Complementary and Alternative Medicine: Is It Alternative or Mainstream for Managing Low Back Pain?
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- Epidemiologic studies have emphasized the limitations of accurately studying the prevalence of tic disorders. Epidemiologic reports of the prevalence of obsessive-compulsive disorder (OCD) in Tourette syndrome (TS) vary greatly based on the definitions used and range from 10 to 35% to approximately 40%.
- Some studies have cited higher levels of comorbidity when including obsessive-compulsive symptoms without fulfilling disorder criteria. Interestingly, patients with comorbid OCD have a higher likelihood of complex tics at the initial presentation, which can further blur the distinction between tics versus compulsions in this cohort.
- Obsessive-compulsive symptoms may occur later compared with tic onset, and psychoeducation should emphasize this possibility. However, OCD associated with TS has earlier onset compared with OCD alone.
- In the last decade, dozens of novel agents of abuse have emerged, many of them chemical variants of the naturally occurring cathinone found in the plant Catha edulis.
- Synthetic cathinones may be sold under the name of bath salts or plant food to subvert legal restrictions on their use. Their beta-ketone amphetamine structure results in their amphetamine-like sympathomimetic effects. However, synthetic cathinones also seem to modulate serotonin release, resulting in various psychoactive effects.
- Toxicity in patients using synthetic cathinones varies from euphoria and intoxication, to florid violent hallucinations, hyperthermia, rhabdomyolysis, seizures, and death. Unlike many other street drugs, synthetic cathinones are often known more commonly by their street name (e.g., bath salts), with the exact chemical composition changing over time in response to legal pressures.
