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. dawson_hedges@byu.edu

Abstract

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.

Abstract

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.

Abstract

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.

Abstract

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]

Should Violent Criminal Offenders Be Tested for Past Exposure to Lead? and is treatment possible?

Fairfax economist Rick Nevin has spent more than a decade researching and writing about the relationship between early childhood lead exposure and criminal behavior later in life. (By Lois Raimondo -- The Washington Post)



Research Links Lead Exposure, Criminal Activity


Data May Undermine Giuliani's Claims


By Shankar Vedantam


Washington Post Staff Writer


Sunday, July 8, 2007; Page A02


Rudy Giuliani never misses an opportunity to remind people about his track record in fighting crime as mayor of New York City from 1994 to 2001.


"I began with the city that was the crime capital of America," Giuliani, now a candidate for president, recently told Fox's Chris Wallace. "When I left, it was the safest large city in America. I reduced homicides by 67 percent. I reduced overall crime by 57 percent."

Behavioral approaches to toluene intoxication.

Environ Res. 1993 Jul;62(1):53-62.

Behavioral approaches to toluene intoxication.

Saito K, Wada H.

Department of Hygiene and Preventive Medicine, Hokkaido University, School of Medicine, Sapporo, Japan.

Abstract

Toluene is a chemical that is very useful in our lives but harmful to our health. Behavioral toxicology has the merit of providing an accurate indication of functional toxicity to the CNS through the analysis of learned behavior and use of behavioral analysis techniques that give us various learning paradigms for investigating the effects of chemicals on memory, stimulus discrimination, attention, time perception, etc. Learning is a common ability among various species and it is possible to predict toxicity to human health from animals. Behavioral toxicology is assumed to play an important role in occupational and environmental health. Using typical test batteries such as shuttle, Sidman, and pole-climb avoidance, and FI, FR, DRL, and DMS tasks, the effects of toluene were investigated and the results were reviewed. One important objective of a test battery is to be able to detect already-known toxicity. Behavioral toxicology research indicated such effects of toluene toxicity as hyperactivity, ataxia, addiction, insomnia, and memory disturbances. Some excellent results which might indicate clinically unknown effects of toluene such as hearing loss, impairments of time discrimination, and improvements of STM were also demonstrated. Introduction of blood and brain toluene levels as an index of toluene exposure and more sophisticated learning tasks which reflect specific higher nervous functions of the CNS has been proposed.

PMID: 8325266 [PubMed - indexed for MEDLINE]

Corticosteroid-Induced Psychotic and Mood Disorders

Psychosomatics 42:461-466, December 2001


© 2001 The Academy of Psychosomatic Medicine



Corticosteroid-Induced Psychotic and Mood Disorders

Diagnosis Defined by DSM-IV and Clinical Pictures

Ken Wada, M.D., Norihito Yamada, M.D., Toshiki Sato, M.D., Hiroshi Suzuki, M.D., Masahito Miki, M.D., Yomei Lee, M.D., Kazufumi Akiyama, M.D., and Shigetoshi Kuroda, M.D.

Received November 15, 2000; revised March 23, 2001; accepted March 12, 2001. From the Department of Neuropsychiatry, Okayama University Medical School 2-5-1, Shikata-cho, Okayama 700-8558, Japan, Department of Psychiatry, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. Address correspondence and reprint requests to Dr. Wada Department of Psychiatry, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. E-mail: kenwada@do3.enjoy.ne.jp

The authors investigated long-term outcome and treatment strategy of corticosteroid-induced psychotic and mood disorders as defined by DSM-IV. Review of medical records of 2,069 referral patients revealed 18 applicable patients. Their clinical characteristics, longitudinal courses, and treatments were studied. The authors identified 15 patients with mood disorder and 3 patients with psychotic disorder. Increasing doses or resumption of corticosteroids had the strongest influence on the psychiatric course. These two corticosteroid-induced psychiatric disorders may have different pathophysiological substrates closely related to patient vulnerability. Effective psychopharmacological treatment options were indicated with consideration being given to the underlying diseases.


Key Words: Cortiscosteroid • Mood Disorder • Psychotic Disorder