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.
Abstract
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]
Saturday, March 26, 2011
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.
catherine@redgraphite.co.uk
Abstract
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]
Amey C.
catherine@redgraphite.co.uk
Abstract
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. alfiamaladoss@yahoo.ca
Abstract
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]
Amaladoss A, O'Brien S.
Department of Psychiatry, Queen's University, Kingston, ON, Canada. alfiamaladoss@yahoo.ca
Abstract
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.
Abstract
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]
Kucukardali Y, Solmazgul E, Terekeci H, Oncul O, Turhan V.
Department of Internal Medicine, Gulhane School of Medicine, Haydarpasa Training Hospital, Istanbul, Turkey.
Abstract
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.
Abstract
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]
McKnight RF, Hampson S.
Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, OX3 7JX Oxford, UK.
Abstract
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.
Abstract
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.
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.
Abstract
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.
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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