Episodic Ataxia vs Somatization Disorder
Notice bibliographique
Résumé
Dear Editor: Charles Bonnet syndrome (CBS) is characterized by complex visual hallucinations in psychologically normal people; it is usually seen in elderly people in the context of ocular pathology causing visual deterioration (1). The main hypothesis is that these hallucinations represent release phenomena attributable to deafferentation of the visual association areas of the cerebral cortex that leads to a form of phantom vision. Most intriguingly, unlike visual hallucinations associated with psychiatric disorders, patients with CBS have insight and report the hallucinations as nonthreatening. Several modalities have been tried to treat this condition, including valpromide (2), reperidone (3), carbamazepine (4), melperone (5), valproate (6), cisapride (7), and ondansetron (8). We report a case of CBS successfully treated with mirtazapine. Case Report An African-American man, aged 59 years, was admitted to a tertiary care community hospital for pneumonia. The patient had a history of type 2 diabetes, chronic renal failure requiring dialysis, and bilateral macular degeneration. His visual acuity was almost hand motion. On the fifth day of his hospitalization, psychiatry was consulted because he was experiencing visual hallucinations. The patient had no psychiatric history and had never taken any psychotropics. To everyone's astonishment, he had been visually hallucinating for at least 3 years and had never mentioned this to any one except his family members. His hallucinations consisted of seeing groups of people and farm animals, more frequently in the evening. They usually occurred during periods of wakefulness and with his eyes open. He reported them as nonthreatening and felt comfortable seeing very vivid pictures. He acknowledged some sleep problems and inconsistent appetite but gave no evidence of having depressive disorder or any other psychiatric condition. His cognition was intact, as he scored 27/30 on the Mini-Mental State Examination (3), only losing points on the visual items. A complete blood count and complete metabolic profile revealed results consistent with chronic renal failure. A magnetic resonance imaging study showed age-related atrophie changes. He was given the diagnosis of CBS, and we started him on mirtazapine 7.5 mg at bedtime. Supportive therapy and therapy to increase insight into his condition were also considered. His antibiotics were gradually weaned as his pneumonia slowly resolved. The patient's sleep pattern improved, and his visual hallucinations remitted within the next 3 days. He had no recurrence of visual hallucinations after a month of follow-up with his primary care physician. We chose mirtazapine for several reasons. First, cisapride and ondansetron are also 5-HT^sub 3^ receptor antagonists (8) and have been shown to treat CBS. Mirtazapine is a presynaptic alpha 2 antagonist that acts by increasing noradrencrgic and serotonergic neurotransmission (8). …
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».