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Alhendi F, Burahmah A. Delusional Parasitosis or Morgellons Disease: A Case of an Overlap Syndrome. Case Rep Dent 2023; 2023:3268220. [PMID: 37152271 PMCID: PMC10159739 DOI: 10.1155/2023/3268220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/22/2022] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
Background. Delusional parasitosis (DP) is a monosymptomatic hypochondriacal psychosis where the patient has the delusion of being infested with parasites, whereas Morgellons disease (MD) is described when the patient has fixed ideation of fibers or other materials emerging from skin. Both psychological and organic causes can result into the delusion of infestation, and careful examination is required to exclude secondary causes. Oral DP can result in self-inflected mutilations of the oral mucosa. To our knowledge, oral DP is only rarely reported in the literature. Here, we describe and discuss the management of a case of overlap between oral DP and oral MD at the oral medicine (OM) clinic. Case Report. A 50-year-old male presented to the OM clinic with ulcerations of oral and perioral tissues. Patient reported inflicting wounds to himself using a shaving blade to extirpate worms and pieces of glass from underneath his oral and perioral mucosa. Clinical and laboratory investigations ruled out parasitic infestations. Self-inflected ulcers were treated with topical steroids and prophylactic antifungals, and the patient was referred for psychiatric evaluation. A diagnosis of primary DP was reached, and the patient was managed with antipsychotics. Practical Implications. Oral health care providers should be familiar with oral manifestations of psychiatric disorders and should be able to manage such patients in a multidisciplinary team of internist, dermatologist, and psychiatrist.
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Affiliation(s)
- Fatmah Alhendi
- Department of Oral Medicine, Ministry of Health of Kuwait, P. O. Box (5), Safat 13001, Kuwait
| | - Abdullatif Burahmah
- Department of Oral Medicine, Ministry of Health of Kuwait, P. O. Box (5), Safat 13001, Kuwait
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Alsafwani Z, Aljishi M, Shiboski C, Jordan R, Villa A. Oral manifestations of delusional infestation: a case series. BMC Oral Health 2022; 22:652. [PMID: 36581857 PMCID: PMC9799679 DOI: 10.1186/s12903-022-02664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Delusional infestation (DI) is a rare psychotic disorder characterized by a patient's false belief that the body is infested with living or non-living organisms in the absence of clinical evidence of disease. Based on the underlying etiology, DI can be classified into primary and secondary forms based on the presence or absence of an underlying condition or previously diagnosed psychiatric disorder. This paper discusses a condition that is not commonly reported in the literature. CASE PRESENTATION Here, we describe four patients diagnosed with DI of the oral cavity. In each case, the patients' intraoral examinations revealed either traumatic lesions or no signs of mucosal disease. Management involved symptom management, medical therapy, and/or a referral to the primary care provider. CONCLUSION Because oral health care providers may encounter patients with DI, they should familiarize themselves with this unusual condition in order to recognize the condition and initiate prompt referral to a psychiatrist.
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Affiliation(s)
- Zahra Alsafwani
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Morooj Aljishi
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA ,grid.411975.f0000 0004 0607 035XDepartment of Biomedical Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, IAU, Dammam, Saudi Arabia
| | - Caroline Shiboski
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Richard Jordan
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Alessandro Villa
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA ,grid.418212.c0000 0004 0465 0852Miami Cancer Institute, Baptist Health South Florida, Miami, FL USA
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Abstract
Ekbom's syndrome represents a relatively uncommon neuropsychiatric condition characterized by the recurrent and bizarre fixed delusional belief to be infested by small organisms or even unanimated materials ('Morgellons disease'), without any objective evidence of infestation/parasitosis. The condition, mainly diagnosed in a nonpsychiatric setting, is supposed to be largely underestimated and, hence, undermanaged. The present comprehensive review aims at investigating Ekbom's syndrome, from a historical, epidemiological, clinical and therapeutic perspective, by providing diagnostic-treatment strategies in managing this condition in routine psychiatric clinical settings. The prototypical patient is a middle-aged woman (or a younger subject in those cases in which substance and/or alcohol abuse is implicated), often single, divorced or widowed (loneliness component and social withdrawal), who has already consulted several specialists due to skin lesions associated with a firm and delusional belief to be infested. The identification and diagnosis are challenging due to poor patient's insight, poor knowledge and collaboration between specialists and differential diagnoses to be considered before asking for a psychiatric referral. Management and treatment strategies mainly derive from isolated case reports or observational studies with a small sample size. Further randomized clinical trials should be performed to evaluate the efficacy of newer antipsychotic drugs, including long-acting injectable formulations.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Alessia Gentilotti
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Giordani
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
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Liao PC, Wei CJ, Chen PH. Onset of psychosis following strokes to the cerebellum and thalamus. PSYCHOSOMATICS 2017; 59:413-414. [PMID: 29054750 DOI: 10.1016/j.psym.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Po-Chiao Liao
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Jen Wei
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Umezaki Y, Miura A, Watanabe M, Takenoshita M, Uezato A, Toriihara A, Nishikawa T, Toyofuku A. Oral cenesthopathy. Biopsychosoc Med 2016; 10:20. [PMID: 27293481 PMCID: PMC4903001 DOI: 10.1186/s13030-016-0071-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/01/2016] [Indexed: 01/15/2023] Open
Abstract
Cenesthopathy is characterized by abnormal and strange bodily sensations and is classified as a ‘delusional disorder, somatic type’ or ‘somatoform disorder’ according to the DSM 5. The oral cavity is one of the frequent sites of cenesthopathy, thus the term ‘oral cenesthopathy.’ Patients with oral cenesthopathy complain of unusual sensations without corresponding abnormal findings in the oral area, such as excessive mucus secretion, a slimy sensation, or a feeling of coils or wires being present within the oral region. They usually visit multiple dentists rather than psychiatrists. Without a proper diagnosis, they repeatedly pursue unnecessary surgical procedures to remove their ‘foreign body’. This sometimes creates a dilemma between the dentists and patients. The nosography of oral cenesthopathy has been discussed in some case reports and reviews but is overlooked in mainstream medicine. This review focuses on the various aspects of oral cenesthopathy. The estimated prevalence of cenesthopathy was 0.2 to 1.9 % in a study done at a Japanese university psychiatry clinic and 27 % in a study done at a Japanese psychosomatic dentistry clinic. Oral cenesthopathy do not have clear disposition, while some studies reported that elderly women were most commonly affected. Its pathophysiology has not been fully elucidated. However, recent studies have suggested a right > left asymmetrical pattern of the cerebral blood flow of patients with oral cenesthopathy. Antidepressants, antipsychotic drugs, electroconvulsive therapy, and psychotherapy might be effective in some cases, though it is known to be intractable. To date, the epidemiology, pathophysiology, etiology, classification and treatment of oral cenesthopathy are unknown due to the few reports on the disorder, though there are a few case reports. To overcome this difficult medical condition, clinico-statistical and case–control studies done under rigorous criteria and with a large sample size are required.
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Affiliation(s)
- Yojiro Umezaki
- Psychosomatic Dentistry Clinic, Dental Hospital, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Anna Miura
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Motoko Watanabe
- Psychosomatic Dentistry Clinic, Dental Hospital, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Miho Takenoshita
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Akihito Uezato
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Akira Toriihara
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Toru Nishikawa
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Japan
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Spitoni GF, Pireddu G, Galati G, Sulpizio V, Paolucci S, Pizzamiglio L. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study. PLoS One 2016; 11:e0151213. [PMID: 27028404 PMCID: PMC4814090 DOI: 10.1371/journal.pone.0151213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/23/2016] [Indexed: 02/08/2023] Open
Abstract
Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20), in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.
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Affiliation(s)
- Grazia Fernanda Spitoni
- Department of Psychology–Sapienza University of Rome, Rome, Italy
- Laboratory of Neuropsychology, IRCCS Santa Lucia Foundation, Rome, Italy
- * E-mail:
| | - Giorgio Pireddu
- Department of Psychology–Sapienza University of Rome, Rome, Italy
- Laboratory of Neuropsychology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Gaspare Galati
- Department of Psychology–Sapienza University of Rome, Rome, Italy
- Laboratory of Neuropsychology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Valentina Sulpizio
- Department of Psychology–Sapienza University of Rome, Rome, Italy
- Laboratory of Neuropsychology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Stefano Paolucci
- Laboratory of Neuropsychology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Luigi Pizzamiglio
- Laboratory of Neuropsychology, IRCCS Santa Lucia Foundation, Rome, Italy
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Al-Imam AML. A systematic literature review on delusional parasitosis. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2016. [DOI: 10.1016/j.jdds.2015.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Watanabe M, Umezaki Y, Miura A, Shinohara Y, Yoshikawa T, Sakuma T, Shitano C, Katagiri A, Takenoshita M, Toriihara A, Uezato A, Nishikawa T, Motomura H, Toyofuku A. Comparison of cerebral blood flow in oral somatic delusion in patients with and without a history of depression: a comparative case series. BMC Psychiatry 2015; 15:42. [PMID: 25886053 PMCID: PMC4364484 DOI: 10.1186/s12888-015-0422-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/19/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral somatic delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group). METHODS Participants were 27 patients of a psychosomatic dentistry clinic, all diagnosed with OSD. They were categorized into either the non-depression group (17 patients) or the depression group (10 patients) on the basis of assessments by their personal medical providers. CBF was examined using single-photon emission computed tomography. RESULTS There was no difference in clinical presentation between the two groups. A significant right dominant asymmetry in the temporal and posterior cerebral regions was observed in both groups. In the central region, a right dominance was seen in the non-depression group, while a left dominance was seen in the depression group. Moreover, the mean regional CBF values for patients in the depression group were significantly lower in several regions (including bilateral callosomarginal, precentral, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, and hippocampus; and right central and cerebellum) than for patients in the non-depression group. CONCLUSION These results suggest that the temporal and posterior cerebral regions are involved in in the pathophysiology of OSD, regardless of depression history, and that widespread CBF reduction is a characteristic of remitted depression.
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Affiliation(s)
- Motoko Watanabe
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Yojiro Umezaki
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Anna Miura
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Yukiko Shinohara
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Tatsuya Yoshikawa
- Psychosomatic Dentistry Clinic, Tokyo Medical and Dental University Dental Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Tomomi Sakuma
- Psychosomatic Dentistry Clinic, Tokyo Medical and Dental University Dental Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Chisa Shitano
- Psychosomatic Dentistry Clinic, Tokyo Medical and Dental University Dental Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Ayano Katagiri
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Miho Takenoshita
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Akira Toriihara
- Department of Diagnostic Radiology and Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Akihito Uezato
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Toru Nishikawa
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Haruhiko Motomura
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
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Takahashi T, Fuke T, Washizuka S, Hanihara T, Amano N. A review of recent case reports of cenesthopathy in Japan. Psychogeriatrics 2013; 13:196-8. [PMID: 25913770 DOI: 10.1111/psyg.12015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 03/13/2013] [Accepted: 03/21/2013] [Indexed: 11/26/2022]
Abstract
Idiopathic abnormal bodily sensations, or cenesthesic symptoms, are exhibited in a wide variety of mental illnesses. In Japan, patients with abnormal bodily sensations are often diagnosed with cenesthopathy. This study reviewed recent case reports of cenesthopathy. Of the 100 identified cases, young patients were more commonly men with predominant bodily cenesthesic symptoms, while older patients (≥40 years) were more commonly women with cenesthesic symptoms restricted to the oral cavity (oral cenesthopathy).
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Affiliation(s)
- Tohru Takahashi
- Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan
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Camargo LC, Sánchez KP. [Thalamic Stroke and Associated Behavior Disorders. Possibilities for Integral Management: Case Report]. REVISTA COLOMBIANA DE PSIQUIATRIA 2012; 41:436-443. [PMID: 26573506 DOI: 10.1016/s0034-7450(14)60017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/29/2012] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Since ancient Greece, cerebrovascular accidents have been described with no variation. Even today, they are still a catastrophic event in the lives of patients with a high risk of disabling sequelae. METHODOLOGY Case report of a 56-year male patient with thalamic ischemia. RESULTS The intervention with integral strategies involving pharmacological management and cognitive interventions was decisive for the satisfactory evolution of the patient. CONCLUSIONS The management of patients with cerebrovascular accidents cannot be limited to the emergency room. Pharmacological advances in programs and cognitive intervention methods provide intervention tools from the very beginning of the stroke thus reducing the impact of long-term sequelae, and consequently enabling a better reintegration of the patient to his family.
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Affiliation(s)
- Loida Camargo Camargo
- Neuróloga, servicio de Neurología, Hospital Universitario Clínica San Rafael-OHSJD, Bogotá, Colombia.
| | - Katherine Parra Sánchez
- Residente de Psiquiatría tercer año, Fundación Universitaria Juan N. Corpas, Hospital Universitario Clínica San Rafael-OHSJD, Bogotá, Colombia
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