1/10. Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient.The authors report a case of probable serotonin syndrome caused by the coadministration of sertraline and oxycodone. A 34 year-old male patient experienced visual hallucinations and severe tremor after dramatically increasing his dosage of oxycodone while on stable amounts of sertraline and cyclosporin. Discontinuation of cyclosporin did not result in resolution of his symptoms. Consideration of a possible sertraline-oxycodone interaction led to withholding sertraline, which resulted in symptom resolution. serotonin syndrome has been noted with sertraline in combination with other drugs, but this is the first report in combination with a narcotic analgesic. Possible pharmacological mechanisms are discussed. In complicated patients that are taking multiple medications, physicians should be aware of this possible interaction to avoid delay in the diagnosis of serotonin syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Visual, tactile, and phobic hallucinations: recognition and management in the emergency department.OBJECTIVES: The purposes of this case series are to review the acute manifestations of hallucinatory phenomenon in young children, with a focus on visual, tactile, and phobic hallucinations (VTPH) as an important part of the differential diagnosis; and to describe 10 children who presented to the Children's National Medical Center Emergency Department (CNMC ED) with VTPH. methods: The medical records of children identified with VTPH who were evaluated during a 20-month period in 1998 to 1999 were reviewed. The diagnosis was established if the hallucinations were well documented as being anxiety-related, not auditory, and with no evidence of underlying organic etiology. All cases were initially screened in the emergency department. Demographic information included age, gender, duration, and description of symptoms, stressors, family psychiatric history, and outpatient treatment. RESULTS: Ten children with this disorder were encountered. VTPH can be differentiated from other causes of hallucinations in that the children are preschool to young school age; their hallucinations are tactile and visual, presenting at night; and symptoms are anxiety-based but short-lived. When toxins, drug reactions, central nervous system, and febrile etiologies are ruled out, timely consultation with the psychiatry team can eliminate costly and time-consuming procedures and avoid further emotional distress for the child and family. CONCLUSIONS: VTPH is a more commonly occurring disorder than previously reported in the pediatric emergency medicine literature. Emergency physicians who recognize the characteristics of this diagnosis are encouraged to seek psychiatric consultation rather than performing unnecessary and costly diagnostic tests.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Olfactory and visual hallucinations in Parkinson's disease.Management of hallucinations in patients with parkinson disease is a challenge for both the physician and the patient. They occur in more than 30% of patients and they present mostly as visual hallucinations but other forms such as auditory and tactile hallucinations have been reported. We have reported an interesting patient with olfactory hallucinations and visual hallucinations. To our knowledge, olfactory hallucinations have been rarely described in patients with Parkinson's disease and might be added to the late complications of Parkinson's disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. neuroleptic malignant syndrome: life-threatening complication of neuroleptic treatment in adolescents with affective disorder.neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal side effect of neuroleptic treatment characterized by hyperthermia, rigidity, rhabdomyolysis, and delirium. In recent clinical studies of adults it was suggested that affective disorder is a risk factor for the development of neuroleptic malignant syndrome. The cases of two adolescents with neuroleptic malignant syndrome who were treated with neuroleptic therapy because of psychotic symptoms in association with primary affective disorders are reported. The occurrence of these cases, as well as the observations in adults, suggests that attention to the primary psychiatric diagnosis is important in neuroleptic usage and that physicians should be vigilant to the occurrence of neuroleptic malignant syndrome in the pediatric population.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Benzodiazepine prescription abuse and the benzodiazepine withdrawal syndrome.benzodiazepines are among the most widely-prescribed medications in the world. Although tolerance is unlikely, abuse is widespread. Prescription abuse is especially common, with medication being taken for longer periods than intended, or at the wrong dosage, or for purposes not intended by the physician. Prolonged use, even at therapeutic levels, can produce a definite "benzodiazepine withdrawal syndrome" with disturbing symptoms such as insomnia, twitching, and restlessness, leading to prolongation of the already inappropriate usage. Suggestions for reducing this abuse are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Altered mental status in the elderly.Misdiagnosis of treatable dementia in the aged is costly to society and the family, and is unmeasurable in personal tragedy. The 4 Ds of the elderly--dementia, depression, delirium, and delusion--are discussed. family physicians are encouraged to seek out treatable disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Acute psychosis after mefloquine: a case report.A self-limiting psychosis characterized by visual and auditory hallucinations and isomnia occurred in a 17-year old male after mefloquine administration for presumed chloroquine resistant falciparum malaria. The attending physician failed to recognise the association between mefloquine and psychosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Angel's Trumpet psychosis: a central nervous system anticholinergic syndrome.The authors warn physicians that intoxication by Angel's Trumpet (datura sauveolens) is becoming more frequent due to its use by adolescents and young adults as a legal, readily available hallucinogen. Ingestion of Angel's Trumpet flowers or a tea brewed from them results in an alkaloid-induced central nervous system anticholinergic syndrome characterized by symptoms such as fever, delirium, hallucinations, agitation, and persistent memory disturbances. Severe intoxication may cause flaccid paralysis, convulsions, and death. Treatment with intravenous physostigmine reverses the toxic effects of Angel's Trumpet.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Systemic toxicity from ocular homatropine.Toxidromes are well known to emergency physicians. An unclear or incomplete history and subtle findings on physical examination make the diagnosis of poisonings challenging. This article reports a patient who had an acute onset of visual hallucinations, pressured speech, and mania. Although she denied taking any medications, she was ultimately diagnosed as having anticholinergic toxicity. On further questioning of family members, it was discovered that she was being treated for anterior uveitis with 5% homatropine. This case illustrates the potential role of ocular medications in systemic toxicity. patients often do not consider eyedrops to be medications, and their use may be overlooked in the medical history. It also is important to educate patients and medical staff in methods to minimize systemic toxicity when using ocular medication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Visual hallucinations after enucleation.Visual phenomena are frequently reported in patients after ocular trauma, surgery or progressive visual degeneration. In particular, hallucinations are often seen by patients following enucleation. Whereas these visions can be verbally described to the physician, they can never actually be seen. This article focuses on the case of a female artist who experienced visual hallucinations after enucleation of her dominant right eye. In addition to her verbal descriptions, she was able to express these hallucinations visually on canvas. Her case offers insight to caregivers about the nature of visual hallucinations in patients with similar experiences. A review of the general characteristics and etiologies of such visual phenomena is also included.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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