The presentation of both Cotard and Capgras syndromes is uncommon in schizophrenia. We present a case of a 23-year-old male with the diagnosis of schizophrenia with Cotard syndrome who later developed Capgras syndrome. By persisting significant symptoms despite the use of two antipsychotics, he was given the diagnosis of treatment-resistant schizophrenia, and his symptoms improved with clozapine. This is one of the few cases of Cotard and Capgras syndromes in a patient with schizophrenia.
a Médico residente de psiquiatría. b Médico psiquiatra.Diagnóstico erróneo de psicosis inducida por cocaína en una persona con esquizofrenia y masticadora de hojas de coca.Cocaine-induced psychosis as a misdiagnosis in a patient with schizophrenia and coca leavechewing.
RESUMENEn el Perú existe una elevada prevalencia de trastornos por consumo de estimulantes y aunque no existen estadísticas precisas, puede asumirse la ocurrencia de múltiples casos de psicosis inducida por el consumo de clorhidrato de cocaína o pasta básica de cocaína. Por otro lado, la masticación de hojas de coca constituye parte del acervo cultural e histórico de un gran segmento de la población peruana. A propósito de un caso de confusión diagnóstica (un cuadro de esquizofrenia en un paciente masticador de hojas de coca diagnosticado erróneamente como psicosis inducida por cocaína, en base a la positividad de un examen de metabolitos urinarios de dicha sustancia) revisamos razonablemente la bibliografía correspondiente al cuadro clínico de psicosis inducida por consumo de cocaína, su diagnóstico diferencial con otras psicosis, y las características de las pruebas de laboratorio para la detección de cocaína y sus derivados. Concluimos recomendando un mayor conocimiento e información respecto a los fenómenos asociados al consumo de la hoja de coca y de la cocaína, por parte del personal de salud, a fin de prevenir confusiones diagnósticas como la del caso aquí reportado.PALABRAS CLAVE: Esquizofrenia, psicosis inducidas por sustancias, coca, errores diagnósticos.
SUMMARYIn Peru, there is a high prevalence of stimulant use disorders and thus, although no accurate statistics are available, multiple cases of psychoses induced by cocaine hydrochloride and cocaine paste intake may occur. Moreover, chewing of dry coca leaves is part of the cultural and historical heritage of a large segment of the Peruvian population. On the basis of a case of psychiatric misdiagnosis (a primary schizophrenic psychosis in a chewer of coca leaves, misdiagnosed as cocaine-induced psychosis based on an positive test of urinary cocaine metabolites), we review pertinent literature on the clinical presentation of cocaine-induced psychosis and its differential diagnosis with other psychoses, and the characteristics of the laboratory tests used for the detection of cocaine and its metabolites. As a conclusion, the suggestion is made that health and mental health workers should have more information and knowledge about the phenomena associated with the consumption of coca leaves and cocaine, in order to avoid misdiagnosis similar to the reported case.
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