Dorsolateral Prefrontal Cortex Impairment in Methoxetamine-Induced Psychosis: An 18 F-FDG PET/CT Case Study

J Psychoactive Drugs. Jul-Aug 2019;51(3):254-259. doi: 10.1080/02791072.2019.1578444. Epub 2019 Feb 9.

Abstract

Novel psychoactive substances (NPSs) have currently become a major public health concern because of relatively easy accessibility to these compounds and difficulty in identifying them with routine laboratory techniques. Here, we report the 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (18F-FDG PET/CT) case study of a 23-year-old man who developed a substance-induced psychotic disorder after having intravenously injected himself with an unspecified amount of methoxetamine (MXE), a ketamine derivative hallucinogen. From a clinical perspective, a blunted affective responsiveness with diminished social drive and sense of purpose, along with a profound detachment from the environment, was observed. Psychometric and neuropsychological assessments highlighted severe dissociative symptoms and lack of motivation, along with a mild impairment of verbal fluency, working memory, and attention. Patient's 18F-FDG PET/CT scans displayed a significant bilateral deficit of tracer uptake within the dorsolateral prefrontal cortex (DLPFC). DLPFC activity is critical to goal-oriented cognitive functions, including working memory and sustained attention. DLPFC is also involved in both the temporal integration across multiple sensory modes and in the volitional control of actions, leading to the possibility to construct logically coherent temporal configurations of thought, speech, and behavior. This report highlights that a single acute MXE intoxication may produce severe brain impairment.

Keywords: F-FDG PET/CT; dorsolateral prefrontal cortex; methoxetamine; novel psychoactive substances; substance-induced psychosis.

Publication types

  • Case Reports

MeSH terms

  • Cyclohexanones / administration & dosage
  • Cyclohexanones / adverse effects*
  • Cyclohexylamines / administration & dosage
  • Cyclohexylamines / adverse effects*
  • Fluorodeoxyglucose F18
  • Hallucinogens / administration & dosage
  • Hallucinogens / adverse effects*
  • Humans
  • Male
  • Neuropsychological Tests
  • Positron Emission Tomography Computed Tomography
  • Prefrontal Cortex / drug effects*
  • Prefrontal Cortex / pathology
  • Psychoses, Substance-Induced / diagnosis
  • Psychoses, Substance-Induced / etiology*
  • Young Adult

Substances

  • Cyclohexanones
  • Cyclohexylamines
  • Hallucinogens
  • Fluorodeoxyglucose F18
  • 2-(3-methoxyphenyl)-2-(ethylamino)cyclohexanone