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.


Affiliations

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.

Abstract


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.

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[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. katrien.stuer@gmail.com

Abstract

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. anjalisathyab@yahoo.co.in

Abstract

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. sgenuis@incentre.net

Abstract

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.

Abstract

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]

Sydenham chorea and psychosis

Tijdschr Psychiatr. 2010;52(4):265-9.

[Article in Dutch]

Mengde W, Jessurun AY.

Caprileskliniek, Willemstad, Curacao. W.Mengde@ggzbreburggroep.nl

Abstract

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.

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