UN ESPEJO ABOMINABLE
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En 1975, el doctor Oliver Sacks visita un hospital en Nueva York y entra en contacto con Jimmie, un hombre de 49 años, envejecido prematuramente, descrito como “desvalido, demente, confuso, desorientado”. Jimmie se aterroriza cuando el doctor le muestra 2/ un espejo. El paciente pregunta si se trata de una pesadilla, de una broma, si se ha vuelto loco. No puede creer que el espejo le muestra las canas de un hombre maduro sobre un rostro arrugado. Jimmie cree sinceramente que tiene 19 años. El doctor lo tranquiliza, le dice que

Mortality in people with #depression: a large-scale systematic review and meta-analysis of relative risk and aggravating or attenuating factors, including antidepressant treatment.

An important paper!

What can we learn from it?
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onlinelibrary.wiley.com/doi/full/10.10… 2/8 The authors conducted a meta-analysis of cohort studies to synthesize mortality risk estimates associated with #depression due to any and specific causes, and when depression is accompanied by comorbid conditions. Effects of antidepressant medication and ECT were evaluated.

Me invitaron a la Academia de Medicina de México a participar en un evento bastante atípico acerca del pensamiento posmoderno y su influencia sobre las humanidades médicas y la cultura de la salud. Estos son algunos de los puntos que me parecieron dignos de atención: Estoy lejos de ser un conocedor en la materia. Como otros lectores curiosos, leí en las últimas décadas los libros de Lyotard, Jameson, Rorty, Bauman, Lipovetsky, Vattimo, Habermas, acerca del posmodernismo en las artes y el pensamiento, y acerca de la "condición posmoderna"

1/14 Al estudiar las condiciones neuropsiquiátricas, necesitamos un abordaje doble. Hay un aspecto neuropatológico, es decir, un conjunto de procesos neuronales alterados por la patología, y el análisis de esos patrones biológicos nos ofrece claves esenciales para una explicación 2/ mediante una perspectiva en tercera persona. Con esto me refiero a la perspectiva de un observador externo que usa controles de calidad para garantizar la máxima exactitud y precisión en las mediciones. Pero también hay un aspecto psicopatológico: hay alteraciones conductuales

"Biomarkers of inflammation are associated with an overrepresentation of neurovegetative symptoms, including anhedonia, fatigue, and psychomotor slowing."

Advancing an Inflammatory Subtype of Major Depression | American Journal of Psychiatry
1/4 psychiatryonline.org/doi/10.1176/ap… 2/4
Increased levels of biomarkers of inflammation are associated with an overrepresentation of neurovegetative symptoms, including anhedonia, fatigue, and psychomotor slowing, and can predict response to antidepressant treatments. Importantly, however, increased inflammatory

#Psychosis of autoimmune origin? What are the features? Is there a therapeutic response to immunotherapy?

Welcome to our new paper!
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1/We studied the psychopathological patterns & outcomes following immunotherapy in 164 cases of autoimmune psychosis
sciencedirect.com/science/articl… 2
*1406 patients with a syndromic diagnosis of psychosis were hospitalized at the National Institute of Neurology & Neurosurgery of Mexico (2016-2024). An autoimmune origin was suspected in 195 patients (13%) After diagnostic workup, 164/195 cases were diagnosed by the neurology

1/ Prosigo con la crítica a las ideas antipsiquiátricas de la Dra Froxán (y su escuela). Dice que "la psiquiatría es una disciplina sin fundamento." Esto se basa en la dicotomía según la cual solo hay a) enfermedades cerebrales o b) problemas psicológicos que no son biológicos ni 2/ patológicos. La posición de la psiquiatría es: a) existen enfermedades cerebrales que no afectan significativamente la organización del comportamiento, b) existen enfermedades cerebrales que afectan significativamente la organización del comportamiento, por alteración de

Musical Hallucinations, or Musical Obsessions?
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For the past 6 months, a 67-year-old man suffers from long episodes in which he 'hears in his head' a series of repetitive songs that he had previously performed with his musical group, but had not heard in recent years. 2/7
...these are Mexican romantic songs of a popular nature. He experiences repetitive cycles of a single verse of the song, which begin in the morning and persist throughout the day, at a high volume, making it difficult for him to focus on events around him. The patient says

"We present a classification of depressive episodes based on the proximate mechanisms that led to the original mood change that caused the depressive episode. We identify discrete depression subtypes that are induced by: 1) infection, 2) long-term stress

sciencedirect.com/science/articl… 3) loneliness, 4) traumatic experience, 5) hierarchy conflict, 6) grief, 7) romantic rejection, 8) postpartum events, 9) the season, 10) chemicals, 11) somatic diseases and 12) starvation. We further examine the ultimate functions of these subtypes and show that not all types of

The debate on function & dysfunction in mental disorders is important. But this blog makes a superficial approach to the Capgras delusion. There is no explanation in terms of function or dysfunction. It seems that there is only another bit of denialism
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https://twitter.com/EpistInnocence/status/1816367787738124296

2/10 Fagerberg & Garson start with an example of the Capgras delusion: Riad thinks that her wife has been replaced by a "perfect impostor". Two features need to be explained: 1) the misidentification problem (Riad cannot identify his wife), & 2) the reduplication problem (Riad

In the field of #Neuropsychiatry, we deal with complex problems. Consider the case of a 40 year old man with a persistent somatic delusion after a traumatic brain injury. He grew up in an environment of poverty & social violence. He used several drugs during his youth
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The most dangerous drugs he used were inhalants. At age 25, he suffered a severe traumatic brain injury, leading to a brain hemorrhage in the frontal pole & a coma state. He survived, but in the weeks after the recovery he started to suffer from delusions & hallucinations,

Allow me to share this new case study on #delusions of love & pasion in the behavioral variant of frontotemporal #dementia
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At age 59, after the death of her husband & after the loss of her son to suicide, Mrs M showed features of the so-called Clerambault delusion... 2/7
According to Mrs M, she & Mr. D were deeply in love; he had stopped drinking so they could marry soon. They would go to Costa Rica for their honeymoon. Mrs. M had packed her suitcases & waited for Mr D to pick her from home, for several weeks. But the daughter explained that/

Shaping Memories via Stress: A Synaptic Engram Perspective

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#Stress modulates the activity of #memory systems. At the cellular level, #noradrenaline & glucocorticoid release induced by acute stress exposure affects synapse function & plasticity...
sciencedirect.com/science/articl…
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...which are critical substrates for learning & memory. Recent evidence suggests that memories are supported in the brain by sparsely distributed neurons within networks, termed engram cell ensembles. While the physiological and molecular effects of stress on the synapse are

Warning: very long 🧵👀🤡
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Some persons (critics or defenders of psychiatry) asked me in good faith to openly discuss my characterization of "anti-psychiatry". I will do so in good faith. I believe that at least 4 categories can be identified: 1) Uncritical psychiatry, 2/25
2) Self-critical psychiatry, 3) Critics of psychiatry, & 4) Anti-psychiatry. I will not focus on categories #1 & #2 as it is not the aim of this analysis, but I believe good psychiatrists fall into category #2. IMO, critics of psychiatry focus on debating the scientific...

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My own thoughts on "mental disorders as brain disorders": Kendler's approach represents an advancement from a purely metaphysical perspective, but it appears to be applicable only (partially) to disorders with high genetic risk such as schizophrenia, bipolar disorder, autism,

https://twitter.com/JRBneuropsiq/status/1763959370679804358

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ADHD, excluding others. Even within the high-risk categories, the known genetic variables don't account for all the cases falling under these diagnoses. IMO, genetic risk doesn't necessarily validate these whole categories as brain diseases, but rather, it suggests that...

1/7 Ways in which major #depression may be concieved as an illness (I won't use the concept of 'disease'):
a) A significant increase in the risk of premature death
b) Functional disability
c) A change of the organism's interaction pattern in a way that jeopardizes the organism’s

https://twitter.com/tolchinsky/status/1742169918139724064

2/7 ...integrity
d) a significant loss of quality of life and psychological well-being due to intense and prolongued emotional suffering
e) a significant dysfunction in cognitive processes
f) a significant amount of physical symptoms, like pain, autonomic symptoms, gastro-

1/5 The use of clinical neuroimaging in #psychiatry is essential for excluding the presence of brain pathologies that may underlie atypical psychopathological patterns. A system of red flags proves useful in refining the selection of patients who necessitate clinical neuroimaging

https://twitter.com/JRBneuropsiq/status/1732200002477228197

2/5 ...Throughout the process, clinicians should consider the importance of a) Syndromal, b) Topographic, & c) Etiological levels of diagnostic reasoning

Level #1 calls for a careful semiological assessment which relies on descriptive psychopathology, phenomenology,clinimetrics,

1/7 Many academics argue that 'mental disorders' & 'neurological diseases' are mutually exclusive, 'essentially different', but the fact is that many neurological diseases are causally related to mental health/psychiatric disorders. I'll give some examples 👇🏼🧵

https://twitter.com/ISEPPDirector/status/1711384570019406225

2/7 Epilepsy is always a neurological disease, but many patients with this condition unfortunately develop mental health problems such as psychosis. In this case, the neurological & the psychiatric are not synonyms, but they are not mutually exclusive, in fact, they're related

1/5 A friend brought his mother to the hospital. She had been diagnosed with Alzheimer's & Parkinson disease. She had signs of both diseases, but this confluence is rare. By looking at the history, I found out that she was taking many drugs & that it all started with #anxiety... 2/5 ...a GP prescribed a comercial formula that combines a low dose of antipsychotic & a benzodiacepine. The patient developed Parkinsonism as a side effect. She suspended the drug & went to a neurologist who thought that it was really Parkinson disease, and gave her l-dopa...

1/13 Periódicamente los especialistas en Psiquiatría debemos hacer una réplica razonada y basada en evidencia frente a las críticas que surgen en los medios académicos. Crítica: "El modelo biomédico tiene escasa o nula evidencia." Respuesta: El modelo médico en psiquiatría... 2/13 ...no debe caracterizarse como "biomédico", ya que es un modelo que integra variables biológicas, psicológicas y sociales, si bien es válida la crítica de que la dimensión social y psicológica está insuficientemente implementada; en última instancia esto requiere...

Clinical case! 🧠💭🧵
1/7 A 26-year-old woman from a rural region of Mexico presented in a state of catatonia. At age 21, she begun to exhibit aggressiveness. At age 23, she started having difficulties handling money, she constantly misplaced things. Sometimes she was disoriented 2/7 At age 26, 2 days after delivering her first child, she had a (first) psychotic episode, with incoherent speech, disorganized behavior, aggressiveness, visual & auditory hallucinations. She neglected her newborn, saying repeatedly that the child was not hers.