Prazosin use in a patient with rare Neurobeachin gene deletion shows improvement in paranoid behavior: a case report

Background Disruption of the Neurobeachin gene is a rare genetic mutation that has been implicated in the development of autism and enhanced long-term potentiation of the hippocampal CA1 region, causing a heightened conditioned fear response and impaired fear extinction. Prazosin, an alpha-1 receptor antagonist, has been used in patients with posttraumatic stress disorder to mitigate the increased alpha-1 activity involved in fear and startle responses. Here we report a case of a patient with a rare Neurobeachin gene deletion, who demonstrated marked and sustained improvement in paranoid behavior within days of prazosin initiation. Case presentation The patient is a 27-year-old White male with autism spectrum disorder, obsessive–compulsive disorder, and schizophrenia, with a chromosome 13q12 deletion including deletion of the Neurobeachin gene, who presented to the emergency department due to worsening functional status and profound weight loss as a result of only eating prepackaged foods. He had not showered or changed clothes in several months prior to presentation. He was hospitalized in the inpatient psychiatric unit for 2 months before prazosin was initiated. During that time, he demonstrated paranoia as evidenced by heightened sensitivity to doors opening, guarded interactions, and limited communication with providers and other patients. He also exhibited poor grooming habits, with aversion to showering, shaving, and changing clothes. Since initiating prazosin, he has demonstrated a brighter affect, initiates and maintains conversations, showers and changes clothes on a regular basis, and eats a variety of foods. At the time of this report, the patient was discharged to live in an apartment with a caregiver after a 7-month inpatient hospitalization. Conclusions Low-dose prazosin shows rapid and sustained improvement in paranoid behavior in a patient with a rare Neurobeachin gene deletion. Prazosin has a relatively favorable side effect profile with once-daily dosing and low cost. Prazosin may provide clinical improvement in patients with Neurobeachin gene deletions due to its theoretical attenuation in fear response through alpha-1 antagonism.

Motivations and repercussions regarding crack consumption: the collective discourse of users of a Psychosocial Care Center

Aim: To identify the motivations and repercussions related to crack consumption by people attending a Centro de Atenção Psicossocial Álcool e Drogas (CAPS AD) (Psychosocial Care Center Alcohol and Drugs) in Bahia. Method: This is a qualitative study developed with eight crack users attending a CAPS AD in a city of Bahia. Interviews, whose content was organized by the technique of the Collective Subject Discourse, were conducted in October and November 2013. Results: The study reveals that the curiosity and the desire to belong to peer groups are events that motivate crack experimentation, and its consumption triggers aggressive and paranoid behavior, depression, financial losses and family and friends abandonment. Conclusion: Given the consequences to social relations and health, actions to prevent the use and consumption of crack are necessary, particularly in order to intervene on the motivations that prompt the first use and relapse.

Is Totalitarianism a New Phenomenon? Reflections on Hannah Arendt's Origins of Totalitarianism

Contrary to Arendt's claims, totalitarianism is not unique to the modern world. It is found occasionally in past ages and is exemplified in Shaka's rule over the Zulu. It is not clear whether the ideological “logic” of modern dictators differs from the seemingly paranoid behavior of Shaka or of certain ancient despots. Indeed, if Aristotle's account is accurate, certain extreme despots, by definition, treated citizens as slaves or household laborers. They thus projected the private realm into the public, effectively abolishing both; Arendt is wrong to say that modern dictators were the first to do so.