Highlights From Residents’ Journal: December 2020

Nootropics are psychoactive substances that are widely accessible to purchase in the United States. Two such substances, kratom, a naturally derived nootropic, and phenibut, a gamma-aminobutyric acid (GABA) analogue, are psychoactive substances that have neuropsychiatric effects mimicking those of prescribed medications. They are marketed as supplements and perceived by some consumers as an attractive alternative to prescribed psychiatric medications. They are also used recreationally, which has raised concerns about them as emerging drugs of abuse. Psychiatric trainees should be aware of the potential of use by their patients, as well as the effects of toxicity and withdrawal. This article provides a concise review for psychiatric trainees of existing literature regarding kratom and phenibut.

One of the most characteristic associations with FNSD is recent physical abuse, sexual abuse, or neglect preceding the onset of symptoms. However, since publication of DSM-5, diagnosis of the condition no longer requires known antecedent trauma. Indeed, a meta-analysis of published studies with quantitative reporting of FNSD cases found that only 49% of patients reported a traumatic stressor. Furthermore, although the classical model of the condition suggested early childhood trauma as being of particular importance, an analysis of patients with conversion pathology determined that recent physical abuse—as was present in the case presented here—had the strongest association with the condition. This internal conflict can manifest as a wide constellation of symptoms, which can pose significant challenges to clinicians.

Autoimmune encephalitis is a complex disorder that can present with various neuropsychiatric symptoms, making recognition of the disease challenging. Recently, the N-methyl d-aspartate receptor (NMDA-r) subtype of autoimmune encephalitis has become increasingly recognized in the psychiatric community due to its propensity to be mistaken as a psychiatric disorder. Another autoimmune encephalitis subtype, anti–leucine-rich glioma-inactivated 1 protein (LGI-1) antibody encephalitis, has been shown to have greater incidence and prevalence, compared with the NMDA-r subtype, making it an important diagnosis for psychiatrists to consider.