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      Psychiatric comorbidities in a young man with subacute myelopathy induced by abusive nitrous oxide consumption: a case report

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          Abstract

          Nitrous oxide (N 2O), a long-standing anesthetic, is known for its recreational use, and its consumption is on the rise. Several case studies have reported neurological and psychiatric complications of N 2O use. To date, however, there has not been a study using standardized diagnostic procedures to assess psychiatric comorbidities in a patient consuming N 2O. Here, we report about a 35-year-old male with magnetic resonance imaging confirmed subacute myelopathy induced by N 2O consumption, who suffered from comorbid cannabinoid and nicotine dependence as well as abuse of amphetamines, cocaine, lysergic acid diethylamide, and ketamine. Additionally, there was evidence of a preceding transient psychotic and depressive episode induced by synthetic cannabinoid abuse. In summary, this case raises awareness of an important mechanism of neural toxicity, with which physicians working in the field of substance-related disorders should be familiar. In fact, excluding N 2O toxicity in patients with recognized substance-related disorders and new neurological deficits is compulsory, as untreated for months the damage to the nervous system is at risk of becoming irreversible.

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          Most cited references16

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          Nitrous oxide (laughing gas) is an NMDA antagonist, neuroprotectant and neurotoxin.

          Extensive research has failed to clarify the mechanism of action of nitrous oxide (N2O, laughing gas), a widely used inhalational anesthetic and drug of abuse. Other general anesthetics are thought to act by one of two mechanisms-blockade of NMDA glutamate receptors or enhancement of GABAergic inhibition. Here we show that N2O, at anesthetically-relevant concentrations, inhibits both ionic currents and excitotoxic neurodegeneration mediated through NMDA receptors and, like other NMDA antagonists, produces neurotoxic side effects which can be prevented by drugs that enhance GABAergic inhibition. The favorable safety record of N2O may be explained by the low concentrations typically used and by the fact that it is usually used in combination with GABAergic anesthetics that counteract its neurotoxic potential.
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            Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)

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              The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.

              One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.
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                Author and article information

                Journal
                Subst Abuse Rehabil
                Subst Abuse Rehabil
                Substance Abuse and Rehabilitation
                Substance Abuse and Rehabilitation
                Dove Medical Press
                1179-8467
                2016
                29 September 2016
                : 7
                : 155-159
                Affiliations
                [1 ]Department of Neurology
                [2 ]Department of General Psychiatry, Center for Psychosocial Medicine
                [3 ]Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
                Author notes
                Correspondence: Falk Mancke, Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Voßstraße 2, Heidelberg D-69115, Germany, Tel +49 6221 56 35709, Fax +49 6221 56 5374, Email falk.mancke@ 123456med.uni-heidelberg.de
                Markus Weiler, Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg D-69120, Germany, Tel +49 6221 56 7504, Fax +49 6221 56 5461, Email markus.weiler@ 123456med.uni-heidelberg.de
                [*]

                These authors contributed equally to this work

                Article
                sar-7-155
                10.2147/SAR.S114404
                5047713
                27729826
                c632af1d-8b69-4b23-b1b7-a393facec248
                © 2016 Mancke et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Case Report

                addictive disorders,laughing gas,subacute combined degeneration,substance use disorder,vitamin b12 deficiency

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