Leonardo Caixeta

Neuroimaging during Trance State: A Contribution to the Study of Dissociation.

Despite increasing interest in pathological and non-pathological dissociation, few researchers have focused on the spiritual experiences involving dissociative states such as mediumship, in which an individual (the medium) claims to be in communication with, or under the control of, the mind of a deceased person. Our preliminary study investigated psychography – in which allegedly “the spirit writes through the mediums hand” – for potential associations with specific alterations in cerebral activity. We examined ten healthy psychographers – five less expert mediums and five with substantial experience, ranging from 15 to 47 years of automatic writing and 2 to 18 psychographies per month – using single photon emission computed tomography to scan activity as subjects were writing, in both dissociative trance and non-trance states. The complexity of the original written content they produced was analyzed for each individual and for the sample as a whole. The experienced psychographers showed lower levels of activity in the left culmen, left hippocampus, left inferior occipital gyrus, left anterior cingulate, right superior temporal gyrus and right precentral gyrus during psychography compared to their normal (non-trance) writing. The average complexity scores for psychographed content were higher than those for control writing, for both the whole sample and for experienced mediums. The fact that subjects produced complex content in a trance dissociative state suggests they were not merely relaxed, and relaxation seems an unlikely explanation for the underactivation of brain areas specifically related to the cognitive processing being carried out. This finding deserves further investigation both in terms of replication and explanatory hypotheses.

Demência na doença de Parkinson

OBJETIVO: A presenca de sindromes psiquiatricas, incluindo demencia, associada a disturbios motores tem sido cada vez mais reconhecida durante a ultima decada, com destaque para o prejuizo cognitivo na doenca de Parkinson idiopatica. Esta revisao enfocara a epidemiologia, os aspectos clinicos, diagnosticos diferenciais, mecanismos subjacentes e o tratamento da demencia na doenca de Parkinson idiopatica. METODO: Uma revisao da literatura dos estudos que investigaram a demencia da doenca de Parkinson idiopatica foi realizada. RESULTADOS: A demencia e altamente prevalente na doenca de Parkinson idiopatica. O prototipo da demencia na doenca de Parkinson idiopatica consiste numa sindrome disexecutiva com comprometimento da atencao, funcoes executivas e, secundariamente, a memoria. Neuroquimicamente, o deficit mais significativo parece ser colinergico; a demencia se correlaciona com a presenca de corpos de Lewy corticais e limbicos. Evidencias preliminares sugerem que os anticolinesterasicos podem ser efetivos na demencia da doenca de Parkinson idiopatica. CONCLUSOES: O prejuizo cognitivo na doenca de Parkinson idiopatica e associado a caracteristicas proprias e e responsavel por importante incapacidade nestes pacientes.

Demência semântica: avaliação clínica e de neuroimagem. Relato de caso

Semantic dementia is a clinical syndrome in the spectrum of frontotemporal lobar degeneration group. We report on a 63 years old man who presented with memory disorder of semantic nature for visual and mainly verbal material when he was 57 years old. Mild behavior impairment was present and related to exaggerated responses to algic stimuli and repetitive behavior. Structural and functional neuroimaging methods disclosed asymmetric bitemporal damage, mainly on the left. Differential diagnosis should be considered with Alzheimers disease, another subtypes of the frontotemporal lobar degeneration group and any other syndrome that presents with a fluent aphasic progressive disorder.

Primary progressive aphasia beginning with a psychiatric disorder

Primary progressive aphasia (PPA), frontotemporal dementia (FTD), and semantic dementia (SD) are clinical subtypes of frontotemporal lobar degeneration (FTLD). PPA is characterized by marked changes in language ability.1 Although anxiety is identified in 39% of FTLD subjects, agitation, irritability, and depression may also be observed.2 Frustration and anxiety have been frequently reported as early symptoms of PPA, but they are commonly construed by patients and their relatives as secondary consequences of the social embarrassment caused by the difficulty with language.3 Similarly, the avoidance of social situations by these patients is frequently interpreted as a reaction to the loss of language abilities. n nHere, we report a patient with PPA who initially presented with panic attacks. To the best of our knowledge, this is the first case of PPA manifesting with panic attacks as the first symptom. This case provides further evidence of the variable and circumscribed nature of the clinical presentation of focal cerebral degeneration.

Huntington's disease presenting as posterior cortical atrophy

mg (normal range 78-280), confirming the diagnosis of GM1 Gangliosidosis. Type 3 GM1 gangliosidosis is characterized by onset around the second decade of life with slowly progressive extrapiramidal signs, such as dystonia and parkinsonism. There is also a high prevalence of gait disturbance and dysarthria. Other symptoms are short stature, bone abnormalities, cognitive impairment, ataxia and cardiac disorders. Orofacial dystonia is a common feature of type 3 GM1 gangliosidosis, with a prevalence of 87.5% according to a recent report. Facial dystonia with proeminent involvement of oromandibular muscles is a frequent manifestation of neuroleptic induced movement disorders. However, there is also a number of dystonia syndromes in wich proeminet orofacial involvement occur, and their presence should alert the clinician to their possibility (Table). We suggest that in patients with early-onset dystonia, the occurance of facial grimacing should lead to the consideration of type 3 GM1 gangliosidosis, particularly when associated with speech and cognitive impairment, gait disturbances and bone abnormalities.

Altered state of corporal consciousness related to alien hand syndrome and schizophrenic motor passivity

Some patients with schizophrenia present a related phenomenon in which they believe their limbs are under the control of an alien force (motor passivity). 5 There are some attempts to elucidate the nature and mechanism of passivity phenomena (experiences that ones conscious actions or thoughts have not been willed by oneself) wich include the dysfunction of an internal self-monitoring system that normally enables the distinction between internally generated actions and external influences on intentional behavior. Motor imagery is the mental simulation of specific motor actions and it is based upon the internal representation of intended but unexecuted motor actions. 5 We propose, therefore, that alien limb phenomenon can represent a very bizarre kind of altered state of body consciousness related to a right hemisphere disturbance and that they share symptomatological characteristics and possible pathogenic grounds with the schizophrenic motor passivity. Dear Editor, Alien hand syndrome, a neglected phenomenon in Psychiatry, is one of the most intriguing examples of altered auto-perception in brain injury cases. The main feature of alien limb phenomenon is the individuals perception of the affected hand as being out of volitional control while performing simple to complex extravolitional motor activities. 1,2 We report here the case of a 41 years-old, left-handed, HIV positive, white woman who was admitted at our university hospital presenting, during the previous month, right hemicranial headache, associated with fever, shivers, vomiting and asthenia. She also complained about a pulling sensation at her mouth on the left side, as well as local erythema and drooling. At the same period, she developed brief episodes of left hand weakness, associated with dysarthria. Two weeks later, the patient lost control of her left hand, mainly at night: when she woke up, her left hand was grasping her right arm. Since then, her dominant hand has presented extravolitional movements, as having a will of its own, not responding to volitional commands such as opening a door or catching an umbrella, but grasping objects that were useless for the patient at the moment, and wich she could not easily release. For many times, the patient realized that her left hand was in front of her face, as if it were looking at her. She was afraid of her hand: it seemed to be a monster . It also scratched and hurt the patients face and body. She had been talking to her hand and even fighting with it. …

Psychiatry disorders and dengue: is there a relationship?

OBJECTIVEnThe aim of this study was to examine the relationship of compulsive hoarding with dengue.nnnMETHODnFifty two adults notified by health vigilance authorities because of inappropriate trash accumulation in vacant lots in Goiânia, Central Brazil, completed a questionnaire regarding the presence and severity of hoarding behavior (Hoarding Rating Scale-Interview HRS-I). Five dimensions of hoarding are evaluated with this instrument: difficulty using spaces due to clutter, difficulty discarding possessions, excessive acquisition of objects, emotional distress and functional impairment due to hoarding behaviors.nnnRESULTSnThe sample was primarily male, with an average age of 49 years. Eighty six percent of the sample scored 14 or greater on the HRS-I, indicating pathological hoarding. The medias of the five HRS-I domains were high, indicating severeness of all dimentions of pathological hoarding.nnnCONCLUSIONnThese results highlight the relationship between psychiatric disorder and actions upon environmental conditions that favors dengue, as well as its associated public health burden.

The development of the dementia concept in 19th century.

The dementia concept has been reformulated through its history and the 19th century was remarkable in the construction of this concept as we understand it today. Like other syndromes, much of the history of the dementia concept comes from the attempt to separate it from other nosological conditions, giving it a unique identity. The fundamental elements for the arising of the dementia modern concept were: a) correlation of the observed syndrome with organic-cerebral lesions; b) understanding of the irreversibility of the dementia evolution; c) its relation with human ageing; and d) the choice of the cognitive dysfunction as a clinical marker of the dementia concept.

Posterior cortical atrophy - a prototypical case of dementia beginning with visual symptoms: case report

Dementia presenting with prominent higher order visual symptoms may be observed in a range of neurodegenerative conditions and is often challenging to diagnose. We describe a case of progressive dementia presenting with prominent visual cortical symptoms. A 55-year-old, right-handed, woman with early onset of visual impairment not associated with anterior visual pathology, presenting with dyslexia, visual agnosia, Balints syndrome, and spatial disorientation. Ophthalmologists should consider this condition especially in presenile patients with slowly progressive higher-order visual symptoms. Although described in association with different conditions, it may also occur in Alzheimer disease.

Do attention deficit/hyperactivity disorder symptoms exist among Brazilian indigenous children?

The validity of the clinical constructs of attention deficit hyperactivity disorder (ADHD) has been generalized for all human populations of different cultures worldwide. Yet important population groups have yet to be adequately studied so as to definitively confirm this generalization. Objective To investigate the presence of symptoms of ADHD in children living within an indigenous community. Methods We performed interviews in a bid to screen for symptoms of ADHD among settlement-dwelling indigenous children of the Karajá ethnic group in the Brazilian Amazonian Region. Results Three narratives are presented highlighting the classical symptomatological triad of ADHD: inattentiveness, hyperactivity and impulsiveness. Conclusions Some of ADHD’s major characteristics, described in the most common disease classification worldwide, are clearly described by children of this population. We concluded that ADHD symptoms are present in this population which diverges greatly in cultural issues compared to the Western world.