Acta Medica Port
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Ingestion of high doses of nutmeg causes potentially serious and disabling medical and psychiatric consequences. No isolated component of nutmeg has been identified as responsible for all symptoms observed during intoxication, however myristicin, one of the essential oil's components of this spice, is believed to be responsible for most psychoactive effects, although the exact mechanism is not known. ⋯ In this paper we present the case of a patient who after consuming 18 to 28 g of nutmeg developed a severe psychotic episode, with disorganized speech, psychomotor agitation and mystical/grandiose delusional ideation. The symptoms resolved quickly, and after one year of clinical stability without therapy, was discharged from the specialist consultation.
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Comment Letter
[Choosing Wisely Portugal: The View of Portuguese Doctors].
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Palliative care in oncology is an interdisciplinary approach, centered on patients and their families, carried out along the course of neoplastic diseases, based on symptom control, assertive communication and shared decision-making. Although clinical guidelines recommend a holistic intervention, early integration of palliative care into traditional oncological treatment, research shows a great delay in referral of patients, restricting palliative care to end-of-life care. ⋯ It is necessary to take measures that encourage oncologists to obtain further training in palliative care, as a formal, compulsory internship, integrated in their specific training program. This way, a new generation of physicians will surely change the lives of cancer patients, and their families, integrating - without disproportionate rationing - oncology and palliative medicine.