1/147. Complicated delirium in a cancer patient successfully treated with olanzapine.delirium is common among cancer patients, especially those with advanced disease. Typical treatment involves addressing the underlying cause if possible; eliminating nonessential and/or other drugs that can worsen confusion, manipulating the environment; and administering antipsychotic drugs to control symptoms and agitated behavior, and attempt to clear the patient's sensorium. The newer atypical antipsychotics may have potential in the treatment of delirium and also have the added benefit of causing less akithisia and other extrapyramidal side effects. This is illustrated by the case of a 59-year-old woman with leukemia and pain of unclear etiology who developed a delirium and a moderate to severe extrapyramidal syndrome (EPS) in the setting of escalation of her pain medications and concomitant escalation of prochlorperazine. The patient presented with confusion and moderate to severe cogwheeling rigidity, masked facies, bradykinesia, and tremor. Additionally, the patient had a relatively recent history of subdural hematoma and one seizure. Conservative management including eliminating multiple nonessential medications (including the prochlorperazine); changing her opioid analgesic; providing a 24-hour companion: and administering low doses of haloperidol (0.5 mg-2.0 mg) were not effective in treating the patient's delirium. The patient's EPS was dramatically worse following haloperidol doses. After approximately I week without improvement, the patient was started on olanzapine 5 mg daily with initial improvement but with residual confusion in the evenings and overnight. The dose was titrated up to 10 mg nightly with 2.5 mg as needed during the day. After 3 days on this regimen, the patient's mental status exam was normal and she was discharged home. We discuss the potential utility of this atypical antipsychotic in the palliative care setting.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/147. dextromethorphan- and pseudoephedrine-induced agitated psychosis and ataxia: case report.pseudoephedrine and dextromethorphan are therapeutic constituents of numerous commonly used, over-the-counter cough and cold preparations. Although this drug combination is generally considered quite safe if utilized in recommended doses, overmedication or overdose can result in serious neurologic and cardiovascular abnormalities that occasionally can be life-threatening. We present a case of a 2-year-old child who developed hyperirritability, psychosis, and ataxia after being overmedicated with a pseudoephedrine/dextromethorphan combination cough preparation, and discuss probable mechanisms of toxicity and risk factors for adverse events.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
3/147. A case of interferon alpha-induced manic psychosis in chronic hepatitis c.It is well known that mood disorder such as depression occasionally develops during interferon (IFN) therapy for chronic viral hepatitis. So far, however, IFN-induced manic disorder has been rarely reported. We present a case of manic psychosis which developed during IFN treatment for chronic hepatitis c. A 35-year-old man with chronic hepatitis positive for hepatitis c virus rna in serum was treated with natural IFN alpha with a daily dosage of 5 million units. Six weeks later he complained of insomnia, and then became exhilarated, talkative, restless and aggressive. Since the mental state was compatible with manic disorder, IFN therapy was immediately ceased. Simultaneously, psychotropic drugs were administered. One week later, the psychiatric disturbances disappeared. He has been keeping his usual social interactions without the psychotropic drugs after that. It is suggested that manic psychosis happened secondary to IFN alpha treatment.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
4/147. Non-steroidal anti-inflammatory drugs with adverse psychiatric reactions: five case reports.Adverse drug reactions of non-steroidal anti-inflammatory drugs (NSAIDs) are quite prevalent, but there are few reports about possible adverse psychiatric reactions, which may be ignored or underestimated. We describe here five psychiatric outpatients, two with major depressive disorders, one bipolar disorder, one schizophrenic disorder and one anxiety disorder, who were treated with NSAIDs for pain due to rheumatoid arthritis, osteoarthritis or other painful neuromuscular conditions. All five patients developed a moderate to severe depressive state, three patients became obviously paranoid, and four had either thoughts of suicide or an attempt while undergoing co-administration of NSAIDs. The psychiatric symptoms remitted when the NSAIDs were stopped. The depressive and paranoid symptoms returned on seven occasions of re-use or re-challenge with the same or a different type of NSAID in all five patients. When the NSAIDs were stopped again, the patients had another remission of the adverse psychiatric reactions, and eventually recovered to their baseline mental states in clear temporal relationships. The cases presented suggest that NSAIDs can induce or exacerbate idiosyncratic reproducible adverse psychiatric symptoms in certain vulnerable patients, including those with a variety of psychotic or neurotic disorders, and also in elderly persons, but these undesirable side-effects were generally transient and disappeared on withdrawal of the NSAIDs.- - - - - - - - - - ranking = 3keywords = drug (Clic here for more details about this article) |
5/147. Efficacy of quetiapine in Parkinson's patients with psychosis.Eleven patients with Parkinson's disease (PD) and acute psychosis received flexible doses of quetiapine between 25 and 300 mg/day based on clinical response and tolerance. Ten patients were receiving dopaminergic agents at baseline. Serial efficacy ratings (brief psychiatric rating scale, Clinical Global Impressions Scale), neuromuscular symptom assessments (Abnormal Involuntary movement Scale, Simpson-Angus Scale, Unified Parkinson's disease Rating Scale [UPDRS]), and adverse events monitoring were performed for up to 52 weeks. The patients had moderate hallucinations and/or delusions at baseline before the initiation of quetiapine. Nine of the 11 patients completed at least 12 weeks of treatment. Quetiapine was well tolerated in all but one patient, who became dizzy within the first week and withdrew from the study. Ten patients presented with moderate visual hallucinations. Quetiapine was markedly effective in controlling visual hallucinations in six of these patients. Symptoms of paranoia or delusions were less responsive to quetiapine. Four patients withdrew because of adverse events or comorbid medical problems, two withdrew because of a lack of efficacy, and five completed 52 weeks of treatment. The introduction of quetiapine did not exacerbate parkinsonian symptoms. Motor dysfunction, as measured by the UPDRS, revealed a slow, gradual worsening consistent with the progression of PD. Atypical antipsychotic medications such as quetiapine have a reduced likelihood of causing adverse drug-induced parkinsonism and therefore a possible role in treating psychotic symptoms in patients with PD.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
6/147. Psychotic symptoms and confusion associated with intravenous ganciclovir in a heart transplant recipient.A 65-year-old man underwent orthotopic cardiac transplantation and was prophylactically treated for cytomegalovirus infection with intravenous ganciclovir. He received standard dosages and had normal renal function. After 6 days of therapy he experienced psychotic symptoms with hallucinations, confusion, and disorientation. His altered mental status resolved after the drug had been discontinued for 5 days. ganciclovir was suspected as a cause of the symptoms. Alternative etiologies of were explored and excluded.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
7/147. Unusual case report: Nonpharmacologic effects of sildenafil.Sildenafil (Viagra), by virtue of its conflict-laden symbolic meanings, may be particularly likely to have psychosocial consequences, either therapeutic or disruptive. The author presents two cases of men in their mid-seventies who took sildenafil and who were admitted to a locked geropsychiatry unit because of homicidal ideation toward their wives that occurred while they were not under the direct effect of the drug. In one case, a wife's rejection of her husband's advances seemed to uncover many hidden resentments that they bore toward each other. In the other, sildenafil failed to restore potency to a patient with diabetes, and he developed a jealous delusion that his wife was having an affair.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
8/147. Psychosis in a methadone-substituted patient during interferon-alpha treatment of hepatitis c.interferon-alpha (IFN-alpha) is the only effective treatment for chronic hepatitis b and C. Over 2/3 of methadone-substituted patients suffer from chronic hepatitis c but a history of psychiatric disorders or drug addiction is still seen as a contraindication for IFN-alpha because of a possible increased risk of severe psychiatric side effects such as depression, suicide attempts or psychotic episodes. We report on the case of a 33-year-old patient with chronic hepatitis c and a positive psychiatric history (drug abuse, borderline personality and four suicide attempts). After 4 months of therapy with IFN-alpha he developed a psychosis with persecution mania, complex thought disorder, disturbance of sexual identity, sleeplessness, anxiety, depression and increased irritability with suicidal thoughts. Symptoms did not disappear after discontinuation of interferon treatment. To our knowledge, there are no other reports of persistent psychosis with a possible association to interferon treatment. Development of psychosis and other psychiatric side-effects may be an indication of possible neuromodulatory effects of IFN-alpha with long-term treatment. On the other hand, the treatment for hepatitis c was successful. Ideas for safer treatment in methadone patients with psychiatric co-morbidity and chronic hepatitis c are needed.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
9/147. Medication-induced dystonias in nine patients with dementia.Evidence from previous studies of neuroleptic side effects suggests that acute dystonic reactions are rare in elderly patients. The authors report 9 cases of dystonic reactions in patients with dementia following the initiation of antipsychotic medication. The cases are important in documenting that drug-induced dystonias do occur in patients with dementia, that risperidone appears to have contributed to dystonia among elderly patients, and that the categorization of dystonic reactions needs further clarification.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
10/147. indomethacin induced psychosis.indomethacin is a commonly prescribed non-steroidal anti-inflammatory drug. While its adverse effects on gastrointestinal and renal systems are well described, its central nervous system effects are less well known. This case report describes an elderly man, prescribed indomethacin for gout, who presented with psychosis.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
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