Paintings produced spontaneously by patients with neurological lesions represent a fascinating op... more Paintings produced spontaneously by patients with neurological lesions represent a fascinating opportunity to analyze some aspects of the underlying disease and involved brain mechanisms. Many cases of artists who have suffered spatial neglect following a neurological disease have been reported in the literature. However, only a few studies evaluating the different subtypes of graphic neglect and aspects related to the construction of perspective (three dimensionality) in works of art have been published. In the present article, we present the case of an artist who, after resection of a central neurocytoma that affected the right thalamo-parietal connections, suffered an impairment of the ability to create perspective in his paintings and involuntary omission of only shapes in the left side of his paintings, although colors and contours were preserved.
Movement disorders can be defined as neurological syndromes presenting with excessive or diminish... more Movement disorders can be defined as neurological syndromes presenting with excessive or diminished automatic or voluntary movements not related to weakness or spasticity. Both Parkinson’s disease (PD) and Huntington’s disease (HD) are well-known examples of these syndromes. The high prevalence of comorbid psychiatric symptoms like depres- sion, anxiety, obsessive-compulsive symptoms, hallucinations, delusions, impulsivity, sleep disorders, apathy and cognitive impairment mean that these conditions must be regarded as neuropsychiatric diseases. In this article, we review neuroanatomical (structural and functional), psychopathological and neuropsychological aspects of PD and HD. The role of fronto-subcortical loops in non-motor functions is particularly emphasised in order to understand the clinical spectrum of both diseases, together with the influence of genetic, psychological and psychosocial aspects. A brief description of the main psychopharmacological approaches for both diseases is also included
Historically, clinical researchers have underestimated the prevalence and importance of musical o... more Historically, clinical researchers have underestimated the prevalence and importance of musical obsessions, which are defined as intrusive, repetitive, persistent sounds or tunes, not controlled by the will, that cause clinically significant anxiety and distress. Musical obsessions have also been described as the “stuck song syn- drome” and their prevalence is not clearly established, because few cases have been reported. This study reports a case of a 32-year-old female with a history of musical obsessions over the course of 12 years. She suffered episodes in which she heard repetitive musical fragments in her head, such as the chorus lines or portions of known or unknown songs, that caused high levels of anxiety in her daily life. The symp- toms led her to introduce compulsive behaviors such as listening to the song that matched with the obsessive song. Treatment with fluoxetine 60 mg/day for 12 weeks reduced obsessive symptoms by 60%, improving her quality of life. This case allowed us to explore the semiological spectrum that encompasses musical imagery, in which con- cepts that belong to normality are involved, such as musical imagination, involuntary musical imagery, and sticky songs, and other concepts that deal with psychopathological aspects such as musical obsessions, musical hallu- cinations, and palinacousis. Additionally, the case showed us an atypical form of compulsion that accompanied musical obsession, in which the patient sought to complete the obsessive content with real music. Treatment with fluoxetine 60 mg/day generated a symptomatic response but not remission of symptoms.
There is a high prevalence of depression in patients with epilepsy, which negatively impacts thei... more There is a high prevalence of depression in patients with epilepsy, which negatively impacts their quality of life (QOL) and seizure control. Currently, the first-line of treatment for depression in patients with epilepsy is based on selective serotonin reuptake inhibitors (SSRIs). The main objective of this pilot study was to compare cognitive behavioral therapy (CBT) versus SSRIs for the treatment of major depressive disorder (MDD) in patients with temporal lobe epilepsy (TLE). Seven patients who received group CBT were compared with eight patients treated with SSRIs. All were diagnosed with MDD and TLE. Patients were assessed at baseline before treatment and at six and 12 weeks during treatment with the Quality of Life in Epilepsy Scale of 31 items (QOLIE 31), the Beck Depression Inventory (BDI), and the Hospital Anxiety and Depression Scale (HADS). Seizure records were also taken on a monthly basis. After 12 weeks of treatment, both groups showed improved QOL and reduced severity of depression symptoms. There were no statistically significant group differences in the final scores for the BDI (p = 0.40) and QOLIE 31 (p = 0.72), although the effect size on QOL was higher for the group receiving CBT. In conclusion, the present study suggests that both CBT and SSRIs may improve MDD and QOL in patients with TLE. We found no significant outcome differences between both treatment modalities. These findings support further study using a double-blind controlled design to demonstrate the efficacy of CBT and SSRIs in the treatment of MDD and QOL in patients with TLE.
Introduction: The wide gap in terms of research between high-income countries versus low and midd... more Introduction: The wide gap in terms of research between high-income countries versus low and middle-income countries not only prevents the development of the latter in terms of evidence-based medicine, but also limits the understanding of psychiatry at a global level. This inequity is evident among the journals with the highest impact around the world, as they mostly publish articles from developed countries. Objectives: To review and discuss the issues involved in the publication of psychiatric literature among high, low and middle- income countries, as well as defining in simple terms the concept of impact factor. Method: Narrative review of the medical literature. Results and Conclusions: Over 90% of the literature found in the journals with highest impact factor in Psychiatry comes from high-income countries, while only about 6%-10% comes from low and middle-income countries, even though the latter represent 80% of the world’s population. This shows an important publication bias, which significantly affects the international diffusion of studies conduc- ted in low-income countries or in languages other than English, since journals with the highest impact factor are the main source of information and update of millions of psychiatrists around the world.
Introduction: Music is present in all cultures and has been with us from the dawn of human histor... more Introduction: Music is present in all cultures and has been with us from the dawn of human history. Since ancient times music has been attributed a relaxing and healing effect, which becomes evident in healing rituals through chants, dancing, and the interpretation of instruments. With the advancement of neuroscience and imaging techniques, it has become possible to approach the complex mechanisms underlying musical processing. Objective: To review and discuss the mechanisms of neurobiological and cognitive processing of music. To understand the benefits of the anxiolytic effect of music in diverse clinical conditions
The current study describes the case of a woman with symptomatic epilepsy due to brain cysticerco... more The current study describes the case of a woman with symptomatic epilepsy due to brain cysticercosis acquired during childhood. During her adolescence, she developed seizures characterized by metamorphopsia, hallucinations of autobiographic memory and, finally, asomatognosia. Magnetic brain imaging showed a calcified lesion in the right occipitotemporal cortex, and positron emission tomography imaging confirmed the presence of interictal hypometabolism in two regions: the right parietal cortex and the right lateral and posterior temporal cortex. We discuss the link between these brain areas and the symptoms described under the concepts of epileptogenic lesion, epileptogenic zone, functional deficit zone, and symptomatogenic zone.
Paintings produced spontaneously by patients with neurological lesions represent a fascinating op... more Paintings produced spontaneously by patients with neurological lesions represent a fascinating opportunity to analyze some aspects of the underlying disease and involved brain mechanisms. Many cases of artists who have suffered spatial neglect following a neurological disease have been reported in the literature. However, only a few studies evaluating the different subtypes of graphic neglect and aspects related to the construction of perspective (three dimensionality) in works of art have been published. In the present article, we present the case of an artist who, after resection of a central neurocytoma that affected the right thalamo-parietal connections, suffered an impairment of the ability to create perspective in his paintings and involuntary omission of only shapes in the left side of his paintings, although colors and contours were preserved.
Movement disorders can be defined as neurological syndromes presenting with excessive or diminish... more Movement disorders can be defined as neurological syndromes presenting with excessive or diminished automatic or voluntary movements not related to weakness or spasticity. Both Parkinson’s disease (PD) and Huntington’s disease (HD) are well-known examples of these syndromes. The high prevalence of comorbid psychiatric symptoms like depres- sion, anxiety, obsessive-compulsive symptoms, hallucinations, delusions, impulsivity, sleep disorders, apathy and cognitive impairment mean that these conditions must be regarded as neuropsychiatric diseases. In this article, we review neuroanatomical (structural and functional), psychopathological and neuropsychological aspects of PD and HD. The role of fronto-subcortical loops in non-motor functions is particularly emphasised in order to understand the clinical spectrum of both diseases, together with the influence of genetic, psychological and psychosocial aspects. A brief description of the main psychopharmacological approaches for both diseases is also included
Historically, clinical researchers have underestimated the prevalence and importance of musical o... more Historically, clinical researchers have underestimated the prevalence and importance of musical obsessions, which are defined as intrusive, repetitive, persistent sounds or tunes, not controlled by the will, that cause clinically significant anxiety and distress. Musical obsessions have also been described as the “stuck song syn- drome” and their prevalence is not clearly established, because few cases have been reported. This study reports a case of a 32-year-old female with a history of musical obsessions over the course of 12 years. She suffered episodes in which she heard repetitive musical fragments in her head, such as the chorus lines or portions of known or unknown songs, that caused high levels of anxiety in her daily life. The symp- toms led her to introduce compulsive behaviors such as listening to the song that matched with the obsessive song. Treatment with fluoxetine 60 mg/day for 12 weeks reduced obsessive symptoms by 60%, improving her quality of life. This case allowed us to explore the semiological spectrum that encompasses musical imagery, in which con- cepts that belong to normality are involved, such as musical imagination, involuntary musical imagery, and sticky songs, and other concepts that deal with psychopathological aspects such as musical obsessions, musical hallu- cinations, and palinacousis. Additionally, the case showed us an atypical form of compulsion that accompanied musical obsession, in which the patient sought to complete the obsessive content with real music. Treatment with fluoxetine 60 mg/day generated a symptomatic response but not remission of symptoms.
There is a high prevalence of depression in patients with epilepsy, which negatively impacts thei... more There is a high prevalence of depression in patients with epilepsy, which negatively impacts their quality of life (QOL) and seizure control. Currently, the first-line of treatment for depression in patients with epilepsy is based on selective serotonin reuptake inhibitors (SSRIs). The main objective of this pilot study was to compare cognitive behavioral therapy (CBT) versus SSRIs for the treatment of major depressive disorder (MDD) in patients with temporal lobe epilepsy (TLE). Seven patients who received group CBT were compared with eight patients treated with SSRIs. All were diagnosed with MDD and TLE. Patients were assessed at baseline before treatment and at six and 12 weeks during treatment with the Quality of Life in Epilepsy Scale of 31 items (QOLIE 31), the Beck Depression Inventory (BDI), and the Hospital Anxiety and Depression Scale (HADS). Seizure records were also taken on a monthly basis. After 12 weeks of treatment, both groups showed improved QOL and reduced severity of depression symptoms. There were no statistically significant group differences in the final scores for the BDI (p = 0.40) and QOLIE 31 (p = 0.72), although the effect size on QOL was higher for the group receiving CBT. In conclusion, the present study suggests that both CBT and SSRIs may improve MDD and QOL in patients with TLE. We found no significant outcome differences between both treatment modalities. These findings support further study using a double-blind controlled design to demonstrate the efficacy of CBT and SSRIs in the treatment of MDD and QOL in patients with TLE.
Introduction: The wide gap in terms of research between high-income countries versus low and midd... more Introduction: The wide gap in terms of research between high-income countries versus low and middle-income countries not only prevents the development of the latter in terms of evidence-based medicine, but also limits the understanding of psychiatry at a global level. This inequity is evident among the journals with the highest impact around the world, as they mostly publish articles from developed countries. Objectives: To review and discuss the issues involved in the publication of psychiatric literature among high, low and middle- income countries, as well as defining in simple terms the concept of impact factor. Method: Narrative review of the medical literature. Results and Conclusions: Over 90% of the literature found in the journals with highest impact factor in Psychiatry comes from high-income countries, while only about 6%-10% comes from low and middle-income countries, even though the latter represent 80% of the world’s population. This shows an important publication bias, which significantly affects the international diffusion of studies conduc- ted in low-income countries or in languages other than English, since journals with the highest impact factor are the main source of information and update of millions of psychiatrists around the world.
Introduction: Music is present in all cultures and has been with us from the dawn of human histor... more Introduction: Music is present in all cultures and has been with us from the dawn of human history. Since ancient times music has been attributed a relaxing and healing effect, which becomes evident in healing rituals through chants, dancing, and the interpretation of instruments. With the advancement of neuroscience and imaging techniques, it has become possible to approach the complex mechanisms underlying musical processing. Objective: To review and discuss the mechanisms of neurobiological and cognitive processing of music. To understand the benefits of the anxiolytic effect of music in diverse clinical conditions
The current study describes the case of a woman with symptomatic epilepsy due to brain cysticerco... more The current study describes the case of a woman with symptomatic epilepsy due to brain cysticercosis acquired during childhood. During her adolescence, she developed seizures characterized by metamorphopsia, hallucinations of autobiographic memory and, finally, asomatognosia. Magnetic brain imaging showed a calcified lesion in the right occipitotemporal cortex, and positron emission tomography imaging confirmed the presence of interictal hypometabolism in two regions: the right parietal cortex and the right lateral and posterior temporal cortex. We discuss the link between these brain areas and the symptoms described under the concepts of epileptogenic lesion, epileptogenic zone, functional deficit zone, and symptomatogenic zone.
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Papers by Juan Manuel Orjuela-Rojas
This study reports a case of a 32-year-old female with a history of musical obsessions over the course of 12 years. She suffered episodes in which she heard repetitive musical fragments in her head, such as the chorus lines or portions of known or unknown songs, that caused high levels of anxiety in her daily life. The symp- toms led her to introduce compulsive behaviors such as listening to the song that matched with the obsessive song. Treatment with fluoxetine 60 mg/day for 12 weeks reduced obsessive symptoms by 60%, improving her quality of life.
This case allowed us to explore the semiological spectrum that encompasses musical imagery, in which con- cepts that belong to normality are involved, such as musical imagination, involuntary musical imagery, and sticky songs, and other concepts that deal with psychopathological aspects such as musical obsessions, musical hallu- cinations, and palinacousis. Additionally, the case showed us an atypical form of compulsion that accompanied musical obsession, in which the patient sought to complete the obsessive content with real music. Treatment with fluoxetine 60 mg/day generated a symptomatic response but not remission of symptoms.
This study reports a case of a 32-year-old female with a history of musical obsessions over the course of 12 years. She suffered episodes in which she heard repetitive musical fragments in her head, such as the chorus lines or portions of known or unknown songs, that caused high levels of anxiety in her daily life. The symp- toms led her to introduce compulsive behaviors such as listening to the song that matched with the obsessive song. Treatment with fluoxetine 60 mg/day for 12 weeks reduced obsessive symptoms by 60%, improving her quality of life.
This case allowed us to explore the semiological spectrum that encompasses musical imagery, in which con- cepts that belong to normality are involved, such as musical imagination, involuntary musical imagery, and sticky songs, and other concepts that deal with psychopathological aspects such as musical obsessions, musical hallu- cinations, and palinacousis. Additionally, the case showed us an atypical form of compulsion that accompanied musical obsession, in which the patient sought to complete the obsessive content with real music. Treatment with fluoxetine 60 mg/day generated a symptomatic response but not remission of symptoms.