The bridge between classical and ‘synthetic’/chemical psychoses: towards a clinical, psychopathological and therapeutic perspective

© 2019 Orsolini, Chiappini, Papanti, De Berardis, Corkery and Schifano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.The critical spread and dissemination of novel psychoactive substances (NPS), particularly among the most vulnerable youngsters, may pose a further concern about the psychotic trajectories related to the intake of new synthetic drugs. The psychopathological pattern of the “new psychoses” appears to be extremely different from the classical presentation. Therefore, clinicians need more data on these new synthetic psychoses and recommendations on how to manage them. The present mini-review aims at deepening both the clinical, psychopathological features of synthetic/chemical NPS-induced psychoses and their therapeutic strategies, according to the different NPS classes implicated, by underlining the main differences with the “classical” psychoses. A comprehensive review was conducted using the PubMed/Medline database by combining the search strategy of free-text terms and exploding a range of MESH headings relating to the topics of novel psychoactive substances and synthetic/chemical psychoses as follows: {(Novel Psychoactive Substances[Title/Abstract]) AND Psychosis[Title/Abstract])} and for each NPS categories as well, focusing on synthetic cannabinoids and cathinones, without time and/or language restrictions. Finally, an overview of the main clinical and psychopathological features between classical versus NPS-induced chemical/synthetic psychoses is provided for clinicians working with dual disorders and addiction psychiatry. Further insight is given here on therapeutic strategies and practical guidelines for managing patients affected with synthetic/chemical NPS-induced psychoses.Peer reviewedFinal Published versio

Recreational use, analysis and toxicity of tryptamines

The definition New psychoactive substances (NPS) refers to emerging drugs whose chemical structures are similar to other psychoactive compounds but not identical, representing a "legal" alternative to internationally controlled drugs. There are many categories of NPS, such as synthetic cannabinoids, synthetic cathinones, phenylethylamines, piperazines, ketamine derivatives and tryptamines. Tryptamines are naturally occurring compounds, which can derive from the amino acid tryptophan by several biosynthetic pathways: their structure is a combination of a benzene ring and a pyrrole ring, with the addition of a 2-carbon side chain. Tryptamines include serotonin and melatonin as well as other compounds known for their hallucinogenic properties, such as psilocybin in 'Magic mushrooms' and dimethyltryptamine (DMT) in Ayahuasca brews

Hallucinations and dyskinesia with pramipexole in parkinson’s disease-a case report

Pramipexole, a dopamine agonist has a tendency to induce psychotic symptoms, when used to treat Parkinson’s disease (PD). In most of the cases, patient’s psychosis developed after addition of Pramipexole and exacerbated after increasing the dosage. However there has been no case report in which Pramipexole has caused psychosis at lowest starting dose without any add on drug. Here we present a case of PD in which dyskinesia and psychosis appeared with first dose of Pramipexole, as low as 0.125mg. The patient was a 76 year old man with a one year history of PD. One year back patient observed tremors in his hand and slowing of movements. The neurologist prescribed Syndopa plus - 125, Benzhexol (schedule also same as Syndopa) and Pramipexole 0.125 mg at bedtime. The patient decided to start all medicines next day except Pramipexole (125mg) which he took at bed time. Within half an hour, patient started having visual and auditory hallucinations, along with abnormal movements and myoclonic jerks of hand, feet and mouth. He could be seen doing movements as if he is inserting needle in thread. According to him, he could visualize thieves trying to steal his car. Dechallenge with Pramipexole led to complete resolve of psychotic symptoms. After 4 weeks of therapy, there was a gradual but steady improvement in dyskinesia and tremors except slurring in speech

The integration of ego psychological and cognitive behavioral interventions for first episode psychosis : strengthening the self and treating the symptoms

This theoretical study is an exploration of the use of ego psychological and cognitive behavioral interventions as an integrative treatment for the beginning phase of schizophrenia known as first episode psychosis. Schizophrenia develops as first episode psychosis in young adults who are navigating complex developmental tasks. Current research on schizophrenia treatment indicates that appropriate and prompt care following first episode psychosis improves prognosis and allows individuals to regain and maintain developmentally appropriate levels of functioning. This study was undertaken in an effort to identify the holistic treatment needs of young adults experiencing first episode psychosis. The clinical phenomenon of schizophrenia and first episode psychosis was described. Then schizophrenia was conceptualized from an ego psychological and cognitive behavioral orientation. Treatment methods associated with each methodology were detailed and each theory was applied to first episode psychosis. The two theoretical orientations, ego psychology and cognitive behavioral treatment, were applied to a first episode psychosis case. A discussion follows which highlights the importance of utilizing interventions from both modalities to ensure treatment needs are met for first episode psychosis clients

Bringing the "self" into focus: conceptualising the role of self-experience for understanding and working with distressing voices

A primary goal of cognitive behavior therapy for psychosis (CBTp) is to reduce distress and disability, not to change the positive symptoms of psychosis, such as hearing voices. Despite demonstrated associations between beliefs about voices and distress, the effects of CBTp on reducing voice distress are disappointing. Research has begun to explore the role that the psychological construct of “self” (which includes numerous facets such as self-reflection, self-schema and self-concept) might play in causing and maintaining distress and disability in voice hearers. However, attempts to clarify and integrate these different perspectives within the voice hearing literature, or to explore their clinical implications, are still in their infancy. This paper outlines how the self has been conceptualised in the psychosis and CBT literatures, followed by a review of the evidence regarding the proposed role of this construct in the etiology of and adaptation to voice hearing experiences. We go on to discuss some of the specific intervention methods that aim to target these aspects of self-experience and end by identifying key research questions in this area. Notably, we suggest that interventions specifically targeting aspects of self-experience, including self-affection, self-reflection, self-schema and self-concept, may be sufficient to reduce distress and disruption in the context of hearing voices, a suggestion that now requires further empirical investigation

Transcranial Magnetic Stimulation in Schizophrenia

Transcranial magnetic stimulation (TMS) is a method that can be used in neurophysiological research of schizophrenia and in the treatment of some symptoms or syndromes of this mental disorder. The most important indications for TMS (or repetitive TMS—rTMS) are the negative symptoms of schizophrenia and auditory hallucinations. Other less proven indications include cognitive deficit, especially working memory. This text summarizes general knowledge about (r)TMS and its use in schizophrenia. According to recent experiences, TMS is a very promising experimental and therapeutic method, but it needs further research for its optimized use

Estado Confusional Agudo após Corticoterapia Inalada

Background: The connection between corticotherapy and neuropsychiatric symptoms is widely known, being one of the first questions we need to assess when presenting with first episode psychiatric symptoms or confusional state. Aims: To date, data on cases related to inhaled corticotherapy and neuropsychiatric effects is scarce. In this paper we describe a rare case in a young woman. Methods: The clinical case presented led us to try to understand the data published on the subject in order to discuss it in greater length. Results and Conclusions: We present and discuss a 27-year-old patient’s case, with no previous psychiatric disease, who was admitted to our Psychiatric ward after the onset of severe acute behavioural disturbance characterized by aggressiveness, visual and auditory hallucinatory activity, misidentification and altered conscience status. It was later found that seven days earlier she had been prescribed inhaled corticotherapy for a minor respiratory infection. A few days after corticotherapy withdrawal, the clinical symptoms improved significantly.info:eu-repo/semantics/publishedVersio

Previše ili premalo? Poremećaji djelovanja na spektru

Disorders of agency could be described as cases where people encounter difficulties in assessing their own degree of responsibility or involvement with respect to a relevant action or event. These disturbances in one’s sense of agency appear to be meaningfully connected with some mental disorders and with some symptoms in particular—i.e. auditory verbal hallucinations, thought insertion, pathological guilt. A deeper understanding of these experiences may thus contribute to better identification and possibly treatment of people affected by such disorders. In this paper I explore disorders of agency to flesh out their phenomenology in more detail as well as to introduce some theoretical distinctions between them. Specifically, I argue that we may better understand disorders of agency by characterizing them as dimensional. In §1 I explore the cases of Auditory Verbal Hallucinations (AVH) and pathological guilt and I show that they lie at opposite ends of the agency spectrum (i.e. hypoagency versus hyperagency). In §2 I focus on two intermediate cases of hypo- and hyper- agency. These are situations that, despite being very similar to pathological ones, may be successfully distinguished from them in virtue of quantitative factors (e.g. duration, frequency, intensity). I first explore the phenomenon of mind wandering as an example of hypoagency, and I then discuss the phenomenon of false confessions as an example of hyperagency. While cases of hypoagency exemplify situations where people experience their own thoughts, bodies, or actions as something beyond their control, experiences of hyperagency provide an illusory sense of control over actions or events.Poremećaji djelovanja mogu se opisati kao slučajevi u kojima ljudi nailaze na teškoće u procjeni svojeg stupnja odgovornosti ili sudjelovanja u nekom djelovanju ili događaju. Ove se smetnje u nečijem osjećaju djelovanja čine na značajan način povezane s mentalnim poremećajima, a posebno s nekim simptomima – auditornim halucinacijama verbalnog tipa, umetanjem misli i patološkom krivnjom. Bolje shvaćanje ovih iskustava moglo bi poboljšati prepoznavanje, a možda i tretman ljudi koji pate od takvih poremećaja. U ovom članku proučavam poremećaje djelovanja kako bih detaljnije pojasnila njihovu fenomenologiju te između njih uvela neka teorijska razlikovanja. Konkretnije, tvrdit ću da ćemo poremećaje djelovanja možda moći bolje razumjeti ako ih okarakteriziramo kao dimenzionalne. U prvom dijelu proučavam slučajeve auditornih halucinacija verbalnog tipa (AVH) i patološke krivnje te pokazujem da leže na suprotnim krajevima spektra djelovanja (hipoagencija naspram hiperagencije). U drugom dijelu bavim se dvama međuslučajevima hipo i hiperagencije. Iako su vrlo slične patološkima, ove se situacije mogu uspješno razlučiti od njih na temelju kvantitativnih faktora (poput trajanja, frekvencije i intenziteta). Prvo istražujem fenomen lutanja misli kao primjer hipoagencije, a zatim razmatram fenomen lažnih ispovijesti kao primjer hiperagencije. Dok se slučajevi hipoagencije odnose na situacije u kojima ljudi osjećaju da su njihove misli, tijela i djelovanja izvan njihove kontrole, iskustva hiperagencije pružaju varljiv osjećaj kontrole nad djelovanjem i događajima