Cannabis and cyclical vomiting

IntroductionTraditionally, cannabis is associated with antiemetic action after acute consumption. However, in 2004 the cannabinoid hyperemesis as paradoxical effect of chronic users, after years of exposure described.ObjectivesDescription of the cannabinoid hyperemesis.MethodOLOGYA case is presented.ResultsClinical case of a woman who repeatedly comes to the emergency service because of abdominal, nausea and vomiting pain.This is cyclical and hardly controllable. The gastroenterology service studied in depth with negative results. She was followed up by mental health borderline personality disorder and she consumed cannabis at an early age, 20–30 joints daily.When she reaches abstinence in short periods, ceases digestive discomfort. However, aprece digestive symptoms with each relapse. The present case showed improvement with cessation of cannabis so it probably was the cannabinoid hyperemesis syndrome.ConclusionsThe cannabinoid hyperemesis is characterized by recurrent episodes of nausea, vomiting, abdominal pain, and chronic cannabis use. Temporary relief is achieved with hot baths. Ceases when abstinence is achieved. It is a clinical entity that does not have much information and requires further study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cannabinoid hyperemesis syndrome in the pregnant patient: clinical case and literature review

International Journal of Emergency Medicine ◽

10.1186/s12245-020-00311-y ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Julien Flament ◽

Nathan Scius ◽

Henri Thonon

Keyword(s):

Differential Diagnosis ◽

Clinical Case ◽

Pregnant Patient ◽

Rapid Improvement ◽

Case Presentation ◽

Pregnancy And Childbirth ◽

Cannabinoid Hyperemesis Syndrome ◽

Return Home ◽

Hot Baths ◽

In Pregnancy

Abstract Background Cannabis use is on the rise. Several cases of cannabinoid hyperemesis syndrome, secondary to chronic cannabis intoxication, have been described worldwide, but few cases have described this entity in pregnant women. Case presentation We describe a 29-year-old pregnant patient that had consumed cannabis and experienced uncontrolled vomiting. The use of hot baths, the rapid improvement in symptoms, and results of complementary examinations suggested a diagnosis of cannabinoid hyperemesis syndrome. The patient could return home, and she continued her pregnancy and childbirth without peculiarities. Conclusion Cannabinoid hyperemesis syndrome should be considered in the differential diagnosis of vomiting in pregnancy. Consumption of cannabis must be systematically included in the anamnesis. However, it seems to be somewhat unacceptable socially or medically. Consumption must be stopped to manage symptoms.

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Cannabinoid Hyperemesis Syndrome in the pregnant patient: clinical case and literature review

10.21203/rs.3.rs-36159/v2 ◽

2020 ◽

Author(s):

Julien Flament ◽

Nathan Scius ◽

Henri Thonon

Keyword(s):

Differential Diagnosis ◽

Clinical Case ◽

Pregnant Patient ◽

Rapid Improvement ◽

Case Presentation ◽

Pregnancy And Childbirth ◽

Cannabinoid Hyperemesis Syndrome ◽

Return Home ◽

Hot Baths ◽

In Pregnancy

Abstract Background Cannabis use is on the rise. Several cases of cannabinoid hyperemesis syndrome, secondary to chronic cannabis intoxication, have been described worldwide, but few cases have described this entity in pregnant women. Case presentation We describe a 29-year-old pregnant patient that had consumed cannabis and experienced uncontrolled vomiting. The use of hot baths, the rapid improvement in symptoms, and results of complementary examinations suggested a diagnosis of cannabinoid hyperemesis syndrome. The patient could return home and she continued her pregnancy and childbirth without peculiarities. Conclusion Cannabinoid hyperemesis syndrome should be considered in the differential diagnosis of vomiting in pregnancy. Consumption of cannabis must be systematically included in the anamnesis. However, it seems to be somewhat unacceptable socially or medically. Consumption must be stopped to manage symptoms.

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Cannabinoid hyperemesis syndrome: definition, pathophysiology, clinical spectrum, insights into acute and long-term management

Journal of Investigative Medicine ◽

10.1136/jim-2020-001564 ◽

2020 ◽

Vol 68 (8) ◽

pp. 1309-1316

Author(s):

Mahesh Gajendran ◽

Joshua Sifuentes ◽

Mohammad Bashashati ◽

Richard McCallum

Keyword(s):

Symptom Control ◽

Well Being ◽

Clinical Entity ◽

Cyclic Vomiting Syndrome ◽

Cannabinoid Hyperemesis Syndrome ◽

Acute Attacks ◽

Hot Baths ◽

Term Management ◽

Cyclic Vomiting

Although cannabinoid hyperemesis syndrome (CHS) was first reported more than 15 years ago, it still remains an unfamiliar clinical entity among physicians worldwide. CHS is categorized by Rome IV classification as a functional gastroduodenal disorder. It is characterized by stereotypical episodic vomiting in the setting of chronic, daily cannabis use, with cycles decreasing by the cessation of cannabis. CHS is also associated with abdominal pain reduced by hot baths and showers with comparative well-being between attacks. Thus, its clinical presentation resembles ‘classic’ cyclic vomiting syndrome, but eliciting a cannabis history is crucial in diagnosing this entity. In acute attacks, parenteral benzodiazepines are very effective. For prevention and long-term management, tricyclic antidepressants such as amitriptyline are the mainstay of therapy requiring doses in the range of 50–200 mg/d to achieve symptom control. In addition, counseling to achieve marijuana cessation, accompanied by antianxiety medications, is necessary for sustaining clinical outcomes. Once the patient is in remission and off marijuana for a period of 6–12 months, then tapering the dose of amitriptyline can be implemented, with the goal of no therapy being achieved in the majority of patients over time. With the legalization of marijuana in many states, CHS will become an increasingly prevalent clinical entity, so educating about CHS is an important goal, particularly for emergency department physicians who generally first encounter these patients.

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Children's trilogy “LILI, from conflict to conflict Medition” (“Lili, do Conflito à Mediação de Conflitos”)

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.464 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S447-S447

Author(s):

C. Gabriela ◽

C. Lima

Keyword(s):

School Environment ◽

The Other ◽

Early Age ◽

The Third ◽

Conflict Mediation ◽

Competing Interest

The author has devoted her life to matters relating to communication, whether in business contexts, or as a mediator, trainer and moderator.The trilogy “Lili, do conflito à Mediação de Conflitos” aims to help create more informed citizens, starting from an early age, namely in terms of the new forms of solving conflicts.In the first book: “Lili and the conflicts” (“Lili e os Conflitos”), we find the theme of conflicts; how to deal with them; respect for the different other; to put oneself in the place of the other.In the second book: “Lili and Conflict Medition” (“Lili e a Mediação de Conflitos”), we find the space created by conflict mediation so the parts in conflict can be heard; the enormous need to listen to the other; the needed empathy so as to know the reality of the other.In the third and final book: “Lili and the Conflict Mediator” (“Lili e o Mediador de Conflitos”), we explain what it is to be a conflict mediator, this “new” profession, distinguishing it from other professions which also use the word “Mediator”.The author makes presentations of the books and its topics, bringing these issues to debate and making them known to the school environment, both to students and teachers, as well as staff and parents.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychogenic stuttering: A case and review

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1389 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S386-S387 ◽

Cited By ~ 2

Author(s):

A. Almada ◽

R. Simões ◽

M. Constante ◽

P. Casquinha ◽

M.J. Heitor

Keyword(s):

Social Life ◽

Sudden Change ◽

Resonance Imaging ◽

Computed Tomography Scan ◽

Motor Abilities ◽

Negative Results ◽

The Social ◽

Competing Interest ◽

Work Up ◽

Tomography Scan

IntroductionStuttering is a speech disorder characterized by involuntary repetition, prolongation or cessation of a sound. This dysfluency may be developmental or acquired. Acquired dysfluency can be classified as neurogenic or psychogenic.ObjectivesThis case report aims to describe and discuss a case of psychogenic stuttering, providing an updated review on this disorder.MethodsIn and outpatient interviews were performed by Neurology and Psychiatry. Investigation to exclude organic causes included lab exams, electrocardiogram, electroencephalography, computed tomography scan and magnetic resonance imaging. A literature review in Science Direct database, with the keywords “psychogenic stuttering”, was also conducted.ResultsA 63-year-old man was admitted to the Beatriz Ângelo Hospital with an acute stuttering. Speech was characterized by the repetition of initial or stressed syllables, little affected by reading out loud or singing. Comprehension, syntaxes and semantic were not compromised, as weren’t sensory and motor abilities. During admission, stuttering characteristics changed. Multiple somatic complaints and stress prior to the onset and bizarre secondary behaviors were also detected. Work-up didn’t show an organic etiology for that sudden change. An iatrogenic etiology was considered, as sertraline and topiramate were started for depression 1 month before. However, the stuttering pattern, the negative results, the psychological and the social life events suggested a psychogenic etiology.ConclusionsPsychogenic stuttering finds its origin in psychological or emotional problems. It is best classified as a conversion reaction. The differential diagnosis between psychogenic and neurological stuttering can be challenging.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychological treatment of trihotillomania: A case study

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.369 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S417-S417

Author(s):

T. Sarmiento Luque ◽

J.M. Sanchez

Keyword(s):

Public Health ◽

Clinical Case ◽

Psychological Treatment ◽

Cognitive Behavioral ◽

Clinical Aspects ◽

Hair Pulling ◽

Behavioral Techniques ◽

Competing Interest ◽

Treatment Procedures

This paper presents a clinical case of trichotillomania. Therefore, the aim of this study is to present in detail the procedure followed in a case of trichotillomania in a public health context, using cognitive-behavioral techniques, in order to deepen the knowledge of the efficacy of these treatment procedures and demonstrate the feasibility of implementation.The results obtained show significant improvements in different clinical aspects: first, the hair pulling behavior disappeared completely; moreover, anxiety diminished significantly and mood normalized. All these results allow us to conclude that the intervention was successful.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Do Mood Stabilizers Help in Borderline Personality Disorder?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.203 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S47-S47

Author(s):

B. Völlm ◽

J. Stoffers-Winterling ◽

J. Mattivi ◽

E. Simonson ◽

O.J. Storebø ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Meta Analysis ◽

Cochrane Review ◽

Evidence Base ◽

Borderline Personality ◽

Mood Stabilizers ◽

Beneficial Effects ◽

Drug Classes ◽

Competing Interest

BackgroundDespite the relatively weak evidence base, individuals with borderline personality disorder are often treated with pharmacological interventions. Amongst the drugs, which have shown most promise, are mood stabilizers, which were one of the two drug classes with the most beneficial effects in a previous cochrane review though the robustness of findings was described as low (Stoffers et al., 2010). Here we present data on the latest evidence for mood stabilizers based on an updated cochrane review currently underway.MethodsA systematic review and meta-analysis of randomized controlled trials was conducted. All randomized comparisons of drug vs. placebo, drug vs. drug, or drug vs. a combination of drugs in adult BPD patients were eligible for inclusion. Outcomes comprised BPD core pathology as depicted by DSM criteria, associated pathology, i.e., depression and anxiety, general measures of overall psychopathology severity, tolerability, and adverse effects. Two researchers selected trials, assessed quality and extracted data independently.ResultsOnly a limited number of additional trials using mood stabilizers was identified since the publication of the last cochrane review, mainly utilizing Sodium Valproate. This added to the evidence base for mood stabilizers though the overall evidence remains very limited.ConclusionMood stabilizers show some initial evidence for their effectiveness in borderline personality disorder. However, these have to be replicated before wider conclusions can be drawn for clinical practice.Disclosure of interestThe authors declare that they have no competing interest.

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Culture and mental disorders

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.678 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S517-S517

Author(s):

A. Adrián ◽

C. Noval Canga ◽

H. Rebeca ◽

S. Isabel ◽

G. Sofía ◽

...

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Mental Disorders ◽

Psychiatric Diagnosis ◽

Emergency Service ◽

Psychotic Symptoms ◽

Sociocultural Factors ◽

Psychiatric History ◽

Sexual Content ◽

Competing Interest

ObjectivesShow with a case report how psychiatric pathology may face differential diagnosis problems when sociocultural aspects are involved.Methods and materialsSeventy-three year old man, born in Colombia. During the last two months, he had come many times to the emergency service due to behavioural changes. He does not have previous psychiatric history. His daughter refers that one of the patient's sisters has been diagnosed of “mystical madness”. The previous days he abandoned his medical treatment saying that he “gets in touch with his wife and that he wants to meet her”. Since his wife's dead, he had presented an excessively adapted behaviour, without grief symptoms. The first hospitalization day he said we wanted to get married with one of his daughters, with a sexual content speech, being able to get emotional when he spoke about his dead wife. Now the patient is under frequent reviews, and it is thought the differential diagnosis of depression with psychotic symptoms, due to the lack of symptoms remission.ConclusionWhenever we face different psychiatric diagnosis we don’t keep in mind some sociocultural factors, which could be masked and raise different doubts. It is important to keep in mind that each country or ethnical have their own cultural habits which are going to deeply influence patient's personality.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Differentiating Between Bipolar Affective Disorder (Bd) and Borderline Personality Disorder (BPD) – a Clinical Case

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1854 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S504-S504

Author(s):

A. Ballesteros ◽

A. Petcu ◽

B. Cortés ◽

L. Montes ◽

F. Inchausti ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Affective Disorder ◽

Dialectical Behavior Therapy ◽

Clinical Case ◽

Bipolar Affective Disorder ◽

Borderline Personality ◽

Clinical Population ◽

Clinical Approach ◽

Novelty Seeking

IntroductionRecent studies suggest that Borderline Personality Disorder (BPD) could be regarded as an affective disorder within the Bipolar Affective Disorder (BP) spectrum. This is supported by evidence suggesting a clinical/neurobiological overlap between these two disorders. The Temperament and Character Inventory Revised (TCI-R) may help differentiate between the two disorders and orientate the clinical approach, considering the evidence of the medium-term temporal stability of TCI-R in a clinical population.ObjectiveWe present a clinical case diagnosed with BD which underwent testing using TCI-R. TCI-R orientated towards a secondary diagnosis of BPD and the case further received a course of Dialectical Behavior Therapy (DBT) which led to clinical improvement. We therefore study the usefulness of TCI-R in this clinical setting.AimsTo study whether TCI-R may help differentiate between BD and BPD in mood stabilized patients.MethodOur patient is a 52-year-old married male diagnosed with BD. Considering his clinical features of impulsivity/instability of behaviors and pathological interpersonal relationships, patient was started on individual DBT (fortnightly, 4 months). Psychotropic treatment (paroxetine 30 mg/day, lithium 1000 mg/day, aripiprazole 15 mg/day) was not modified.ResultsTCI-R scores: harm avoidance (100%), novelty seeking (53%), reward dependence (20%), persistence (18%), self-directedness (1%), cooperativeness (2%) and self-transcendence (48%). After 4 months of therapy, the patient improved in distress tolerance, acceptance, behavioral activation and assertiveness.ConclusionsTCI-R is an inventory for personality traits in which character scores differ markedly between PD and non-PD patients. It is a useful tool in BPD patients orientating the clinician in the differential diagnosis and the treatment approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cognitive analytic therapy: A bibliometric review

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.581 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s233-s233

Author(s):

E. Gimeno ◽

C. Chiclana

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Meta Analysis ◽

Borderline Personality ◽

Theoretical Concepts ◽

Wide Range ◽

Bibliometric Review ◽

Analytic Therapy ◽

Competing Interest ◽

Cognitive Analytic Therapy

IntroductionCognitive Analytic Therapy (CAT) has emerged as an integrative new approach with promising results in the treatment of personality-disordered patients, particularly in borderline personality disorder. Although this approach has already demonstrated its effectiveness in adults, increasingly studies try to validate it in young population, which has meant a turning point in research.Aim and objectivesThe goal of this study is to know the whole production about CAT in a double way:–articles that describes the main theoretical concepts underlying CAT theory;–articles with evidence supporting its effectiveness in different mental disorders.MethodsA bibliometric review of 397 scientific articles extracted from research databases including Dialnet, EBSCO, PUBMED, Unika and Scholar Google was conducted.ResultsThe results indicate an exponential growth in published studies on CAT, from first publications in the late 1960s, particularly strong in the last two decades and reaching its peak in 2008. Total research includes 247 literature reviews, 109 clinical studies, 47 case studies, 17 letters and comments from authors, 4 studies on diagnostic tests and 1 meta-analysis. Most research has focused on borderline personality disorder or other personality disorders (35% and 12% respectively) and eating disorders (11%). Studies have been conducted with adults (49%) the same as children and adolescents (46%) whereas only the 4% has been developed for elderly population.ConclusionsCognitive analytic therapy represents a well-documented psychotherapy with a proven efficacy in a wide range of clinical contexts.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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