1/106. The coincidence of schizophrenia and Parkinsonism: some neurochemical implications.The hypothesis has recently been advanced that increased activity of central dopaminergic mechanisms underlies the symptomatology of the schizophrenias. The evidence that dopaminergic transmission in the corpus striatum is impaired in Parkinson's disease suggests that observations on the relationship between Parkinson's disease and schizophrenia may illuminate the patholophysiology of the latter disease. Four cases are reported in which an illness with schizophrenic features developed in the setting of longstanding Parkinson's disease; attention is drawn to earlier reports of schizophrenic illnesses occurring as postencephalitic sequelae in the presence of a parkinsonian syndrome. These observations appear to conflict with the view that increased dopamine release in the striatum is necessary for the expression of schizophrenic psychopathology, but do not exclude the possibility that increased transmission may occur at other dopaminergic sites in the brain, for example the nucleus accumbens, tuberculum olfactorium or cerebral cortex. Similarly the dopamine receptor blockade hypothesis of the therapeutic effects of neuroleptic drugs cannot be maintained with respect to an action in the striatum in view of the differences between the actions of thioridazine and chlorpromazine in this structure, but may be tenable for actions at extra-straital sites.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/106. Asymptomatic pancreatitis associated with clozapine.Besides the well-known adverse effects of clozapine, such as granulocytopenia, tiredness and hypersalivation, acute pancreatitis is known to be a very rare complication of the drug. In the literature a total of five case reports have been published so far. We report a case of asymptomatic pancreatitis subsequent to clozapine treatment at therapeutic doses in a 38-year-old male patient with chronic paranoid-hallucinatory schizophrenia. The patient was rehospitalized after an acute exacerbation of the psychosis subsequent to an attempt to change medication on an outpatient basis. Treatment with clozapine was initiated again. During phases of progressively increasing the clozapine dose, serum levels of amylase and lipase were increased; after maintaining daily doses of clozapine of 300 mg and/or 600 mg the pancreatic enzymes normalized quickly within a few days. The patient did not report any pancreas-related complaints, nor did specific diagnostic studies produce any indicative result, only a minor thickening of the head and body of the pancreas in the ultrasound. It is assumed that the phenomenon of subclinical, asymptomatic pancreatitis during increasing dosage of clozapine occurs more often than previously supposed. The monitoring of serum amylase levels during slow increase in clozapine is recommended; if leukocytosis or eosinophilia is present, the possibility of even a subclinical and asymptomatic pancreatitis should be considered.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
3/106. Acute overdose due to benzydamine.benzydamine is a nonsteroidal anti-inflammatory drug, currently available as mouthwash, aerosol, dermal cream, vaginal douche preparation, pills and otic drops. Up to now no cases of poisoning due to this drug have been reported. A 6-year-old girl with an accidental poisoning with benzydamine is described. The episode consisted of hallucinosis without other symptoms and resolved spontaneously in 17 h.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
4/106. Deterioration of parkinsonian symptoms following treatment of dopaminergic hallucinosis with olanzapine.The atypical antipsychotic drug olanzapine has been proposed for treatment of dopaminergic psychosis in Parkinson's disease (PD). We report on a 68-year-old patient who developed a severe akinetic-rigid extrapyramidal syndrome, accompanied by additional paranoid symptoms, following olanzapine treatment of optic hallucinosis in PD. Olanzapine may also induce clinically relevant extrapyramidal side effects in PD patients.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
5/106. Severe gamma-hydroxybutyrate withdrawal: a case report and literature review.We report a case of gamma-hydroxybutyrate (GHB) withdrawal resulting in severe agitation, mental status changes, elevated blood pressure, and tachycardia hours after stopping chronic use of GHB. The patient admitted to substantial GHB abuse on a daily basis for 2.5 years. Previous attempts at cessation reportedly resulted in diaphoresis, tremors, and agitation. The patient's symptoms, negative polypharmacy history, and negative urine and blood toxicological analysis for alcohol, benzodiazepines, sedative-hypnotics, or other substances suggested the diagnosis of GHB withdrawal. Later analysis of a patient drug sample confirmed the presence of GHB. The patient required 507 mg of lorazepam and 120 mg of diazepam over 90 h to control agitation. This is one of the few reported cases of GHB withdrawal and one of the most severe. Given the increasing use of GHB, more cases of severe GHB withdrawal should be anticipated.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
6/106. taste and smell phantoms revealed by brain functional MRI (fMRI).PURPOSE: Our goal was to demonstrate the appearance of phantom tastes and smells (phantageusia and phantosmia, respectively) by use of functional MRI (fMRI) of the brain and to demonstrate the efficacy of drug treatment that inhibited both the subjective presence of these phantoms and the fMRI brain activation initiated by these phantoms. METHOD: Multislice FLASH MR or echo planar MR brain scans were obtained in two patients with phantageusia and phantosmia in response to memory of two tastants (salt and sweet); memory of two odors (banana and peppermint); actual smell of amyl acetate, menthone, and pyridine; and memory of phantom tastes and smells before and after treatment with thioridazine and haloperidol. Activation images were derived using correlation analysis, and ratios of brain area activated to total brain area were obtained. RESULTS: Prior to treatment, both patients experienced persistent birhinal and global oral obnoxious tastes and smells in the absence of any external stimulus. The fMRI response to memory of phantoms was activation in sensory-specific brain regions for taste and smell, respectively. fMRI activation was greater than for memory of any tastant or odorant or for actual smell of any odor. After treatment with thioridazine or haloperidol, which successfully inhibited each phantom in each patient, fMRI response to phantom memory was significantly inhibited and was significantly lower than for memory of any tastant or odorant or actual smell of any odorant. CONCLUSION: These results demonstrate that (a) phantom taste and smell can be revealed by fMRI brain activation, (b) brain activation in response to taste and smell phantoms is localized in sensory-specific brain regions for taste and smell, respectively, (c) brain activation in response to memory of each phantom initiated the greatest degree of activation we had previously measured, and (d) treatment with thioridazine or haloperidol inhibited both the presence of each phantom and its associated fMRI brain activation. This is the first study in which phantom tastes and smells have been demonstrated by an objective technique and treatment that inhibited the phantoms was characterized by objective inhibition of fMRI activation. These two patients represent a relatively common group that may be classified as having primary phantageusia and phantosmia distinct from those with phantoms or auras secondary to neurological, migrainous, psychiatric, or other causes.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
7/106. Palinopsia and polyopia in the absence of drugs or cerebral disease.OBJECTIVE: To report the occurrence of palinopsia and polyopia in patients who neither used drugs nor had diseases of the cerebral hemispheres, a group in which these visual symptoms have not been reported. METHOD: The patient records in the database of an academic neuro-ophthalmology unit were reviewed. RESULTS: Seventeen patients were identified in the database with the diagnosis of palinopsia or polyopia, of whom eight had diseases of the cerebral hemispheres, leaving nine patients for analysis. No patients with a history of drug toxicity were identified. In one patient the symptoms presented during an initial episode of demyelinative optic neuritis in the absence of clinical or laboratory evidence of cerebral lesions. In another patient they developed immediately after laser treatment of diabetic macular edema. A third patient developed the symptoms in association with visual loss from Leber's hereditary optic neuropathy. The other six patients were healthy individuals. CONCLUSION: Palinopsia and related visual symptoms can occur in otherwise healthy individuals and in patients with disease apparently confined to the eye or the optic nerve.- - - - - - - - - - ranking = 6keywords = drug (Clic here for more details about this article) |
8/106. A female with central anticholinergic syndrome responsive to neostigmine.Central anticholinergic syndrome is a rarely observed condition in children. The occurrence of this syndrome after ingestion of solanum pseudocapsicum is infrequent because findings tend to be milder and localized to the gastrointestinal system, without central nervous system involvement. Most patients do not present with diagnostic problems because their relatives can usually report any ingestion of poisonous agents; however, when drug poisoning or plant ingestion is uncertain, a differential diagnosis with encephalitis must be considered. physostigmine salicylate is the specific antidote because it crosses the blood-brain barrier because of its tertiary ammonium group. neostigmine methylsulfate has a quaternary ammonium group, which prevents its penetration through the blood-brain barrier; hence its primary influence is believed to be due to its action on the peripheral nervous system. We describe a female with central anticholinergic syndrome caused by ingestion of solanum pseudocapsicum. A slow intravenous infusion of neostigmine methylsulfate (0.03 mg/kg) immediately resolved the clinical picture. To our knowledge, this case is the first reported of central anticholinergic syndrome occurring after ingestion of solanum pseudocapsicum in a child and the first report of a complete and rapid remission after intravenous neostigmine methylsulfate administration.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
9/106. Hypnopompic hallucinations with donepezil.A case of hypnopompic hallucinations associated with donepezil is described. Electroencephalogram (EEG) and sleep EEG changes are common in Alzheimers disease and acetylcholinesterase inhibitor drugs can affect rapid eye movement sleep and alertness. The importance of assessing sleep in patients treated with these drugs is discussed.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
10/106. Antiepileptic drug-induced visual hallucinations in a child.The neurologic signs and symptoms of carbamazepine and phenytoin toxicity, such as ataxia, dysarthria, and nystagmus, are well known. The psychiatric manifestations of toxicity, such as psychosis and hallucinations, however, are less widely recognized. This study reports the case of a 9-year-old male with seizures who developed intermittent complex visual hallucinations after therapy with antiepileptic drugs was begun. This study considered seizures, migraine, underlying psychiatric diathesis, and drug toxicity as possible etiologies but after extensive investigation concluded that his symptoms were most likely a drug side effect.- - - - - - - - - - ranking = 7keywords = drug (Clic here for more details about this article) |
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