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]

Organic causes of mania.

Mayo Clin Proc. 1988 Sep;63(9):906-12.

Larson EW, Richelson E.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905.

Comment in:
Mayo Clin Proc. 1989 Jan;64(1):129-30.


Manic syndromes have many neurologic, toxic, and metabolic causes. It is important for clinicians to be able to distinguish these organic disorders from primary idiopathic mania (bipolar disorder). The cardinal symptom of organic mania is an abnormally and persistently elevated or irritable mood. Organic mania usually develops in patients who are older than 35 years of age, whereas bipolar disorder generally has its onset between late adolescence and age 25 years. In patients with the first episode of mania, the clinician should thoroughly elicit information about current symptoms, recent infections, use of drugs, and past or family history of psychiatric disorders. In addition, a complete medical examination, computed tomography of the head, electroencephalography, and screening for drugs and toxins should be done. Treatment of organic mania includes correcting the underlying disorder when possible.

PMID: 3137394 [PubMed - indexed for MEDLINE]

Suspected antidepressant-induced switch to mania in unipolar depression: a first-person narrative.

J Affect Disord. 2010 Sep;125(1-3):111-5. Epub 2010 Jun 8.

Amey C.


BACKGROUND: Antidepressant-induced switch to mania has not been thoroughly characterized in bipolar disorder and is even less well understood in unipolar depression.

METHOD AND RESULTS: I describe, as a first-person narrative, my own experience of psychotic mania, which was suspected to have been induced by the tricyclic antidepressant, dosulepin. I have had a 16-year history of depression and was receiving sertraline 50 mg od when I was prescribed, off licence, dosulepin 25 mg 1-2 nocte for insomnia. Within days, I developed mild hypomanic symptoms and returned to my GP, who discontinued dosulepin but continued treatment with sertraline. I was also referred for psychiatric assessment. Two months later, I was detained under Section II of the Mental Health Act 1983 and admitted to hospital with psychotic manic symptoms.

CONCLUSION: More understanding of antidepressant-induced switch to mania is needed in unipolar depression. My case study highlights the need for prompt specialist care for patients with depression reporting even mild, sub-threshold symptoms of mania.

2010 Elsevier B.V. All rights reserved.

PMID: 20570368 [PubMed - indexed for MEDLINE]

Cough syrup psychosis.

CJEM. 2011 Jan;13(1):53-6.

Amaladoss A, O'Brien S.

Department of Psychiatry, Queen's University, Kingston, ON, Canada.

Over-the-counter medications are widely accessible and used. Cough suppressant syrups contain dextromethorphan (DM), which has the potential to be abused, with resultant psychiatric symptoms. This case report describes a young woman presenting with psychotic mania secondary to DM abuse. We also describe the treatment of this toxidrome and include the results of a literature search on this topic. The recognition of cough syrup as an agent of abuse and its toxidrome is important. This will facilitate early diagnostic clarification and promote efficient treatment strategies.

PMID: 21324299 [PubMed - in process]

Herpes zoster ophthalmicus and syndrome of inappropriate antidiuretic hormone secretion.

Intern Med. 2008;47(5):463-5. Epub 2008 Mar 3.

Kucukardali Y, Solmazgul E, Terekeci H, Oncul O, Turhan V.

Department of Internal Medicine, Gulhane School of Medicine, Haydarpasa Training Hospital, Istanbul, Turkey.


The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. This report describes SIADH that developed in an elderly woman with single dermatomal herpes varicella zoster ophthalmicus without evidence of varicella zoster encephalitis or dissemination. A 76-year-old woman was admitted to our department for evaluation of left facial pain, confusion and disorientation. Further investigation revealed hyponatremia 112 mEq/L, low serum osmolality, high urine osmolality, normal renal function, normal adrenal and thyroid hormones, and high plasma vasopressin 40 pg/mL. These results indicate that the hyponatremia in this case was due to SIADH and that SIADH was caused by an increased release of vasopressin probably because of the antiviral drug (acyclovir) or infection of varicella zoster virus (VZV) in a single dermatome.

PMID: 18310984 [PubMed - indexed for MEDLINE]

Hyponatremia-induced change in mood mimicking late-onset bipolar disorder.

Gen Hosp Psychiatry. 2011 Jan-Feb;33(1):83.e5-7. Epub 2010 Oct 27.

McKnight RF, Hampson S.
Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, OX3 7JX Oxford, UK.

OBJECTIVE: Hyponatremia and bipolar disorder are rarely considered to have common features. This report describes a case of hyponatremia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) presenting as late-onset bipolar disorder and discusses the evidence linking hyponatremia to mood disorders.

METHOD: Case report and review of published literature.

RESULTS: This case provides evidence that mood changes identical to those seen in bipolar disorder may be caused by hyponatremia at a variety of concentrations.

CONCLUSIONS: Further research is required to determine causes of SIADH in psychiatric patients with symptomatic hyponatremia and to elucidate the mechanism by which hyponatremia causes changes in mood. In older patients presenting with new-onset bipolar disorder, a physical etiology must always be excluded.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID: 21353139 [PubMed - in process]

Risk of herpes zoster among patients with psychiatric diseases: a population-based study.

J Eur Acad Dermatol Venereol. 2011 Apr;25(4):447-53. doi: 10.1111/j.1468-3083.2010.03811.x.

Yang YW, Chen YH, Lin HW.

Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan Department of Dermatology, College of Medicine, Taipei Medical University, Taipei, Taiwan School of Public Health, Taipei Medical University, Taipei, Taiwan Biostatistic Research and Consulting Center, Taipei Medical University, Taipei, Taiwan.


Background: Psychiatric disorders have been shown to be associated with impaired immune response, including decreased cellular immunity to varicella-zoster virus. However, the risk of herpes zoster (HZ) in psychiatric patients is, to date, unknown.

Objective The aim of this study was to determine the risk of herpes zoster (HZ) in psychiatric patients compared with the general population. Methods We used data from the Taiwan Longitudinal Health Insurance Database from 2004 to 2006. Our study cohort consisted of patients aged 18 years and older diagnosed with psychiatric disorders in 2004 (N = 42 340). The comparison cohort (N = 169 360) consisted of four age- and gender-matched controls randomly selected for every patient in the study cohort. All subjects were followed from the date of cohort entry until they developed HZ or the end of 2006, whichever was earliest. Stratified Cox proportional hazard regressions were performed to compute the 2-year HZ-free survival rates. Results After adjusting for potential confounders, we found patients with psychiatric disorders were more likely to have an episode of HZ than the control population [adjusted hazard ratio (HR), 1.29; 95% confidence interval (CI), 1.18-1.38]. When stratified by age and psychiatric diagnostic categories, in patients aged ≤60 years, the adjusted HRs for HZ were 1.34 (P = 0.026) for patients with affective psychoses, 1.42 (P < 0.001) for those with neurotic illness or personality disorders and 1.53 (P < 0.001) for patients with other mental disorders. However, in patients aged >60 years, only neurotic illness or personality disorders were significantly associated with an increased risk of HZ (adjusted HR, 1.26; P = 0.003).

Conclusions: Our analysis suggests that patients with psychiatric disorders are at increased risk of HZ, especially those aged ≤60 years. Further study is required to elucidate the nature of this association.

© 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

Herpes simplex type 2 virus encephalitis presenting as psychosis

Kalarickal J. Oommen, M.D.,

Peter C. Johnson, M.D.

C. George Ray, M.D.
Kalarickal J. Oommen, M.D.


Requests for reprints should be addressed to Dr. Peter C. Johnson, Department of Pathology, Arizona Health Sciences Center, Tucson, Arizona 85724.

From the Departments of Neurology, Pathology and Pediatrics, Arizona Health Sciences Center, Tucson, Arizona.

Accepted 20 January 1982.


The current literature recognizes two antigenic types of herpes simplex virus, type 1 and 2. Type 1 is the most common cause of sporadic necrotizing encephalitis in the United States, with a mortality rate of 30 to 70 percent, and leaves various neurologic sequelae in the survivors. Herpes simplex virus type 2 has been recognized as an etiologic agent in fatal infections in neonates and a mild meningitis in adults, but its role in encephalitis in adults is less well known. We report a case of herpes simplex virus type 2 encephalitis with an analysis of four additional cases previously documented in the literature. Herpes simplex virus type 2 may cause more infections than is presently recognized, and we suggest that some cases of acute psychosis may, like in our case, represent herpes simplex virus type 2 encephalitis.

Click here for full article.

Thursday, March 24, 2011

[Mania following the use of a decongestant].

Tijdschr Psychiatr. 2007;49(2):125-9.
[Article in Dutch]

Stuer K, Claes S.
Psychiatrisch Ziekenhuis Heilig Hart, Ieper, België.


We report on the case of a 56-year-old woman with no psychiatric history who had a manic episode after taking a decongestant containing pseudoephedrine (a secondary or organic mania). The aetiology, differential diagnosis, treatment and risk factors for a manic episode are discussed. In addition, we review published articles on the subject of mania induced by pseudoephedrine.

PMID: 17290343 [PubMed - indexed for MEDLINE]

Mania as a presentation of primary hypothyroidism.

Singapore Med J. 2009 Feb;50(2):e65-7.
Sathya A, Radhika R, Mahadevan S, Sriram U.

Associates in Clinical Endocrinology, Education and Research, Geo Towers, 3rd floor, Apollo Speciality Hospital Annexe, Chennai 35, India.


Hypothyroidism is a common problem in clinical practice, with diverse manifestations. Neuropsychiatric problems include affective disorders, disturbances in cognition and psychosis. Mania is commonly associated with hyperthyroidism. Only a few selected case reports mention mania as a presenting feature of hypothyroidism. We report a case of mania with psychotic symptoms in a 47-year-old woman who had no previous history of psychiatric disorder. She had signs of florid hypothyroidism. She required both antipsychotic drugs and thyroxine replacement for the amelioration of her symptoms. The report is followed by a brief review of the literature on mania as a clinical presentation of hypothyroidism and its probable pathogenesis. One has to have a high index of suspicion of underlying organic causes in patients presenting with depression, psychosis or cognitive disorders.

PMID: 19296014 [PubMed - indexed for MEDLINE]

Human exposure assessment and relief from neuropsychiatric symptoms: case study of a hairdresser.

J Am Board Fam Pract. 2004 Mar-Apr;17(2):136-41.

Genuis SJ, Genuis SK.
Department of Obstetrics and Gynecology, University of Alberta, Canada.


Human exposure assessment and the results of implementing 'precautionary avoidance' suggested a relationship between a hairdresser's neuropsychiatric symptoms and occupational exposure to potentially hazardous chemicals. A variety of investigations in response to patient complaints of depression, emotional instability and various physical symptoms revealed no objective abnormality; the CH2OPD2 mnemonic (community, home, hobbies, occupation, personal habits, diet and drugs) recommended by the Ontario College of Family Physicians was used as a first-line screening tool to assess potential environmental exposure to toxins. After occupational leave of absence, the patient reported cessation of symptoms. Environmental causes for familiar medical problems are frequently undiagnosed; it is recommended that, where appropriate, a screening tool for evaluation of environmental exposure to toxics be incorporated into primary care assessment and management of patients.

PMID: 15082673 [PubMed - indexed for MEDLINE]

Organic affective illness associated with lead intoxication.

Am J Psychiatry. 1984 Nov;141(11):1423-6.

Schottenfeld RS, Cullen MR.


Psychiatrists treating patients with depression or nonspecific somatic complaints seldom think of lead intoxication as a possible cause. Because occupational exposure to lead is so common, these disturbances may often be associated with lead intoxication. To facilitate earlier clinical recognition and proper treatment among the many individuals at risk, the authors describe four cases of organic affective disturbance associated with lead intoxication, review the neuropsychiatric disturbances that have been reported with chronic exposure to lead, and report the results of their experience evaluating the psychiatric aspects of lead intoxication among individuals exposed in their work.

PMID: 6496787 [PubMed - indexed for MEDLINE]

Tuesday, January 25, 2011

Sydenham chorea and psychosis

Tijdschr Psychiatr. 2010;52(4):265-9.
[Article in Dutch]
Mengde W, Jessurun AY.
Caprileskliniek, Willemstad, Curacao.


Sydenham chorea (SC) is a complication of a group A beta-haemolytic streptococcal infection which is characterised by involuntary, choreatic movements. There is a definitive link between SC and psychoses. Furthermore, patients with SC seem to run a greater risk of developing neuroleptic-induced movement disorders. In this case-study of a 19-year-old psychotic male with a history of SC, the authors illustrate that this complicates the treatment of a psychotic episode.

PMID: 20503168 [PubMed - indexed for MEDLINE]

Promethazine-Induced Psychosis in a 16-Year-Old Girl

Charles Timnak, M.D., and Ondria Gleason, M.D., Tulsa, Okla.

TO THE EDITOR: Promethazine is a phenothiazine derivative and an H1 receptor antagonist that is commonly used for symptomatic relief of nausea and vomiting and for allergic conditions. Some clinicians also use promethazine as a cough suppressant. Promethazine is known to cause CNS side effects, including confusion, nervousness, disorientation, and hallucinations.1

There are currently few case reports of promethazine-induced psychosis. A report in the Medical Journal of Australia indicated two cases involving promethazine-induced psychosis in children.2 A case study of a 3-year-old patient reported severe visual hallucinations and agitation after treatment with promethazine.3 One case involved a middle-aged woman, who overdosed on promethazine and was disoriented and agitated and experienced hallucinations.4 A geriatric patient also developed psychosis after intramuscular administration of promethazine.5 We now report on a 16-year-old African American girl who developed psychotic symptoms after receiving treatment with promethazine.

Case Report

Alice, a 16-year-old African American girl with no prior psychiatric history, came to the emergency room with a chief complaint of hallucinations. Her symptoms had developed 5 days previously and included fever and a cough. She was taken to a local emergency room, diagnosed with an upper respiratory infection, and given azithromycin. Her condition worsened over the next 2 days. She was again taken to the emergency room, given an injection of promethazine, and discharged with a prescription for oral promethazine with codeine.

[Acute psychotic disorders related to bupropion: review of the literature].

Encephale. 2010 Dec;36(6):461-71. Epub 2010 Mar 15.

[Article in French]
Javelot T, Javelot H, Baratta A, Weiner L, Messaoudi M, Lemoine P.

Service "Les Hortensias", centre psychothérapique Nord Dauphiné, 100, avenue du Médipôle, 38307 Bourgoin-Jallieu cedex, France.


RATIONALE AND OBJECTIVES: Bupropion, or amfebutamone, is an atypical antidepressant also used during tobacco cessation. From a structural standpoint, it resembles amphetamine drugs with psychostimulant effects, and endogenous monoamines. From a pharmacological standpoint, bupropion, and two of its most important active metabolites, inhibit dopamine and norepinephrine reuptake. It has recently been discovered that bupropion may act as a non-competitive cholinergic nicotinic receptor antagonist, and that it may inhibit the activation of reward systems triggered by nicotine. Buproprion's efficacy as a smoking cessation aid has been demonstrated by numerous clinical trials that have compared its effects with those of placebo and other nicotinic substitutes. In 2001, buproprion SR received marketing authorization in France as a smoking cessation aid, under the name ZYBAN®. Tobacco addiction indeed remains a major public health issue. Among patients with psychiatric conditions, chronic tobacco consumption is frequent. The development of non-nicotinic drugs may therefore enhance therapeutic possibilities. However, the psychotropic effects of these molecules should be taken into account. We have recently reported the case of a patient with schizoaffective disorder, who presented two acute bupropion-induced psychotic episodes. We have also undertaken an exhaustive bibliographical research on this subject. The aim of the present study is to present the information available to us, in order to suggest aetiopathogenic hypotheses and therapeutic proposals.

Acute psychosis due to the interaction of legal compounds--ephedra alkaloids in 'vigueur fit' tablets, caffeine in 'red bull' and alcohol.

Med Sci Law. 2001 Oct;41(4):331-6.
Tormey WP, Bruzzi A.
Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland.


A short-lasting episode of acute psychosis in a 32-year-old male which followed the consumption of alcohol, caffeine and 'vigueur fit' tablets containing ephedra alkaloids is reported. Less than two days after the event, a urine sample contained 22 microg/ml of ephedrine and 5 microg/ml of pseudoephedrine. Despite detailed pharmacological evidence being given at a jury trial, he was convicted of assault and trespass and was fined pounds sterling 16,000. An earlier incident involving misbehaviour on an aircraft again involving alcohol and ephedrine resulted in a conviction and a court order to provide twice weekly urine tests for alcohol for a period of six months. He stopped taking the alkaloid tablets after the second incident. There was no history of aberrant behaviour in this man outwith the period when taking these tablets. Ephedra alkaloids may cause psychosis and their effects can be exaggerated by interaction with caffeine and ethanol. To protect the public, the use of stimulant drugs in over-the-counter weight control programmes should be prescription only and the package insert should include a warning on the dangers of concomitant use of ethanol.

PMID: 11693229 [PubMed - indexed for MEDLINE]

Caffeine and psychiatric symptoms: a review.

J Okla State Med Assoc. 2004 Dec;97(12):538-42.
Broderick P, Benjamin AB.
University of Oklahoma, 2312 North Indiana Avenue, Oklahoma City, Oklahoma 73106, USA.


Caffeine is a widely used psychoactive substance that has the potential to contribute to many psychiatric symptoms. This review article aims to address the specific research studies and case reports that relate caffeine to psychiatric symptoms. Caffeine can cause anxiety symptoms in normal individuals, especially in vulnerable patients, like those with pre-existing anxiety disorders. Caffeine use is also associated with symptoms of depression due to either a self-medication theory, or a theory that caffeine itself causes changes in mood. Psychosis can be induced in normal individuals ingesting caffeine at toxic doses, and psychotic symptoms can also be worsened in schizophrenic patients using caffeine. Sleep and symptoms of ADHD may be altered by caffeine as well. Prevention of caffeine-induced psychiatric symptoms is possible by recognizing, educating, and treating patients using a tapering approach.

PMID: 15732884 [PubMed - indexed for MEDLINE]

Caffeine-induced psychosis.

CNS Spectr. 2009 Mar;14(3):127-9.
Hedges DW, Woon FL, Hoopes SP.
Department of Psychology, Neuroscience Center, Brigham Young University, Provo, UT, USA.


As a competitive adenosine antagonist, caffeine affects dopamine transmission and has been reported to worsen psychosis in people with schizophrenia and to cause psychosis in otherwise healthy people. We report of case of apparent chronic caffeine-induced psychosis characterized by delusions and paranoia in a 47-year-old man with high caffeine intake. The psychosis resolved within 7 weeks after lowering caffeine intake without use of antipsychotic medication. Clinicians might consider the possibility of caffeinism when evaluating chronic psychosis.

PMID: 19407709 [PubMed - indexed for MEDLINE]

Psychiatric side effects attributed to phenylpropanolamine.

Pharmacopsychiatry. 1988 Jul;21(4):171-81.
Lake CR, Masson EB, Quirk RS.
Dept. of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.


Phenylpropanolamine (PPA) is a sympathomimetic drug similar in structure to amphetamine which, in the United States, is present in over 130 medications, primarily decongestants, cough/cold remedies, and anorectic agents. We have reviewed 37 cases (published in North America and Europe since 1960) that received diagnoses of acute mania, paranoid schizophrenia, and organic psychosis and that were attributed to PPA product ingestion. Of the 27 North American case reports, more reactions followed the ingestion of combination products than preparations containing PPA alone; more occurred after ingestion of over-the-counter products than those obtained by prescription or on-the-street; and more of the cases followed ingestion of recommended doses than overdoses. Groups at particular risk appear to be those with a past or family psychiatric history, children under the age of 6 and post-partum women. Failure to recognize PPA as an etiological agent in the onset of symptoms usually led to a diagnosis of schizophrenia or mania, lengthy hospitalization, and treatment with substantial doses of neuroleptics or lithium. While generally safe at recommended doses, PPA can be hazardous to susceptible individuals and we urge physicians to be alert to the potential for PPA related psychiatric reactions. We have compiled an alphabetized table (Table 1: Prescription and Over-the-Counter Products Containing Phenylpropanolamine) allowing busy clinicians quick access to those drugs containing PPA.

PMID: 3060884 [PubMed - indexed for MEDLINE]

Organic affective psychosis associated with the routine use of non-prescription cold preparations

Br J Psychiatry. 1990 Apr;156:572-5.
Brown TM, Golden RN, Evans DL.
Department of Psychiatry, University of North Carolina, School of Medicine, Chapel Hill 27599.


A patient experienced an organic affective psychosis on three separate occasions after taking recommended doses of non-prescription cold/sinus preparations. The possible underlying pharmacological mechanisms of this clinical reaction lend support to the cholinergic-adrenergic balance hypothesis of affective disorders. Recognition of this acute drug-induced state can lead to appropriate short-term pharmacotherapy and can prevent misdiagnosis of a major affective disorder or schizophrenia.

PMID: 2386871 [PubMed - indexed for MEDLINE]

Dextromethorphan- and pseudoephedrine-induced agitated psychosis and ataxia: case report.

J Emerg Med. 1999 Mar-Apr;17(2):285-8.
Roberge RJ, Hirani KH, Rowland PL 3rd, Berkeley R, Krenzelok EP.
Department of Emergency Medicine, Western Pennsylvania Hospital, Pittsburgh 15224, USA.


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.

PMID: 10195488 [PubMed - indexed for MEDLINE]