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2/10 Fagerberg & Garson start with an example of the Capgras delusion: Riad thinks that her wife has been replaced by a "perfect impostor".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.

#Depression is associated with alterations in corticostriatal reward circuitry. One pathophysiological pathway that may drive these changes is #inflammation... ...This study examined whether increased inflammation in depression affects corticostriatal reward circuitry to lead to deficits goal-directed motor behavior. Resting-state fMRI maging was conducted on 48 medically stable, unmedicated outpatients with major depression...

El abordaje del suicidio requiere una transformación política para atender las determinantes sociales, pero también para generar los servicios de salud y de atención psicológica necesarios
#DiaMundialPrevencionSuicidio
1/8 🧵👇 Según la Organización Mundial de la Salud, entre los países con tasas más altas de suicidio se encuentran Groenlandia, Lituania, Rusia, Corea del Sur, Japón, Bélgica y Sudáfrica. En el extremo opuesto, Jordania, Filipinas, Indonesia, Turquía y Argelia tienen cifras muy bajas. 2/8

"Machine Consciousness is a Metaphor"
@BernardJBaars talking about Wilder Penfield... as should be! The "Penfield test"

This is a relevant meta-analysis:

Cerebrospinal Fluid (CSF) Biomarkers in Patients With Unipolar #Depression Compared With Healthy Control Individuals ja.ma/3EAO4xt a través de @JAMAPsych part of @JAMANetwork .

1/ What are the main results? A small🧵😉 2/ It is a systematic review & meta-analysis of 97 studies. CSF levels of interleukin 6 and cortisol were higher among patients with unipolar depression. Levels of homovanillic acid, γ-aminobutyric acid, somatostatin, brain-derived neurotrophic factor, amyloid-β 40, were lower.

When caring for patients with psychopathological problems, sometimes the clinician must consider whether the patient has an underlying neurological condition. When should we order diagnostic studies (brain imaging and others) in #Psychiatry? Here are some general recommendations: 1) Abnormal neurological examination. A neurological clinical exam showing abnormal sensitive, motor or autonomic signs.

As an example: a woman had a new onset of psychotic #depression. The presence of visual impairment was the clue to indicate a MRI, which showed a brain tumor

Conversábamos @fhernandhah y yo sobre la validez de los experimentos mentales en el marco de la ciencia. ¿Tiene valor científico un experimento que no se realiza mediante la manipulación de lo real, sino que surge como un juego imaginativo estructurado mediante el rigor lógico? Si alguien no está familiarizado con el concepto de los experimentos mentales, diré que han sido un recurso imaginativo y lógico de la filosofía desde la antigüedad, y un recurso de la tradición científica a partir de los tiempos de Galileo.

1/5 Si hoy se discute el estatus epistemológico del psicoanálisis, la perspectiva histórica nos muestra que fue una avenida importante para el desarrollo intelectual de algunas mujeres que vivían, como Sabina Spielrein, las consecuencias de la opresión patriarcal. 2/5 El psicoanálisis tiene un lado oscuro anclado en su propia versión del culto al patriarca, pero al menos -en teoría- significó una oportunidad para pensar en forma crítica los desenlaces psicopatológicos y culturales del patriarcado como estructura psicológica y social.