern description of a persecutory delusional syndrome. Lasègue was a careful clinical observer who emphasized a symptomatic approach to psychiatric nosology and was less concerned with course and outcome. He details the evolution of persecutory delusions from increasing referential observations of real events, to the resulting anxious confusion and then the emergence of explanatory delusional beliefs. Once formed, these beliefs, he notes, are relatively impervious to correction. Lasègue was unusual for his time in emphasizing a "first-person perspective" on psychotic experiences, and quotes from his patients in his case history, of which he presents 15. Of these, 12 had auditory hallucinations and 4 passivity phenomena. While conceptualized differently than mid-19th century pre-Kraepelinian German writing on delusional syndromes, and unique on its focus on persecutory delusions, Lasègue's important essay shared a common view on the key features of a broad nonaffective delusional-hallucinatory syndrome. It was this syndrome that Kraepelin, over multiple drafts in the first 6 editions of his textbook from 1883 to 1899, was to divide into his mature concepts of paranoia and the paranoid subtype of dementia praecox.
Topics: Humans; History, 19th Century; Delusions; Syndrome; Psychiatry; Paranoid Disorders; Hallucinations; Schizophrenia
PubMed: 37318157
DOI: 10.1093/schbul/sbad086 -
Ideggyogyaszati Szemle May 2023
Although rumination and schizotypal traits can be considered transdiagnostic phenomena and can occur within non-clinical population as well, a relatively small...
BACKGROUND AND PURPOSE
Although rumination and schizotypal traits can be considered transdiagnostic phenomena and can occur within non-clinical population as well, a relatively small number of research has been carried out on the topic involving both patient and non clinical participants. The aim of this study is to examine the relationship between schizotypal traits and rumination using a transdiagnostic approach, involving participants living with psychotic disorders and sine morbo individuals.
.METHODS
We recruited participants living with psychotic disorders (paranoid schizophrenia, hebephrenia, schizoaffective disorder, etc.) (n = 30) and controls who had not been diagnosed with any mental illnesses (n = 67). The connection between rumination and schizotypal traits was examined by self-report questionnaire method in a cross-sectional arrangement. The Oxford-Liverpool Inventory was used to measure schizotypal traits, and the Ruminative Thought Style Questionnaire was used to determine the level of rumination.
.RESULTS
Schizotypal symptoms (β = 0.575; p < 0.001), especially cognitive disorganization (β = 0.459; p < 0.001) and unusual experiences (β = 0.221; p = 0.029) significantly explained the degree of rumination.
.CONCLUSION
Our results support the hypothesis that the association between rumination and schizotypic traits is due to decreased cognitive inhibitory functions.
.Topics: Humans; Schizotypal Personality Disorder; Cross-Sectional Studies; Psychotic Disorders; Surveys and Questionnaires; Personality
PubMed: 37294028
DOI: 10.18071/isz.76.0149 -
Psychiatric Services (Washington, D.C.) Dec 2023Black adults in the United States are more likely to be diagnosed as having schizophrenia spectrum disorders and to report experiences of paranoia than are White adults....
Black adults in the United States are more likely to be diagnosed as having schizophrenia spectrum disorders and to report experiences of paranoia than are White adults. Cultural mistrust, or marginalized groups' adaptive skepticism toward dominant historically White institutions, is associated with paranoia among Black individuals, suggesting that experiences of paranoia may be culturally mediated. The authors aimed to explore thematic differences between Black and White adults with schizophrenia spectrum disorders in their experiences of paranoia, including potential differences in persecutory content, cultural mistrust, and related themes. The authors conducted a thematic content analysis of archival qualitative data on experiences of paranoia reported by Black and White adults with schizophrenia spectrum disorders (N=21) in a structured clinical interview. Distinct themes related to cultural mistrust and persecutory paranoia emerged among the participants, suggesting that lived experiences of persecution and discrimination may affect how Black adults with schizophrenia spectrum disorders interpret threat and express paranoia. These findings highlight the importance of culturally responsive approaches in assessment and conceptualization of clinical paranoia versus cultural mistrust.
Topics: Adult; Humans; Paranoid Disorders; Schizophrenia; White; Interpersonal Relations
PubMed: 37254507
DOI: 10.1176/appi.ps.20220089 -
Frontiers in Oncology 2023Malignant peripheral nerve sheath tumors (MPNSTs) are a group of rare soft tissue sarcomas of mesenchymal origin. These tumors generally require extensive local excision...
INTRODUCTION
Malignant peripheral nerve sheath tumors (MPNSTs) are a group of rare soft tissue sarcomas of mesenchymal origin. These tumors generally require extensive local excision owing to their aggressive potential. Though the role of radiotherapy is controversial, in this report, we present the case of an MPNST in the forearm that was treated with microsurgery followed by image-guided radiation therapy to achieve complete tumor disappearance at the 18-month follow-up.
CASE REPORT
A 69-year-old woman with underlying paranoid schizophrenia was referred to our department with pain, severe swelling, and ecchymosis of her right forearm. Physical examination showed hypoesthesia in the segments innervated by the median nerve and reduced motor strength of her right hand. A gadolinium-enhanced MRI showed a large malignant peripheral nerve sheath tumor (13 x 8 x 7 cm) of the median nerve in the forearm. She underwent microsurgical en-bloc tumor resection with sparing of the median nerve. Thirty-five days postoperatively, she underwent image-guided radiotherapy (IGRT) using volumetric modulated arc therapy (VMAT). Serial MRI scans of the forearm with Gadolinium and whole-body CT scan with contrast enhancement at 30 days, 6 months, 1 year, and 18 months postoperatively documented no tumor recurrence, remnants, or metastases.
CONCLUSIONS
In this report, we demonstrate the successful use of advanced radiotherapy techniques such as IGRT while avoiding demolitive surgery for MPNST. Though a longer follow-up is necessary, at the 18-month follow-up, the patient demonstrated good outcomes from surgical resection followed by adjuvant RT for MPNST in the forearm.
PubMed: 37182190
DOI: 10.3389/fonc.2023.1129537 -
Trials Apr 2023Young people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure...
VR-SOAP, a modular virtual reality treatment for improving social activities and participation of young people with psychosis: a study protocol for a single-blind multi-centre randomized controlled trial.
BACKGROUND
Young people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Causes of these problems are multifaceted, but culminate in difficulties with interacting in daily life social situations. Current treatments have only moderate effects on social functioning and often target one specific domain. Virtual reality (VR) has the potential to improve the treatment of social interaction difficulties. We developed a modular VR treatment for social functioning and participation (VR-SOAP). In this study, the effect of this intervention will be investigated in a randomized controlled trial (RCT).
METHODS
A total of 116 participants (age 18-40) with a DSM-5 diagnosis of schizophrenia spectrum or other psychotic disorder and problems with social functioning will be recruited from mental healthcare institutes in the Netherlands. Participants will be randomized to the experimental condition (VR-SOAP) or active VR control condition (VRelax). VR-SOAP consists of 14 sessions and 5 modules addressing causes of impaired social functioning: four optional modules (1-4) and one fixed module (5). Vrelax consists of 14 sessions that entail psychoeducation, stress management, relaxation techniques, and the exploration of relaxing environments in VR. Primary outcomes are quantity and quality of social contacts, leisure activities and social participation, measured with the experience sampling method (ESM). Secondary outcomes are psychiatric symptoms, social behaviour, social cognition, self-esteem, self-stigma and paranoid thoughts. Treatment effects will be compared at pre-treatment (baseline), post-treatment and at 6-month follow-up.
DISCUSSION
If VR-SOAP proves to be effective, it provides therapists with a much-needed tool to improve social functioning of young adults with a psychotic disorder. Additionally, since the treatment consists of multiple modules targeting different transdiagnostic factors, this trial might provide input for new treatments to improve social functioning in a range of symptoms and disorders, e.g. mood, autism spectrum and anxiety disorders.
TRIAL REGISTRATION
On the 10th of November 2021, this trial was registered prospectively in the Dutch Trial Register as NL9784 .
Topics: Young Adult; Humans; Adolescent; Adult; Cognitive Behavioral Therapy; Treatment Outcome; Psychotic Disorders; Social Behavior; Virtual Reality; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 37061694
DOI: 10.1186/s13063-023-07241-z -
Psychiatria Danubina 2023The objective of the study was to evaluate safety and tolerability of tDCS treatment in schizophrenia patients. Our results confirm already established evidence that...
INTRODUCTION
The objective of the study was to evaluate safety and tolerability of tDCS treatment in schizophrenia patients. Our results confirm already established evidence that tDCS is a very safe and well tolerated method of non-invasive brain stimulation for patients with schizophrenia.
SUBJECTS AND METHODS
Database of 219 tDCS sessions in patients with paranoid schizophrenia has been analyzed.
RESULTS
During 219 tDCS sessions there were no serious adverse effects. All adverse effects were mild to moderate and transitory and the most frequent were: itching/tingling (81%), burning (53%) or heat sensation (48%) and skin reddening (35%). Itching/tingling and burning sensation were also frequently reported as at least moderately severe. All major adverse events (itching/tingling, burning/heat sensation) were more often localized by patients under the anodal pad. Men were more prone to experience some adverse events (itching/tingling, burning/heat sensation, skin reddening, metallic taste and tiredness). Most of the adverse events had their onset at the beginning of tDCS session, resolved by the end of tDCS session (with the exception of skin reddening, which recovered within 30 minutes after stimulation) and were associated with mild or moderate distress.
CONCLUSION
Our results confirm already established evidence that tDCS is a very safe and well tolerated method of non-invasive brain stimulation for patients with schizophrenia.
Topics: Male; Humans; Adult; Transcranial Direct Current Stimulation; Schizophrenia; Pruritus
PubMed: 37060590
DOI: 10.24869/psyd.2023.33 -
Clinical Medicine Insights. Case Reports 2023Delusion of pregnancy is defined as a persistent belief that one is pregnant despite concrete evidence to the contrary. Despite being reported as an isolated event,...
Delusion of pregnancy is defined as a persistent belief that one is pregnant despite concrete evidence to the contrary. Despite being reported as an isolated event, delusion of pregnancy has been reported in many patients with underlying psychiatric conditions such as schizophrenia, bipolar disorder, psychotic depression, and other physiological disorders of mental function. This case study reports a case of a 44-year-old, drug-naïve female with delusion of pregnancy affected by paranoid schizophrenia. Pharmacological treatments are frequently insufficient in controlling this condition and are often supplemented with adjunctive psychotherapy.
PubMed: 37033675
DOI: 10.1177/11795476231161169 -
Cureus Feb 2023Tachy-brady syndrome is the result of sinus node dysfunction (SND), an electrocardiographic phenomenon caused by defective pacemaker functioning that leads to...
Tachy-brady syndrome is the result of sinus node dysfunction (SND), an electrocardiographic phenomenon caused by defective pacemaker functioning that leads to alternating arrhythmias. We present a case of a 73-year-old male with multiple mental health and medical comorbidities who was admitted to the inpatient floor for catatonia, paranoid delusions, refusal to eat, inability to cooperate with activities of daily life, and generalized weakness. Upon admission, a 12-lead electrocardiogram (ECG) showed an episode of atrial fibrillation with a ventricular rate of 64 beats per minute (bpm). During hospitalization, telemetry recorded a variety of arrhythmias such as ventricular bigeminy, atrial fibrillation, supraventricular tachycardia (SVT), multifocal atrial contractions, and sinus bradycardia. Each episode spontaneously reverted and the patient remained asymptomatic throughout these arrhythmic changes. These frequently fluctuating arrhythmias on resting ECG confirmed the diagnosis of tachycardia-bradycardia syndrome, also known as tachy-brady syndrome. Medical intervention, especially for cardiac arrhythmias, in patients with paranoid and catatonic schizophrenia can be challenging, as they might not share their symptoms. Additionally, certain psychotropic medications can also cause cardiac arrhythmias and must be carefully evaluated. The decision was made to start the patient on a beta-blocker and direct oral anticoagulation for reducing the risk of thromboembolic events. Due to an unsatisfactory response to drug therapy alone, the patient qualified as a candidate for definitive treatment with an implantable dual-chamber pacemaker. Our patient had a dual-chamber pacemaker implanted to prevent bradyarrhythmias and continued oral beta-blockers to prevent tachyarrhythmias.
PubMed: 37007363
DOI: 10.7759/cureus.35557