Psychotic Reactions Research Articles

Neurologic and Psychotic Reaction Induced by Lidocaine

Toxic, nonallergic reactions to lidocaine and other local anesthetics are marked by high serum concentrations that cause central nervous system (CNS) or cardiovascular system toxic effects. Excessive blood concentrations can result from direct intravascular injection or from injection of an excessive dose into the correct tissue space with subsequent vascular absorption. We describe a patient who received therapeutic doses of topical lidocaine for flexible bronchoscopy and developed a neurologic and psychotic reaction. He had no history of drug allergies and risk factors for CNS toxicity. Although some cases of lidocaine-induced neurotoxicity have been described, our report is a rare case that shows CNS toxicity may occur even without overdose. We took this opportunity to suggest that the smallest possible effective dose of lidocaine should be used along with monitoring for signs of CNS toxicity.

Ziconotide: a new option for intrathecal analgesia

Ziconotide is the synthetic equivalent of a neuroactive peptide found in the venom of the fish-hunting marine snail Conus magus. Its analgesic effect is mediated by a blockade of the N-type calcium channel in the dorsal horn of the spinal cord. The drug is currently licensed for continuous intrathecal infusion in the treatment of chronic intractable pain, and its analgesic efficacy has been demonstrated in both animal and human studies. Ziconotide-induced analgesia is not associated with the development of tolerance, respiratory depression or endocrine side effects, as is common in opioids. Ziconotide is a potent analgesic with a narrow therapeutic window. A low starting dose with slow upward titration, while monitoring the patient, is the recommended strategy for avoiding the more serious side effects, such as delirium, acute psychotic reactions, suicidal ideation and coma.

“Don't Tread on Me”: The Ethos of '60s Garage Punk

The term “punk,” when used in reference to '60s garage music, is not well understood. In essence, garage punk developed when American youths mimicked the sound of British R&B and the attitudes of British rockers, but ended up creating a cruder, snottier, and more urgent sound that expressed their own concerns and views of life. Garage punk focuses on liberation from social expectations, conventions, and mores, and it usually takes the form of songs in which the garage punk puts down or rejects his errant girlfriend, professes his enlightenment or hip superiority, or describes his “psychotic reaction” to some emotional trauma.

Cross-Cultural Aspects of Trauma and Dissociation

Abstract The importance of culture and the cross-cultural manifestions of trauma and dissociation was presented. A discussion of culture and psychopathology was shown, noting that although psychiatric disorders appear in all cultures, their form and expression may vary often in a way that is linked to cultural belief systems. The Culture-Bound Syndromes of amok, ataque de Nervios, falling out or blacking out, latah, nervios, pibloktoq, qi-gong psychotic reaction, shin-byung, spell, susto, and zar, seen as having dissociative symptoms, were then presented with relevant research. The Possession Trance Disorder was also presented as a cultural disorder. Finally, therapeutic considerations to better facilitate cultural sensitivity were noted.

Persistent Auditory Hallucinations That Are Unresponsive to Antipsychotic Drugs

Persistent Auditory Hallucinations That Are Unresponsive to Antipsychotic Drugs

Out Is In

Out Is In Regina Weinreich The Outlaw Bible of American Literature Edited by Alan Kaufman, Neil Ortenberg, and Barney Rosset Thunder's Mouth Press http://www.thundersmouthpress.com 662· pages; paper, $27.50 The R. Crumb Handbook R. Crumb and Peter Poplaski MQ Publications http://www.mqpublications.com 442 pages; cloth, $25.00 Round up the usual suspects! William S. Burroughs , Hunter S. Thompson, Terry Southern, Henry Miller, Kathy Acker, Patti Smith, Norman Mailer, and more—outlaws all represented by excerpts of their writing in a holy shrine of non-canonical work. Mix in snippets of Dee Dee Ramone, Lenny Bruce, Ralph Steadman, Margaret Sanger, Emma Goldman, and you get a picture of what this compendium of marginalized yet revered artists ennobles. The Outlaw Bible of American Literature is not the Norton Anthology of in-your-face literature, although its sheer heft forces comparison. This inspired work evokes nostalgia for the passions of a time when politics and art were equivalent, when an up yours philosophy was a cry for a better, truer America. Take this bit from Kathy Acker, from her novel Don Quixote: Which Was a Dream (1986): "I think Prince should be president of the United States because all our presidents since World War II have been stupid anyway and are becoming stupider up to the point of lobotomy. . . ." Of course she was thinking ofReagan when she began this prophetic paragraph. Or take the piece by Annie Sprinkle on how the movie Deep Throat initiated her career as prostitute, stripper, porn star, and conceptual artist . Hers is a journey through the criminal legal system that leads to some deep thoughts about an America rife with hypocrisies. Or take Cookie Mueller's behind the scenes account of life on the set of John Waters's outrageously satirical Pink Flamingos, with its unforgettable shit-eating finale: "What's the worst thing that can happen to me when I eat the dogshit?" Divine asked us.... There was no question that Divine would eat the dogshit. He was a professional. It was in the script, so he was going to do it. . . . This was show biz. Divine didn't balk and he wasn't the only one. Mink Stole was going to do a big scene that called for her red hair to catch on fire. All this coincides with the language of rebellion at large in the culture, epitomized in Patti Smith's L'Anarchie Flier with its headline, "You Can't Say 'Fuck' in Radio Free America." Witness the judicious use of that unmentionable four-letter word in super rock critic Lester Bangs's deadpan from Psychotic Reactions and Carburetor Dung (1988): "'What do you feel like doing right now?' I replied, automatically, same tone of voice as one might say, ? could go for a tuna sandwich on rye,' I said: ? wanna fuck.' A second of silence. Then: 'Okay,' she said, just as casually. 'Come on over.'" Bangs explores the wild, primitive, organic nature of this come on: "I wanted to fuck this woman in the mud of a ditch while a firestorm of white-hot PLO and Israeli bullets whizzed over our heads." It's enough to remind you that in America there are some people who simply do not want to be fucked that way. Similarly, in a legendary 1947 letter about screwing a virgin hejust met on a Greyhound bus in frustration over a missed opportunity with another girl ("all my pent up emotion finding release in this young virgin"), Neal Cassady gushes in a torrent of words, a style which would become a model for Kerouac's iconic writing. As the fictional Dean Moriarty, the Holy Goof, whose proclamation "Sex is Holy" appears throughout On the Road (1955), he makes a vital connection: his trinity of sex, soul, death provides the spiritual underpinning for this volume's outlaw sensibility. Ah, the beauty of these spontaneous, original voices, now worthy of becoming essential reading in college courses across the land! But here is someone curiously left out: that ultimate outsider Robert Crumb, the originator of Fritz the Cat, Mr. Natural, and Devil Girl (and this despite the fact that The Outlaw Bible includes work by one...

Why is it so difficult to stop psychiatric drug treatment?: It may be nothing to do with the original problem

In this paper, I argue that the problems that occur after discontinuation or reduction of long-term psychiatric drug treatment may be caused by the process of drug withdrawal itself, rather than representing the course of the underlying illness. Adverse effects induced by discontinuation of psychiatric medication include: (1) a somatic discontinuation syndrome that includes psychological symptoms which may be mistaken for relapse, (2) a rapid onset psychotic reaction after withdrawal of both conventional neuroleptic drugs and some atypicals, notably clozapine (sometimes referred to as supersensitivity psychosis), (3) a psychological reaction to withdrawal, which may be mistaken for relapse or may itself precipitate relapse, (4) a genuine relapse of the underlying condition precipitated by the process of withdrawal. The implications of these effects include the possibility that much of the research on maintenance treatment is flawed and that the recurrent nature of psychiatric conditions may sometimes be iatrogenic. If withdrawal induced adverse effects could be effectively managed, the success of drug discontinuation might be much greater than usually assumed and might outweigh the disadvantages of continued treatment.

P.8.a.022 Analysis of the hospitalized frustrated suicides, classified according to the violence of the method used

In a 3-year epidemiological survey (N = 2623) prevalence of psychosis in epilepsy patients as compared with other chronic medically ill patients is assessed.To explore the role of cerebral pathology as compared to the role of chronic burden of disease in the onset of psychosis.One thousand seven hundred fifty two patients with chronic medical disorders admitted to an Academic Hospital and 901 patients with epilepsy admitted to a tertiary care epilepsy clinic were assessed by CIDI, MINI and clinical psychiatric interview in a two stage screening survey. Medical files were searched for MRI scans about cerebral pathology. Poisson regression analysis was performed to estimate the relative risk for psychosis in both groups.In total, 52 patients with prevalent psychosis were found: 49 (5.4%) in the epilepsy clinic and 3 (0.17%) in the Academic Hospital. Age range (18–88), mean age (42) and gender distribution (equal) were similar in both samples. RR is 8.37 (2.74, 25.52). In 16 of the 49 epilepsy patients, cerebral pathology existed with mainly temporal and frontal localisation and of childhood-onset vascular or infectious origin.This finding suggests that in the onset of psychosis in epilepsy patients, the role of cerebral pathology, especially localized left temporal and frontal, is of strong etiological importance. The following epilepsy endophenotypes should be explored as factors in vulnerability for psychosis as well: frequent and severe epileptic activity; and psychotic reactions to certain AEDs, such as Topiramate and Lamotrigine. Burden of disease does not seem to play an important role.

A case of clarithromycin psychosis.

A 19 year old girl developed an immediate psychotic reaction following IV clarithromycin (Klacid). She responded to atypical antipsychotics but needed psychiatric hospitalisation. She recovered after a year and is now symptom free without any medication. This is a rare side-effect but needs to be recognised.

Two cases of "cannabis acute psychosis" following the administration of oral cannabis

Background Cannabis is the most commonly used illegal drug and its therapeutic aspects have a growing interest. Short-term psychotic reactions have been described but not clearly with synthetic oral THC, especially in occasional users.Case presentationsWe report two cases of healthy subjects who were occasional but regular cannabis users without psychiatric history who developed transient psychotic symptoms (depersonalization, paranoid feelings and derealisation) following oral administration of cannabis. In contrast to most other case reports where circumstances and blood concentrations are unknown, the two cases reported here happened under experimental conditions with all subjects negative for cannabis, opiates, amphetamines, cocaine, benzodiazepines and alcohol, and therefore the ingested dose, the time-events of effects on behavior and performance as well as the cannabinoid blood levels were documented.ConclusionWhile the oral route of administration achieves only limited blood concentrations, significant psychotic reactions may occur.

Hemi-depersonalization syndrome

A high variety of factors were found to be implicated in the emergence of depersonalization episodes. The remarkable case of a patient who developed a hemi-depersonalization syndrome is reported in a patient with known obsessive–compulsive disorder. He complained of feeling his left half of the body as if it was detached from him. The part of the body that was perceived as estranged was inconsistent with the anatomical distribution of the nervous system as the entire left part of his body was concerned, from head to toe. He always remained aware that the sensations were not real, and felt like being an outside observer of the left side of his body. He also developed an isolated delusional idea. The hemi-depersonalization syndrome as well as the delusional idea did not respond to citalopram 20 mg/day, but remitted rapidly under olanzapine 10 mg/day, the obsessive–compulsive symptomatology persisting for several weeks. From the course of hemi-depersonalization syndrome and the available literature, it is concluded that this syndrome is independent from the concomitant OCD and that the observed hemi-depersonalization syndrome is likely to be a manifestation of a psychotic reaction which consisted of both the hemi-depersonalization and delusions.

Treatment of dementia with Lewy bodies and Parkinson's disease dementia

Cognitive decline and dementia affect approximately 30% to 40% of patients with idiopathic Parkinson's disease during the course of their illness. PD-dementia (PDD) and dementia with Lewy bodies (DLB) are second to Alzheimer's disease in causing degenerative dementia in the elderly. The nosological distinction of the conditions has remained controversial because of broad clinical and pathological overlap. Treatment issues in both clinical settings are virtually identical. Treatment of Parkinsonism is often complicated by drug-induced psychosis and reduced levodopa responsiveness. Cognition, alertness, attention, as well as apathy or aggressive behavior have been shown to respond to treatment with cholinesterase inhibitors in randomized controlled trials both in DLB and PDD. Such treatment may also improve hallucinosis, but many patients will require add-on treatment with atypical neuroleptics to control drug-induced psychotic reactions. Clozapine and quetiapine are the drugs most commonly used and, contrary to classic neuroleptics, risperidone or olanzapine do not seem to cause severe side effects according to published data.

Delirium, A Syndrome of Cerebral Insufficiency

Delirium, A Syndrome of Cerebral Insufficiency

New users of antipsychotic medications among children enrolled in TennCare.

The use of antipsychotic medications in children and adolescents for indications other than psychosis or Tourette syndrome is controversial. Newer atypical antipsychotics with profiles of adverse effects that differ from those of traditional antipsychotics may lead providers to prescribe antipsychotics more frequently than in the past for behavioral indications not strongly supported by clinical study. To identify population-based new use of antipsychotics among patients aged 2 to 18 years. Retrospective cohort study, January 1, 1996, through December 31, 2001. Tennessee's managed care program for Medicaid enrollees and the uninsured (TennCare). New use of antipsychotic medications and indications for use by the child's diagnosis, adjusted for age, sex, race, county of residence, enrollment category, and income. The proportion of TennCare children who were new users of antipsychotics, adjusted for demographic characteristics, nearly doubled from 23/10 000 in 1996 to 45/10 000 in 2001 (adjusted incidence rate ratio, 1.98; 95% confidence interval, 1.82-2.16). In 1996, 6.8% of new users received an atypical antipsychotic; by 2001, this had increased to 95.9%. New use for attention-deficit/hyperactivity disorder and affective disorders increased 2.5-fold. New use of antipsychotics for schizophrenia, acute psychotic reaction, Tourette syndrome, and mental retardation or autism remained relatively constant. Secular trends of increasing use were most pronounced for those aged 6 to 12 years (93% increase) and 13 to 18 years (116% increase), although use among preschool children increased 61% during the study period. The proportion of TennCare children who became new users of antipsychotics nearly doubled from 1996 to 2001, with a substantial increase in use of antipsychotics for attention-deficit/hyperactivity disorder, conduct disorder, and affective disorders.

Can memories kindle nonconvulsive behavioral seizures in humans? Case report exemplifying the “limbic psychotic trigger reaction”

We present three hypotheses—(1) the limbic psychotic trigger reaction (LPTR) is a form of nonconvulsive behavioral seizures (NCBS), (2) kindling may occur in the LPTR, and (3) kindling may occur with memory stimuli—and report a case that may exemplify a LPTR kindled by memory and triggered by light and smell. The LPTR has a primate model, in which NCBS are kindled by intermittent exposure to actual subthreshold stimuli. In humans, we propose that such triggering stimuli can be revived by memory alone. Thus, individualized stimuli can trigger partial limbic seizures or seizure-like bizarre episodes with a transient loss of frontal control functions. We present a case of paroxysmal episodes of out-of-character, bizarre, unplanned nonvoluntary acts that occurred with flat affect and without drive motivation (e.g., “fire setting”). Implicated is a transient state of limbic “paleo-consciousness” with preserved memory, autonomic arousal, and first-time brief psychosis (e.g., olfactory, visual hallucinations and depersonalization with olfactory attributes). As in kindled primates, LPTR patients do not show a consistent pattern of morphological brain abnormality; half have had an abnormal electroencephalogram, computed tomography scan, or magnetic resonance image at some time during their lives, and half (including the new patient) have had closed head injuries.

Mainlines, Blood Feasts, and Bad Taste: A Lester Bangs Reader (review)

Mainlines, Blood Feasts, and Bad Taste: A Lester Bangs Reader. Edited by John Morthland. New York: Anchor Books, 2003. [xviii, 409 p. ISBN 0-375-71367-0. $15.]

A case of clarithromycin psychosis

A 19-year-old woman developed an immediate psychotic reaction following intravenous administration of clarithromycin. She responded to atypical antipsychotic drugs but needed psychiatric hospitalisation. She recovered after a year and is now symptom-free without any medication. This is a rare side-effect, but needs to be recognised.

Cannabis-Associated Psychosis

Cannabis has been used for recreational, medicinal and religious purposes in different cultures since ancient times. There have been various reports of adverse effects due to or associated with cannabis consumption, including psychotic episodes. Historically, our understanding of these clinical observations has been significantly hindered by a lack of knowledge regarding their underlying neurobiological and pharmacological processes. However, the discovery of the endogenous cannabinoid system has allowed a greater understanding of these adverse effects to develop. From a clinical perspective, toxic or transient psychotic reactions to the administration of herbal cannabis preparations or specific cannabinoid compounds have to be differentiated from longer-lasting, persistent schizophrenia-like disorders associated with the use of cannabis/cannabinoids. The latter are most likely to be associated with a predisposition or vulnerability to schizophrenia. Interestingly, the recently suggested role of the endogenous cannabinoid system in schizophrenia not related to previous cannabinoid consumption introduces an additional perspective on the mechanism underlying cannabis-associated schizophrenia-like disorders, as well as on the effects of cannabis consumption in schizophrenia. At present, acute psychopharmacological treatment options for cannabis-associated transient and persistent schizophrenia-like psychotic episodes are similar and are based on the use of benzodiazepines and antipsychotics. However, new pharmacological strategies using the endogenous cannabinoid system as a primary target are under development. Long-term psychotherapeutic treatment options involve case management strategies and are mainly based on specialised psychotherapeutic programmes to encourage cannabis users to stop their use of the drug.

Violence in schizophrenia versus limbic psychotic trigger reaction: Prefrontal aspects of volitional action

Two basic kinds of violence in psychoses are juxtaposed: In schizophrenia violence is mostly determined by a persisting distortion of the content of thought through delusions and/or hallucinations, while the prefrontal mediation of intentional volition of action behavior is largely intact. Conversely, all prefrontal functions are briefly, but severely impaired by the fronto–limbic imbalance proposed in a subtype of partial limbic seizures, limbic psychotic trigger reaction (LPTR). LPTR is based on the animal model of limbic seizure kindling (through intermittent mild stimuli) in primates, evoking nonconvulsive “behavioral seizures” with indications of visual hallucinations. Additional prefrontal factors contributing to violence both in schizophrenia and most severely in LPTR, concern the inability to appropriately reset a plan of ongoing action upon intervening circumstances, and/or a reduced ability for the cognitive “appreciation” of the consequences and implications of the acts.

Effect of acute psychotic stress in nondiabetic subjects on beta-cell function and insulin sensitivity.

To determine the effect of acute psychotic stress on glucose homeostasis in nondiabetic subjects. Beta-cell function and insulin sensitivity were determined by the homeostasis model assessment in 39 nondiabetic patients with acute psychotic stress reaction admitted to a psychiatric ward. The clinical global impression (CGI) score was used to evaluate the level of psychological stress. Patients were assessed on admission, after 2 weeks, before discharge, and 6 months after discharge. The mean CGI score decreased significantly with time: 5.3 +/- 0.8 and 1.6 +/- 0.7 on admission and predischarge, respectively (P < 0.001). This was associated with a significant reciprocal increase of mean beta-cell function from 96.8 +/- 33.2 to 134.4 +/- 60% at admission and postdischarge, respectively (P < 0.003), and a decrease of mean insulin sensitivity from 101.7 +/- 36 to 77.1 +/- 34.8% (P < 0.001). In contrast, mean glucose and HbA(1c) levels did not change significantly. Subgroup analysis demonstrated that patients with the highest stress score on admission (> or =6) had significantly higher glucose (P = 0.01) and insulin levels (P = 0.04) than patients with lower score (<6). Furthermore, insulin sensitivity and CGI score on admission were inversely correlated (r = -0.38, P < 0.02). In these patients, no correlation was found between beta-cell function or insulin sensitivity and BMI. These data indicate that beta-cell function and insulin sensitivity are inversely correlated with acute psychotic stress.