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A patient with coccidioidal meningitis was treated with intrathecally administered amphotericin B, and an acute toxic delirium with EEG abnormalities developed. Clinical recovery followed discontinuation of therapy and paralleled EEG resolution. This complication was dose related and argues for caution when initiating intrathecal therapy with amphotericin B at doses greater than 0.025 mg.
The potential for a pharmacologic "overdose" and the cause of death associated with phencyclidine abuse is discussed. Nineteen deaths associated exclusively with phencyclidine intoxication have been documented. In 13 cases the immediate cause of death was asphyxia by drowning or trauma with lower levels of phencyclidine present suggesting behavioral toxicity. In two cases, the presence of phencyclidine in high concentrations constituted the only finding, and the probable cause of death was primary respiratory depression accompanied by seizure activity. A secondary drug effect or concurrent disease process may have contributed to the death of the remaining four individuals.
The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 66 non-narcotic drug abusers as part of an intensive study of polydrug abuse. Patients were classified into four primary drug-of-abuse groups using either stimulants, barbiturates, other sedative-hypnotics, or a combination of these drugs. It was readministered to 42 of these patients after 2 weeks' hospitalization. At admission, the group's MMPI profile was consistent with psychosis. At discharge, most of the MMPI T-scores were sharply reduced, and the groups' profile was consistent with sociopathy. The admission MMPI profiles of the four primary drug-of-abuse groups did not differ. At discharge, the stimulant group's profile remained psychotic, while the profiles of the other three groups were not psychotic. Such results raise the possibility of a toxic psychotic effect of chronic non-narcotic drug abuse. The group of stimulant abusers appeared schizophrenic, while the other groups of non-narcotic drug abusers appeared sociopathic.
In a study of 7 cases of adverse reactions to local anaesthetics the early symptoms of toxicity (malaise, anxiety, feeling of impending death, peripheral paresthesias and tachycardia) are reviewed. Minor toxic reactions produced by these drugs are common, whereas immediate allergic reactions are rare and even, for some authors, non-existent with lignocaine and derivatives. Biological investigations aimed at demonstrating the "allergic" nature of these reactions are valueless and costly.
A case of severe opioid toxicity is described in a 52-year-old cancer patient. The patient presented with classical clinical features of central hyperexcitability associated with opioid toxicity: delirium, myoclonus, hallucinations, hyperalgesia, and a possible seizure. This patient had a background of severe psychosocial distress and somatization in addition to a history of benzodiazepine dependence and alcohol abuse. The occurrence of opioid toxicity in this patient highlights the risks of a unidimensional approach to cancer pain, which ignores the non-organic components of pain, such as psychosocial distress, which will not respond to escalating doses of opioid medication.
During the period January-June 1975 a relatively high death rate (8,29%; 33 out of 398 patients) was noted in young Black males clinically diagnosed as suffering from toxic psychosis caused by alcohol. Pellagra, malnutrition and pneumonia were complicating factors. After a trial period of 6 months, a detoxification unit was established for these high-risk patients. A total of 615 high-risk patients (15,12%; 615 out of 4 065) was treated with a standardized regimen during the 2 1/2-year period June 1975 - December 1977. Thirty-three out of 615 patients (5,36%) died during this period, 1,57% of the total number with toxic psychosis due to alcohol abuse (33 out of 4065) over a 2 1/2-year period. This rate compares favourably with the average reported rate of 10 - 15%. Effective treatment of high-risk alcohol-induced states reduces the complications and death rate.
A case of poisoning with a new organophosphate (fenthion) is reported in which the initial cholinergic crisis was delayed 5 days and recurred 24 days after ingestion. Psychosis was a persistent and sometimes singular manifestation. Because of the high lipid solubility of this pesticide, toxin analysis of repeated fat biopsies was an essential component of the management of this patient.
Although the antimalarial agents chloroquine, hydroxychloroquine, and amodiaquine are widely used to treat a variety of medical conditions, their behavioral toxicity and lethality are not generally recognized. Therapeutic doses sometimes cause psychosis, delirium, personality change, and depression. Since moderately low overdoses of chloroquine can result in rapid death, such behavioral effects could lead to accidental or state-dependent overdosage and death.
Caffeine is a widely used psychoactive substance that has the potential to contribute to many psychiatric symptoms. This review article aims to address the specific research studies and case reports that relate caffeine to psychiatric symptoms. Caffeine can cause anxiety symptoms in normal individuals, especially in vulnerable patients, like those with pre-existing anxiety disorders. Caffeine use is also associated with symptoms of depression due to either a self-medication theory, or a theory that caffeine itself causes changes in mood. Psychosis can be induced in normal individuals ingesting caffeine at toxic doses, and psychotic symptoms can also be worsened in schizophrenic patients using caffeine. Sleep and symptoms of ADHD may be altered by caffeine as well. Prevention of caffeine-induced psychiatric symptoms is possible by recognizing, educating, and treating patients using a tapering approach.
The incidence of tricyclic antidepressant-induced behavioral toxicity appears to be fairly high in elderly patients but has rarely been reported in the young. We present a case of significant behavioral side effects in a young woman secondary to elevated plasma levels of imipramine and desipramine, masquerading as an agitated psychotic depression.
Routine blood samples of 145 consecutive patients seen in the Los Angeles County Psychiatric Hospital Emergency Room during a 48-hour weekday period in June 1979 were examined for phencyclidine (PCP) using a sensitive and specific gas capillary gas chromatographic nitrogen detector (GC2-N) method. Of these 145 samples 63 (43.4%) were positive and PCP levels ranged 0.34 to 142.9 nanograms/ml (mean 14.6 ng/ml +/- 3.4 S.E.M.). An analysis of the records of these 63 patients revealed a wide variety of psychotic clinical pictures resembling mania, depression or schizophrenia with relatively few of the supposedly characteristic manifestations of PCP intoxication. Each of the 63 patients had at least one manifestation of toxic psychosis and/or acute delirium, in addition to the florid symptoms characteristic of functional states. PCP measurement, pharmacokinetics and the possible relationships of this intoxication to the psychiatric manifestations are discussed.
In France, the prevalence of psychiatric disorders has never been studied, despite the fact that such disorders are a major public health problem in prisons. Through the Services Medico-Psychologiques Regionaux (SMPR, Regional Medical and Psychological Departments), the psychiatric disorders of new prisoners, as well as the mental pathologies of the prisoners monitored by these services, have been analysed. All subjects arriving in prison during the month of June 2001, as well as all those monitored during the same period, were surveyed by means of a questionnaire that assessed the symptoms present on arrival in prison and the mental pathologies of the prisoners being monitored. Most of the new prisoners were male (94%). They were relatively young (31 years on average) and had severe problems with social insertion (12% were homeless). There were psychiatric symptoms in 40%, largely disorders associated with addiction or anxiety. The prisoners monitored by the SMPR were older and included more women, but the socio-economic characteristics were similar to those of the new arrivals. Personality disorders represented 34% of the diagnoses, a quarter of the prisoners being monitored suffered from mental disorders associated with the use of toxic substances, 12% suffered from neurotic or anxiety disorders, 8% had a psychotic pathology and 7% mood disorders. Psychiatric disorders are very common in new prisoners and the mental pathology of the subjects monitored by the SMPR is very specific.
The use of lithium ions in the treatment of manic states is discussed. Lithium is possibly the only specific drug treatment presently available for the major psychoses and has met with enthusiasm in England, Scandinavia, Australia and, more recently, in Canada and the United States.A number of the published papers on the subject are not sufficiently comprehensive to provide guidance for even its empiric use; some lack the necessary controls and design to permit comparisons with other studies.Some clinicians with wide experience of lithium therapy do not maintain laboratory control of patients by ordering serum lithium determinations but rely entirely on clinical judgement in establishing drug schedules. This is not advised if one has little experience with lithium therapy because of the possible side effects and toxicity.
The use of cannabis can lead to an acute toxic psychosis, 'flashbacks', depersonalization, derealization and marked cognitive and psychomotor impairment. Further research is needed to establish whether a functional psychosis can be provoked, aggravated or prolonged by cannabis intake. Perhaps of greatest significance among the physical sequelae is the potential to suppress the immune system, impair reproduction, produce respiratory disease and increase the risk of lung cancer.
Impairment in short-term memory and lingering deficit in psychomotor performance are but two of the acute cannabis intoxication components that may have long-term consequences. The former because it affects learning and the latter because it interferes with proper handling of motor vehicles. The most frequently observed complication of cannabis inebriation, however, is a short-lasting acute psychological disturbance with symptoms of panic, paranoid apprehension and personality disorganization. This type of reaction is often not dose-related, and could appropriately be termed "pathological intoxication". In addition to the acute effects of cannabis on mental performance and behaviour, this paper reviews the psychiatric consequences of chronic use and the accumulated evidence on organic toxicity associated with it: residual cognitive deficit, lethargic symptoms, cannabis psychosis, respiratory, gastro-intestinal and cardiovascular complications, as well as effects on immune response and gonadal functions, are discussed. Also included are reviews on the pharmacology and therapeutic potential of cannabinoids.
Ejaculates from 30 patients with alcohol toxic delirium have been tested. We found a decreased number of hypospermia (n = 8) and a reduced sperm density of 18 mill.spermatozoa/ml. Judging sperm density, morphology and motility, 29 sperm-counts are severe pathological. The disturbance of spermiogeneses is most pronounced (2 = 0.01), when increased FSH-values (n = 10) and acute alcohol toxical hepatitis (n = 4) were found, but is less dependent on the drinking habits according to Jellinek or on increased oestradiol values (n = 6) or increased CK-values. The sperm parameters in chronic alcoholics show no better values when fertility has been proved before (n = 10).
While benzodiazepines have been widely used in adult populations, their role in the treatment of anxiety disorders in children and adolescents has not been well established. The authors report on two cases in which benzodiazepine use resulted in psychotic symptoms. The importance of eliciting a careful history as well as being familiar with drugs' side effects and withdrawal effects is stressed.
The use of synthesis drugs is the object of numerous written articles and TV programs in the last, decade. These synthesis drugs or "designer drugs", are well known for their ability to enhance, reinforce or appease social difficulties and relationships. In the research for empathetic and entactogenic relations one discover an obvious lack of communication and "warmth" in personal or professional relationship. An image of chemical "well being" has become a frequent stereotype of a society with an atrophying of performance and values while supposedly dedicating itself to individual performance. The youths are the first victims of these new drugs, the economical and social environment are the main reinforcing factors of this behaviour. The main characteristic of these drugs, is the non-recognition of their danger, some users go so far as to describe this category of substances as "drugs which are not drugs". As a characteristic, the use of a these synthesis drugs is almost recreative, during the week-end and holiday. The drug addiction is different than that of opiates or cocaine. One can observe some cases of real dependence--corresponding to the DSW IV criterion--when the personality of the users is the main characteristic (narcissic failure, immature personality, family and school problems). Many adverse effects--hypertension, kidney failure, psychoses--were declared. The mass-media has presented many articles concerning Ecstasy (MDMA). This is the most used drug during the rave parties. Its adverse effects are well known and proven. The authors would like to present other more recent synthesis drugs, also known as "analogs". These drugs, a kind of mixture between amphetamine-like (MDMA, MBDB, MDA) and misused medicines (ketamine, gamma OH, atropine) represent a real danger. GHB, 2 CB, HMB, are some of these recent substances. The possibility to procure them on the Web, or to produce them by oneself, add to their danger because of the lack of controls on toxicity and quality. The original danger signs were revealed by the FDA and currently a major preoccupation within french specialised services. The major problem for the practitionner is to inform the users, in order to prevent addiction and analyse the solutions.