Cases reported "Hallucinations"

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1/17. Rabbitfish ("aras"): an unusual source of ciguatera poisoning.

    BACKGROUND: ciguatera poisoning is the commonest fish-borne seafood intoxication. It is endemic to warm water tropical areas and is caused by consumption of bottom-dwelling shore reef fish, mostly during spring and summer. The causative agent, ciguatoxin, is a heat-stable ester complex that becomes concentrated in fish feeding on toxic dinoflagellates. The common clinical manifestations are a combination of gastrointestinal and neurologic symptoms. Severe poisoning may be associated with seizures and respiratory paralysis. OBJECTIVE: To describe a series of patients who sustained ciguatera poisoning in an uncommon region and from an unexpected source. patients: Two families complained of a sensation of "electrical currents," tremors, muscle cramps, nightmares, hallucinations, agitation, anxiety and nausea of varying severity several hours after consuming rabbitfish ("aras"). These symptoms lasted between 12 and 30 hours and resolved completely. The temporal relationship to a summer fish meal, the typical clinical manifestations along with the known feeding pattern of the rabbitfish suggested ciguatera poisoning. CONCLUSIONS: The Eastern Mediterranean basin is an unusual region and the rabbitfish an unusual source for ciguatera poisoning. There are no readily available and reliable means for detecting ciguatoxin in humans. A high index of suspicion is needed for diagnosis and a thorough differential diagnosis is essential to eliminate other poisonings, decompression sickness and encephalitis. Supportive therapy is the mainstay of treatment.
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2/17. dextromethorphan psychosis, dependence and physical withdrawal.

    As part of a synthesis of evidence regarding the abuse and addiction liability of dextromethorphan (DM), an over-the-counter cough medicine available in over 140 preparations, an uncommonly published case of dextromethorphan dependence (addiction) is described, with specific, rarely published complications. The individual was interviewed and several medical databases were also reviewed (medline, 1966-present; pubmed) for all content relating to the Keywords: dextromethorphan, abuse, dependence, cough medicine, addiction, withdrawal, psychosis. The patient evidenced history suggesting substance dependence, substance-induced psychosis and substance withdrawal in relation to DM. A literature review revealed that DM has specific serotonergic and sigma-1 opioidergic properties. dextrorphan (DOR), the active metabolite of DM, has similar properties; however, DOR is a weaker sigma opioid receptor agonist, and a stronger NMDA receptor antagonist. DM and DOR display specific biological features of addiction, and are capable of inducing specific psychiatric sequelae. A specific, reproducible toxidrome with significant psychiatric effects occurred, when DM was abused at greater than indicated doses, with more profound and potentially life-threatening effects at even higher doses. DM withdrawal appears evident. DM's active metabolite, DOR, has pharmacodynamic properties and intoxication effects similar to dissociatives, and may be more responsible for the dissociative effect that this DM abuser sought. However, it is this same metabolite that may be fraught with the potentially life-threatening psychoses and dissociative-induced accidents, as well as addiction. While DM has been hypothesized as the most commonly abused dissociative, health-care providers seem largely unaware of its toxidrome and addiction liability.
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keywords = intoxication
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3/17. Hallucinatory fish poisoning (ichthyoallyeinotoxism): two case reports from the Western Mediterranean and literature review.

    Ichthyoallyeinotoxism is a rare kind of food poisoning contracted following the ingestion of fish. The responsible toxins are unknown, and the clinical feature is characterized by the development of CNS disturbances, especially hallucinations and nightmares. As the implicated fish species may be also related to ciguatera poisoning, there may be possible confusion between the two fish-borne intoxications. In order to clarify this, the literature pertaining to "dreamfish" was reviewed and two cases are presented. A 40-year-old man experienced mild digestive troubles and terrifying visual and auditory hallucinations after eating a specimen of Sarpa salpa in a restaurant. As he had severe behaviour troubles, he was managed in the hospital and recovered 36 h after the meal. He was unable to recall the hallucinatory period. Another man, 90-years-old and previously healthy, had auditory hallucinations 2 h after eating a specimen of Sarpa salpa. The two following nights, he had numerous nightmares and recovered spontaneously after a period of 3 days.
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keywords = intoxication
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4/17. Photopsia as a manifestation of digitalis toxicity.

    CASE REPORT: To present a case of photopsia resulting from digoxin intoxication brought about by dehydration in a 72-year-old woman. COMMENTS: Ophthalmologists may be the first clinicians to notice the symptoms of digitalis intoxication, which is potentially a life-threatening condition.
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keywords = intoxication
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5/17. Toxic psychosis following cycloplegic eyedrops.

    A case of toxic psychosis due to cycloplegic eyedrops is reported. The characteristic mental symptoms of atropine intoxication include confusion with vivid visual hallucinations, restlessness, muscular incoordination, and later emotional lability. These symptoms and a short period of retrograde amnesia occurred in our patient. The adverse drug reaction was confirmed following rechallenge. The possible preventive measures against intoxication caused by atropine eyedrops are described. All healthcare professionals should be aware of the possible temporal relationship between the appearance of pathology and the administration of a drug.
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keywords = intoxication
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6/17. Topical diphenhydramine toxicity in a five year old with varicella.

    The toxic effects of oral diphenhydramine are well documented and include central nervous system and anticholinergic symptomatology. We present a case of diphenhydramine intoxication from combined oral/percutaneous medication. Overzealous application of a commercially available topical diphenhydramine preparation resulted in hallucinations and other side effects in a five-year-old child with varicella.
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keywords = intoxication
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7/17. Autoscopic and drug-induced perceptual disturbances. A case report.

    The unique association of autoscopic and toxic hallucinatory phenomena is presented. These two phenomena were clearly differentiated by two clinical aspects--their course of appearance and the patient's attitude. Various conditions affecting the central nervous system have been associated with the autoscopic phenomena. In this case, hallucinatory disturbances were caused by drug intoxication. However, the special features of the autoscopic phenomena were retained and could be clearly distinguished. Psychiatrists should be familiar with the syndrome as lack of clinical recognition might cause wrong treatment decisions--as presented in our patient.
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keywords = intoxication
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8/17. Galanthamine hydrobromide, a longer acting anticholinesterase drug, in the treatment of the central effects of scopolamine (Hyoscine).

    Galanthamine hydrobromide, an anticholinesterase drug capable of penetrating the blood-brain barrier, was used in a patient demonstrating central effects of scopolamine (hyoscine) overdosage. It is longer acting than physostigmine and is used in anaesthesia to reverse the non-depolarizing neuromuscular block. However, studies into the dose necessary to combating scopolamine intoxication are indicated.
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keywords = intoxication
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9/17. A study of benzhexol abuse.

    The occasional abuse of anticholinergic drugs for their psychotropic and specifically hallucinogenic properties has been known for over a century, but benzhexol (trihexyphenidyl) abuse has only recently attracted attention in the literature, mainly in case reports. This paper reports on a study of 21 benzhexol abusers. They were a young, single, and disadvantaged group of polydrug abusers with poor employment, educational, and social skills, who abused benzhexol mainly for its euphorogenic properties. The two major diagnostic categories were antisocial personality disorder and schizophrenia. An unexpected finding was cognitive impairment persisting after acute intoxication.
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keywords = intoxication
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10/17. Prolonged depersonalization after marijuana use.

    The author describes four cases of prolonged depersonalization that occurred months after marijuana use. Each occurred in the setting of a stressful life event. depersonalization is a common experience during acute intoxication with marijuana, and these cases suggest that after the patients had experienced depersonalization, external stressors and intrapsychic factors may have contributed to its continued use as a defense mechanism.
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keywords = intoxication
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