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.

Abstract

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.

Abstract

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. 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."