1/10. multiple chemical sensitivity (MCS)--differential diagnosis in clinical neurotoxicology: a German perspective.The multiple chemical sensitivity syndrome (MCS) is a new cluster of environmental symptoms which have been described and commented on for more than 15 years now in the USA. In the meantime it has also been observed in European countries. The main features of this syndrome are: multiple symptoms in multiple organ systems, precipitated by a variety of chemical substances with relapses and exacerbation under certain conditions when exposed to very low levels which do not affect the population at large. There are no lab markers or specific investigative findings. In our view, MCS is not a separate clinical syndrome but a collective term. A very small part of the patients in question may actually exhibit a somatic or psychosomatic response to low levels of a variety of chemicals in the environment. For another part, even if the MCS symptoms are induced by chemical substances in the environment, the basic hypersensitivity is a psychological stress reaction. In the third and largest group, the patients have been misdiagnosed, i.e. a somatic or psychiatric disease has been overlooked. There is a fourth group of patients in whom there is no evidence of any exposure at all but instead a belief system installed by certain physicians, the media and other groups in society. This paper tries to describe the neurological and neurotoxic aspects of MCS problems and to illustrate it with examples of an alleged outbreak of chronic neurotoxic disease caused by pyrethroids in germany. research strategy should establish clearly determined diagnostic criteria, agreement on the use of specific questionnaires as well as clinical and technical diagnostic procedures, prospective clinical studies of MCS patients and comparative groups as well as experimental approaches.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Forced normalization induced by ethosuximide therapy in a patient with intractable myoclonic epilepsy.Forced normalization (FN) is a well known phenomenon of acute psychosis accompanying seizure control. An 11-year-old boy with intractable myoclonic epilepsy and severe psychomotor delay experienced FN during medication of ethosuximide. Although his myoclonic seizures were completely controlled, behavioral changes, more of the manic type, became evident. EEG during this phenomenon showed almost normal findings. Generally, withdrawal of anti-epileptic drugs in patients with FN is still controversial and much debated. We could conclude that the physician should judge comprehensively the treatment considering the more favorable situation for the patient and the family.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Adverse reaction to dental corticosteroids.The case of an 18-year-old woman who experienced prominent, episodic cognitive dysfunction and affective symptoms, which coincided with a brief administration of dexamethasone, has been presented. Because her symptoms were subtle and intermittent, and because she was no longer taking corticosteroids when she sought medical attention, the diagnosis of a corticosteroid-induced mental disorder was delayed. This case demonstrates the need for heightened awareness, among all practitioners, of the effects of corticosteroids on mental functions. Because it is not possible to predict who will experience mental disturbances with even small doses of corticosteroids, all patients (and their families, if possible) should be informed about the possibility of adverse reactions. dentists and physicians need to weigh the risks and benefits of corticosteroid therapy carefully. Clinicians also should be suspicious of psychiatric disturbances in proximity to corticosteroid use (i.e., even in a patient who is not taking corticosteroids, but who has a history of corticosteroid treatment).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Psychosis with paranoid delusions after a therapeutic dose of mefloquine: a case report.BACKGROUND: Convenient once-a-week dosing has made mefloquine a popular choice as malaria prophylaxis for travel to countries with chloroquine-resistant malaria. However, the increased use of mefloquine over the past decade has resulted in reports of rare, but severe, neuropsychiatric adverse reactions, such as anxiety, depression, hallucinations and psychosis. A direct causality between mefloquine and severe reactions among travelers has been partly confounded by factors associated with foreign travel and, in the case of therapeutic doses of mefloquine, the central nervous system manifestations of plasmodium infection itself. The present case provides a unique natural history of mefloquine-induced neuropsychiatric toxicity and revisits its dose-dependent nature. CASE PRESENTATION: This report describes an acute exacerbation of neuropsychiatric symptoms after an unwarranted therapeutic dose (1250 mg) of mefloquine in a 37-year-old male previously on a once-a-week prophylactic regimen. Neuropsychiatric symptoms began as dizziness and insomnia of several days duration, which was followed by one week of escalating anxiety and subtle alterations in behaviour. The patient's anxiety culminated into a panic episode with profound sympathetic activation. One week later, he was hospitalized after developing frank psychosis with psychomotor agitation and paranoid delusions. His psychosis remitted with low-dose quetiapine. CONCLUSION: This report suggests that an overt mefloquine-induced psychosis can be preceded by a prodromal phase of moderate symptoms such as dizziness, insomnia, and generalized anxiety. It is important that physicians advise patients taking mefloquine prophylaxis and their relatives to recognize such symptoms, especially when they are accompanied by abrupt, but subtle, changes in behaviour. patients with a history of psychiatric illness, however minor, may be at increased risk for a mefloquine-induced neuropsychiatric toxicity. physicians must explicitly caution patients not to self-medicate with a therapeutic course of mefloquine when a malaria diagnosis has not been confirmed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. A steroid stupor in a surgical ward.In the development and management of a steroid-induced stupor, in a 17-year-old man, the dose and route of administration of steroid medication were felt to be important aetiological factors. A co-ordinated plan of management involving the physician, surgeon and psychiatrist is needed in such cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Marijuana use in schizophrenia: a clear hazard.The use of marijuana as the independent variable produced a serious exacerbation of a psychotic process in four schizophrenic patients whose illness was otherwise well controlled with antipsychotic medication. Each patient served as his own control--the sole substance abused was marijuana and antipsychotic medication intake remained constant. Each time marijuana use at moderate levels began, there was exacerbation and deterioration. The author suggests that marijuana use is a special hazard to schizophrenic patients and that physicians should alert such high-risk patients to the possible untoward interaction between their illness and marijuana.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. cocaine-induced psychosis and sudden death in recreational cocaine users.Fatal cocaine intoxication presenting as an excited delirium is described in seven recreational cocaine users. Symptoms began with the acute onset of an intense paranoia, followed by bizarre and violent behavior necessitating forcible restraint. The symptoms were frequently accompanied by unexpected strength and hyperthermia. Fatal respiratory collapse occurred suddenly and without warning, generally within a few minutes to an hour after the victim was restrained. Five of the seven died while in police custody. blood concentration of cocaine averaged 0.6 mg/L, about ten times lower than that seen in fatal cocaine overdoses. police, rescue personnel, and emergency room physicians should be aware that excited delirium may be the result of a potentially fatal cocaine intoxication; its appearance should prompt immediate transport of the victim to a medical facility. Continuous monitoring, administration of appropriate cocaine antagonists, and respiratory support will hopefully avert a fatal outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. patients with delusional and bizarre thinking.patients with delusional or other types of bizarre thinking are often incorrectly labeled as schizophrenic. This error has significant medical and social implications to the patient. Delusional thinking has been linked with a variety of nonschizophrenic problems including the use of licit and illicit drugs, a wide variety of medical diseases, and nonschizophrenic psychiatric disturbances. A series of case studies in which the diagnosis of schizophrenia was incorrectly made elucidates the problem and helps the physician consider the alternatives.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. 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) |
10/10. 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) |
| | Next -> |