Sunday, March 27, 2011

Visual hallucinations from retinal detachment misdiagnosed as psychosis.

J Psychiatr Pract. 2011 Mar;17(2):133-6.

Brda D, Tang EC.
*New York State Psychiatric Institute and Columbia University Department of Psychiatry †Columbia University College of Physicians & Surgeons.


Hallucinations are a common presenting symptom in schizophrenia and other psychotic disorders. In particular, auditory hallucinations, such as hearing voices, are the most common type of hallucination described in schizophrenia, while visual hallucinations are less frequently seen. Hallucinations are also present in disorders that are not primarily psychotic in nature, including mood disorders, substance-induced disorders, and psychosis due to a general medical condition. However, it is extremely important to rule out general medical causes of hallucinations, as they are often treatable and reversible, and if left untreated, the underlying non-psychiatric disorders causing them can lead to irreversible damage. We present a case in which a 48-year-old woman with schizophrenia began to complain of visual disturbances. Because of her delusional interpretation of these disturbances, they were initially attributed to psychosis, but the disturbances were in fact found to be the result of a retinal detachment. (Journal of Psychiatric Practice. 2011;17:133-136).

PMID: 21430493 [PubMed - in process

Cough mixture misuse in Hong Kong--an emerging psychiatric problem?

Addiction. 1996 Sep;91(9):1375-8.
Lam LC, Lee DT, Shum PP, Chen CN.
Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong.

Cough mixture misuse has become a focus of concern in Hong Kong since the late 1980s. Psychiatric admissions related to cough mixture misuse have been reported with increasing frequency during the past 5 years. A retrospective chart review of psychiatric admissions related to cough mixture misuse for a 54-month period was conducted in two psychiatric units in Hong Kong. Twenty-seven subjects were identified. The main psychiatric presentations included acute organic brain syndrome, schizophreniform psychosis and affective episode. They appeared to be associated with the pharmacological activities of opiates, antihistamines and sympathomimetics, the main ingredients of most cough mixtures.

PMID: 8854373 [PubMed - indexed for MEDLINE

Cough mixture induced psychosis.

Br J Clin Pract. 1996 Oct-Nov;50(7):400-1.

Lee DT, Lam LC, Chan KP, Leung HC.
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong.


Cough mixture is the third most commonly abused substance in Hong Kong. Over the last two years, ten cases of cough mixture-induced psychosis were admitted to a University hospital. All of them were clinically indistinguishable from paranoid schizophrenia, but the psychotic symptoms often resolved promptly with the cessation of cough mixture use or a small dose of haloperidol. A representative case is described. The possible underlying aetiological mechanism and the treatment principle are discussed.

PMID: 9015916 [PubMed - indexed for MEDLINE]

Saturday, March 26, 2011

Mania following head trauma.

Am J Psychiatry. 1987 Jan;144(1):93-6.

Shukla S, Cook BL, Mukherjee S, Godwin C, Miller MG.


The authors present psychiatric and neurologic data on 20 patients who developed mania after closed head trauma. An association was seen between severity of head trauma (based on length of posttraumatic amnesia), posttraumatic seizure disorder, and type of bipolar disorder. The manic episodes were characterized by irritable mood rather than euphoria and by assaultiveness. Psychosis occurred in only 15% of the sample, and 70% had no depressive episodes. Bipolar disorders were absent among 85 first-degree relatives. The authors suggest that posttraumatic seizures may be a predisposing factor in posttraumatic mania.

PMID: 3799847 [PubMed - indexed for MEDLINE]

Manic syndrome following head injury: another form of secondary mania.

J Clin Psychiatry. 1987 Jan;48(1):29-30.

Riess H, Schwartz CE, Klerman GL.


Two cases of mania secondary to head injury are reported. Only four well-documented reports of head trauma as a cause of secondary mania were found in an English and foreign literature search, although such a search is made difficult by the paucity of cases meeting modern diagnostic criteria for mania. Previous reviews of the causes of secondary mania have not included head injury, but the two case reports confirm that head injury may be an additional cause. A diagnosis of mania secondary to head trauma should be considered in manic patients with atypical age of onset, absence of previous psychiatric illness, negative family history for bipolar illness, and close temporal proximity of head trauma to subsequent mania.

PMID: 3804982 [PubMed - indexed for MEDLINE]

Mania in neurologic disorders.

Curr Psychiatry Rep. 2000 Oct;2(5):440-5.

Mendez MF.

Neurobehavior Unit (116AF), Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA.


Neurologic disorders can produce "secondary" mania. Clinicians must distinguish secondary mania from primary, idiopathic manic-depressive illness (MBI). In addition to medical and drug-induced causes of secondary mania, neurologic causes usually develop in older patients who may lack a strong family history of MDI. Neurologic causes of mania include focal strokes in the right basotemporal or inferofrontal region, strokes or tumors in the perihypothalamic region, Huntington's disease and other movement disorders, multiple sclerosis and other white matter diseases, head trauma, infections such as neurosyphilis and Creutzfeldt-Jakob disease, and frontotemporal dementia. Patients with new-onset mania require an evaluation that includes a thorough history, a neurologic examination, neuroimaging, and other selected tests. The management of patients with neurologic mania involving correcting the underlying disorder when possible and the judicious use of drugs such as the anticonvulsant medications.

PMID: 11122994 [PubMed - indexed for MEDLINE]