Opioid-induced "nodding" is commonly misinterpreted as benign sleep but represents a high-risk state of fluctuating consciousness caused by drug-induced respiratory depression. This condition may lead to progressive hypoxia and hypercapnia without normal protective arousal. In the fentanyl era, nodding may reflect a subclinical overdose, with a dangerously narrow transition between sedation and fatal respiratory failure, particularly when opioids are combined with alcohol, benzodiazepines, or other sedative agents. We utilized PUBMED to adopt various works linked to this important topic. Accumulating clinical and neuroimaging evidence suggests that repeated non-fatal overdose events and nodding episodes may contribute to cumulative hypoxic-ischemic brain injury, hippocampal volume loss, and persistent cognitive impairment. Current surveillance systems largely emphasize mortality, thereby underestimating the neurological burden among survivors. Public health and clinical frameworks should redefine nodding as a sentinel respiratory-compromise state and prioritize early intervention, expanded reporting, and improved harm-reduction strategies.
We examine the relationship between substance use disorder (SUD) and schizophrenia, emphasizing the role of dopaminergic neurotransmission and genetic predispositions within the context of Reward Deficiency Syndrome (RDS). Our hypothesis posits that a deficiency in gamma-type endorphins leads to persistent hyperdopaminergic activity, amplifying schizophrenia-related symptoms such as hallucinations. Thus, alcohol use may function as a physiological self-healing mechanism by increasing gamma-endorphin levels, thereby mitigating dopaminergic hyperactivity. Additionally, we propose that the DRD2 Taq1 A2 allele could offer protection against SUD in certain individuals with schizophrenia, whereas the Taq1 A1 allele may heighten susceptibility to SUD due to impaired dopaminergic reward processing. The proposed dual genetic pathways arise from the independent yet interrelated genetic bases of SUD and schizophrenia, both involving the dopamine system. Epidemiological studies reveal that psychiatric comorbidity correlates with heightened psychopathology, risky behaviors, and diminished psychosocial performance. Further advanced research, including neuroimaging, genome-wide association studies (GWAS), and epigenetic analyses, is needed to unravel the dopaminergic mechanisms underlying SUD and schizophrenia. Understanding these genetic links may pave the way for precise interventions tailored to specific subpopulations. The findings extend the conceptualization of RDS as a framework for understanding psychiatric and addictive disorders, reinforcing the critical role of dopamine dysregulation in their etiology.
In 1995, Kenneth Blum coined the term "Reward Deficiency Syndrome'(RDS) to provide the mental health field with an umbrella term expressing a dissatisfaction of everyday experiences due to a dysregulation of dopaminergic dysregulation especially the DRD2 Taq A1 polymorphism presenting with up to a 40% reduction of D2 receptors in brain tissue with two copies. While the concept of RDS as the actual real umbrella of all mental illness unlike the current DSM-V (the brain is not carved out as portrayed by this important psychiatric manual) awaits further intensive research. In fact, Steven Hyman (former director of NIMH) suggests otherwise and has urged for research related to etiological causes instead to help explain the failings of mental health. Certainly, the RDS Consortium agrees with this difficult but needed psychiatric challenge. It is noteworthy that as of 2-5-2025, there are 1615 articles listed PUBMED using the word term "Reward Deficiency" and 270 listed for RDS specifically. However, since the initial finding of the first gene discovered to associate with severe alcoholism being the DRD2A1 allele by Blum and Noble and their associates, at least 700 or more genes have been found to be involved in RDS behaviors. While this seems quite complex in a study submitted for publication elsewhere deep silico GWAS meta-meta-analysis and pharmacogenomics mining has filtered the actual gene network down to 29 as a predictive panel of RDS behaviors. However, only 15 of these genes are linked into a network and five of these genes include DRD2, DRD4, OPRMI, COMT and 5-HTTLR. Understanding the relevance of a shared genetic basis for mental illness the RDS consortium is developing novel technology to scientifically "cure" RDS via gene editing technology (e.g. Transplice molecular genetic technology). Certainly, the jury is not in as yet, but we are encouraged about the future following arduous research from the scientific community requiring "all hands on deck".
In spite of the ongoing exquisite work of a multitude of researchers worldwide including governmental institutions like the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and for example in the United States the FDA Medication Assisted Therapy (MAT) embracing Opioid Replacement Therapy (ORT) in 2022, 111,000 people prematurely died from opioid induced overdose. It is estimated that if treatment stays as usual by 2025 the death rate will increase to 165,00.Therefore, we are encouraging the scientific and clinical community to at least consider our "out of the box" thinking whereby we are proposing a new paradigm shift involving the " dopaminergic homeostatic modeling approach and Genetic screening to early identify preaddiction. In this novel approach following detoxification from for example powerful opioids, the patient is administered the validated RDSQ29 to access potential psychological profiling of Reward Deficiency Syndrome (RDS); obtain a cheek cell sample of the patient and perform genetic screening utilizing the Genetic Addiction Risk Severity (GARS); analyze mRNA to identify specific protein deficits/surfeits based on the measured reward genes involved in the Brain Reward Cascade (BRC); produce a customized pro-dopamine regulator (KB220) guided by GARS resulting polymorphisms; objectively employ the mRNA profiling assessment every week during the treatment phase to determine improvement; each treatment program could add on at their choice, for example, cognitive behavioral therapy, brain spotting, trauma therapy, electrotherapy (h-wave device to reduce pain, subluxation repair etc.) mindfulness, exercise, neuromodulation (PrTMS) amongst other modalities. The utilization of this model could prove beneficial to both substance and non-substance behavioral addictions (e. g. gaming). WC261 .
Personalized repetitive Transcranial Magnetic Stimulation (PrTMS®) offers an individualized approach to neuromodulation through customized treatment protocols. This case series aims to explore therapeutic outcomes of PrTMS® in two patients with post-traumatic stress disorder (PTSD), based on standardized rating scale scores and spectral EEG-guided alpha brainwave activity optimization. Participants diagnosed with PTSD received PrTMS® treatments informed by quantitative rating scales and weekly spectral EEG measurements. Weekly psychometric assessments showed an improvement in symptoms, as quantified by PCL-5 (Posttraumatic Stress Disorder Checklist for DSM-5), GAD-7 (Generalized Anxiety Disorder 7-item scale), PHQ-9 (Patient Health Questionnaire-9), and SCI (Sleep Condition Indicator) questionnaires. Specifically, PCL-5 scores demonstrated an average reduction of 20.5 points by the midpoint of treatment (4 weeks), while GAD-7 and PHQ-9 scores decreased by 7 and 8.5 points, respectively, at the end of 7 weeks. Mean SCI scores increased by 6 points by the end of the 7 week-treatment period. While previous studies have also highlighted the role of spectral EEG-directed personalized PrTMS in the treatment of PTSD, ongoing research is needed in order to understand the long-term efficacy of PrTMS®.
Cerebral vasculitis, though rare, represents a serious complication of systemic lupus erythematosus (SLE) and poses numerous challenges in terms of management due to its potential for severe neurological consequences and often poor prognosis. We report the case of a 32-year-old man with SLE who presented with three seizure episodes and cognitive deterioration. Neurological examinations, laboratory analyses, and imaging findings led to a diagnosis of cerebral vasculitis secondary to SLE. Despite intensive immunosuppressive treatment, the patient’s neurological condition deteriorated, resulting in multiorgan failure. Ultimately, the patient died due to multiorgan failure linked to severe central nervous system vasculitis and associated complications. This case highlights the importance of early detection and aggressive treatment of cerebral vasculitis in the context of SLE.
This study provides further evidence demonstrating the beneficial effects of PrTMS® treatment in co-occurring disorders. Furthermore, this study illustrates the benefit of augmenting PrTMS® with tPBM for superior outcomes. The positive results of this novel case study can be attributed to brain wave neuromodulation and increased neuronal ATP production, resulting in synergistic enhanced neuroplasticity and brain optimization. Further, large-scale, randomized and blinded studies are recommended to validate our promising preliminary observations utilizing multifaceted interventions for co-occurring disorders.
Background:Quantitative electroencephalography (qEEG) has proven invaluable in assessing the neuropsychological impact of various substances, providing insight into their effects on brain activity and cognitive functions. KB220, a nutraceutical neuroadaptogen, has shown promise in modifying the dopaminergic system to enhance cognitive and neurological functions without dependency risks. Case Presentation:A 26-year-old male with a history of multiple neuropsychiatric diagnoses, including ADHD, PTSD, and sensory integration disorder, underwent qEEG analysis to explore the effects of KB220 on brain function. The patient's EEG was recorded before and 60 minutes after oral administration of KB220, observing changes in various frequency bands indicative of cognitive and alertness states. Methods:Baseline and post-administration EEG recordings were analyzed to assess changes in Delta, Theta, Alpha, and Beta wave activities, which correlate with alertness, memory processing, and cognitive engagement. The study utilized a 19-channel EEG with a consistent setup to ensure accurate comparative results. Results:Significant alterations were observed in the patient's EEG post-KB220 administration. There was a notable reduction in Delta activity, suggesting increased alertness. Theta and Alpha activities increased, indicating enhanced working memory and neuronal synchrony. Beta activity changes suggested improved focus and cognitive processing. These shifts point towards restoring dopamine homeostasis, potentially enhancing brain activity and cognitive functions. Conclusion:The case highlights the potential of KB220 to significantly impact brain function and cognitive performance through modulation of the dopaminergic system. These findings support further research into KB220 as a beneficial treatment for cognitive delays and neuropsychiatric conditions beyond traditional applications in addiction and reward deficiency syndrome. The data suggest a broader utility for KB220 in improving cognitive outcomes in patients with complex neuropsychiatric profiles.
A 17-year-old female who was recently diagnosed with SLE and taking medication for the same had developed symptoms of depression and nihilistic delusion post-initiation of treatment and hence steroids were discontinued after consultation with a local doctor.She was brought to psychiatry emergency in catatonia after a duration of 2 weeks of stopping steroids.On examination patient had immobility, staring look, posturing, rigidity, negativism.With Routine investigations, organic causes of catatonia were ruled out.Cyclophosphamide, prednisolone, lorazepam along with low dose antipsychotic, antidepressant were started and significant improvement in patient was noted.Catatonia was completely resolved.It is extremely important to pick this rare neuropsychiatric presentation of SLE to promptly initiate treatment and benefit the patient and understand the role of steroid in managing such cases.
Introduction: Stroke is the most common cause of seizures in the elderly, and seizures are among the most common neurologic sequelae of stroke.About 10% of all stroke patients experience seizures, from stroke onset until several years later.Aim: To evaluate the frequency and predictive factors of early and late seizures after stroke. Methodology: A retrospective analysis (Cross-sectional study)Data collection: Data was collected in pre-designed proforma subsequently, the data was entered into the computer. Data analysis:The results were analyzed using SPSS version 22 for Windows. Results:The study included 102patients with stroke, their mean age was70.1 ± 12.2years.Seizure was recorded in 45( 44.1%).Onset of seizure was early in 15.6% and late in 84.4%.History of ischemic heart disease was recorded in 39.2%of-patients.History of hypertension was positive in 79.4%, while diabetes was present in 69.6%.Hyperlipidemia was present in 51%.Almost the seizure was-recorded similar in all age groups, and it was-highest in age group(61-70 years) 48.5%,and lowest in >80 years, the differencewas not-statistically significant.Mean age of-patients-with seizure-was 68.7 ± 11.3, while mean age of patients without seizure was 71 ± 12.9years, the difference between the means was not statistically significant p=0.404Seizure was recorded 43.5% of males and 45% of females, this difference was not significant.All-patients with seizure had history of hypertension.History of diabetes was recorded in77.8%0f patients with seizure.Ischemic heart disease was present in 26.7% of patients with seizure.Ischemic heart disease-was-recorded-in100% of patients aged >80 years, and lowest was in age-group-51-60 years (18.8%),followedby-age-group, 61-70 years 24.2%,than ≤50 years was.33.3% and 71-80 years was 34.8%, these difference was statistically significant p -value was 0.0001.Ischemic heart disease was recorded in 44.1% of males and 36.8% of females, this difference was not statistically significant p = 0.621.Early onset of seizure was recorded in 11.7% of patients who had ischemic heart disease and 17.9% in patients not suffering ischemic heart disease, late onset was recorded in 83.3% of patients with ischemic heart disease and 82.1% of patients without ischemic heart disease this difference was not statistically significant p value was 0.716.Hypertension was present in 72.5% of patients with ischemic heart disease and 27.5% of patients with ischemic heart disease had no hypertension, while 82.5% of patients without ischemic heart disease had hypertension and 17.5% had no hypertension nor ischemic heart disease, this difference was not statistically significant p value = 0.241.Recommendation: Increased awareness of post-stroke seizures may be important in improving outcomes following the stroke.Further research is needed as a cohort study to know more information about post-stroke seizures.
Background: Hypothyroidism can cause hypertension, hypercholesterolemia, cardiac dysfunction, and both hypo-and hypercoagulability; all of which are risk factors for stroke.Objectives: To explore the association between thyroid disease and occlusion of large vessels as well as functional outcome in patients with ischemic stroke. Material and Methods:A retrospective study was conducted among all acute ischemic stroke patients, secondary to large vessel occlusion, admitted to King Fahad Medical City (KFMC), Riyadh, Kingdom of Saudi Arabia, provided that thyroid hormones were measured for those patients.The electronic charts of all eligible patients admitted between January 2021 and June 2022 were reviewed.Severity of stroke was measured through the National Institute of Heath Stroke scale (NIHSS).Functional disability one month after discharge was assessed using the modified Rankin scale (mRS).Levels of thyroid hormones (thyroxine "T4", Triiodothyronine "T3" and thyroid stimulating hormone "TSH"), low density lipoprotein (LDL) as well as glycated hemoglobin (HbA1c) were extracted from patients` electronic files.Results: A total of 177 patients included in the study.Their age ranged between 17 and 100 years (60.74 ± 15.55).Males represented 56.3% of patients.Almost half (47.1%) of cases were categorized as severe stroke while 39.1% were mild to moderate.None of the studied patients` characteristics (age, gender, TSH, T3, T4, LDL, HbA1c) was significantly associated with stroke severity.Concerning functional disability one month after discharge, moderately severe and severe disabilities were observed among 27.7% and 21.5% of patients, respectively whereas death was reported in 15.8% of cases.Patients` age was highest in patients of category 5 (severe disability) (69.0 ± 14.6 years) and lowest among those of category 0 (no disability), p = 0.001.LDL level was highest among patients of category 2 (slight disability) and lowest among those of category 6 (dead) (3.2 ± 1.4 and 2.2 ± 1.1, respectively), p = 0.031.There was a statistically significant association between severity of stroke based on NIHSS scale and impact on functional outcome based on modified ranking scale, p<0.001. Conclusion:Thyroid disorders were not associated with severity of stroke.Older patients had more severe functional disability while LDL was lowest among dead patients.Stroke severity was associated with functional disability.
This case study demonstrates that craniocervical spinal alignment with the EPIC technique spinal procedure appears to have a potential positive impact on ocular function. This paper will report the case of a patient with cranial nerve VI palsy and dizziness, and the clinical improvements following treatment with the soundwave technology of the EPIC technique spinal procedure [1]. Objective:To report the case of a patient with cranial nerve VI (CN VI) palsy and the clinical changes that occurred after receiving treatment using the EPIC (Evolutionary Percussion Instrument Corrections) technique spinal procedure. Clinical Presentation and Evaluation:A 52-year-old female presented with acute insidious onset of cranial nerve VI palsy with complaints of headache and feelings of increased head pressure. Upon eye movement exam, left eye abduction was absent which additionally caused double vision. A neurovascular physical examination using the EPIC technique protocols revealed evidence of the presence of craniocervical subluxation. Radiographic Findings:A four-view pre-adjustment digital radiographic series of the craniocervical region was taken and analyzed utilizing the EPIC technique protocols. The patient's epigenetic structural profile (aka. epigenetic profile) was ascertained as well as the multidimensional vertebral malalignments between occiput (C0), atlas (C1), axis (C2), and angle of lower neck deviation (aka. misalignment profile).The C1 vertebra was laterally displaced to the right in a -θZ direction, and rotationally displaced in a +θY direction. C2 was rotationally displaced in a -θY direction (aka. "spinous left") with a lower neck deviated to the left in a +θZ direction. It is important to note the opposite rotational displacement of C1 and C2 about the Y axis, referred to as counter-rotational malpositions of C1/C2 [1] also referred to as a "variable subluxation" [2].Numerous epigenetic variations were present, the most important of which was bilateral elongated styloid processes observed down to the level of C1 transverse processes.A single correction vector was then calculated based on both the epigenetic and misalignment profiles of data. [1]. Intervention and Outcomes:The patient was given a single soundwave impulse treatment (correction) to her craniocervical region according to the EPIC technique protocols of care using the Integrity Genesis adjusting instrument [1]. Immediately following the initial correction, the patient was re-evaluated for the presence of subluxation using the EPIC neurovascular physical exam and radiographic assessments. Findings revealed neurovascular indicators of subluxation were no longer present. A two-view post-adjustment EPIC digital radiographic series was taken to measure the biomechanical/structural changes from the treatment. Post-adjustment analysis revealed 95% reduction of C1 laterality (θZ), 22% reduction of C1 rotation (θY), 47% reduction of C2 rotation (θY), and 8% reduction in lower neck deviation (θZ). The C1 and C2 counter-rotations reduced by a combined 38%.After the initial EPIC adjustment, the patient's atlas was adjusted three times total in nine office visits over a six-week period. Three days after the first adjustment, limited abduction was restored to the left eye, but by the fifth week of care, left eye abduction was fully restored and the patient no longer experienced double vision. Patient also reported significant reduction in headaches with much less intensity compared to symptomatology she experienced prior to initiating care. Conclusion:This patient's functional ocular improvement following the EPIC technique spinal alignment procedure appears to indicate a potential correlation with craniocervical alignment and cranial nerve function. There are potential vascular correlations between the craniocervical junction and cranial nerve function, however the exact mechanisms of functional improvement is still unknown.It is inherently very difficult to draw any conclusions from a single case study, and more research is needed in the area of craniocervical specific chiropractic care and the impact on cranial nerve function and fluid flow dynamics. However, due to the low risks associated with the EPIC technique spinal procedure and the positive patient outcomes demonstrated in this case, the EPIC procedure deserves further investigation for its potential utilization in cases involving cranial nerve dysfunction.
