EPA-1011 - A case series of codeine cough syrup induced psychotic illness in a national addictions management service

Ayahuasca is a hallucinogen brew traditionally used for ritual and therapeutic purposes in Northwestern Amazon. It is rich in the tryptamine hallucinogens dimethyltryptamine (DMT), which acts as a serotonin 5-HT2A agonist. This mechanism of action is similar to other compounds such as lysergic acid diethylamide (LSD) and psilocybin. The controlled use of LSD and psilocybin in experimental settings is associated with a low incidence of psychotic episodes, and population studies corroborate these findings. Both the controlled use of DMT in experimental settings and the use of ayahuasca in experimental and ritual settings are not usually associated with psychotic episodes, but little is known regarding ayahuasca or DMT use outside these controlled contexts. Thus, we performed a systematic review of the published case reports describing psychotic episodes associated with ayahuasca and DMT intake. We found three case series and two case reports describing psychotic episodes associated with ayahuasca intake, and three case reports describing psychotic episodes associated with DMT. Several reports describe subjects with a personal and possibly a family history of psychosis (including schizophrenia, schizophreniform disorders, psychotic mania, psychotic depression), nonpsychotic mania, or concomitant use of other drugs. However, some cases also described psychotic episodes in subjects without these previous characteristics. Overall, the incidence of such episodes appears to be rare in both the ritual and the recreational/noncontrolled settings. Performance of a psychiatric screening before administration of these drugs, and other hallucinogens, in controlled settings seems to significantly reduce the possibility of adverse reactions with psychotic symptomatology. Individuals with a personal or family history of any psychotic illness or nonpsychotic mania should avoid hallucinogen intake.

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The Co-occurrence Of Eating Disorders And Psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1540 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S425-S425 ◽

Cited By ~ 2

Author(s):

C. Alves Pereira ◽

J.R. Silva ◽

R. Cajão ◽

J.P. Lourenço ◽

T. Casanova

Keyword(s):

Eating Disorders ◽

Critical Reflection ◽

Literature Search ◽

Case Series ◽

The Other ◽

Psychotic Symptoms ◽

Psychotic Illness ◽

Other Hand ◽

Competing Interest ◽

The Relationship

IntroductionSeveral reviews have reported the incidence of schizophrenia in patients with eating disorders (ED) to be between 3–10% and the incidence of transient psychotic episodes to be 10–15%. On the other hand, anorexia nervosa appears to affect 1 to 4% of schizophrenia patients. Reports of psychosis and ED occurring in the same patient have led to various views as to the nature of the relationship between the two.ObjectiveAnalysis of the literature illustrated by different clinical cases in which appears to be a relationship between ED and psychosis.AimsCritical reflection about the hypothesis that could underlie the comorbidity of psychotic illness and ED.MethodsNon-systematic review of a literature search using the keywords: eating disorders; psychosis; comorbidity.ResultsThere is no consistent sequence in the co-occurrence of the two conditions – ED sometimes precede and sometimes follows the onset of psychosis. ED patients can develop psychotic symptoms, most frequently transient in the course of the disorder, while others are subsequently diagnosed with a chronic psychotic disorder. On the other hand, patients with a primary psychotic illness can develop an eating disorder. The connection between the two, however, remains speculative, considering the hypothesis that ED and psychosis can be entirely separate disorders that can, by chance, occur in the same person.ConclusionsThe area of comorbidity and overlapping symptoms in psychiatry requires more deep research. Despite evidence from case series, the comorbidity between ED and psychosis is poorly understood, and firm conclusions cannot be drawn from this analysis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Intrathecal Infusions for Intractable Cancer Pain: A Qualitative Study of the Impact on a Case Series of Patients and Caregivers

Pain Research and Management ◽

10.1155/2009/538675 ◽

2009 ◽

Vol 14 (5) ◽

pp. 371-379 ◽

Cited By ~ 9

Author(s):

Philippa Hawley ◽

Elizabeth Beddard-Huber ◽

Cameron Grose ◽

William McDonald ◽

Daphne Lobb ◽

...

Keyword(s):

Palliative Care ◽

Cancer Pain ◽

Case Series ◽

Palliative Care Unit ◽

Intractable Pain ◽

Management Service ◽

Palliative Care Setting ◽

Intractable Cancer Pain ◽

The Impact ◽

Intrathecal Infusion

BACKGROUND: The need for intrathecal infusion in a palliative care setting is infrequent. Despite established efficacy, safety and cost effectiveness, this is considered an ‘extraordinary measure’ in Canada. Patients requiring this approach are not typical palliative care patients, having shorter and more uncertain life expectancies.OBJECTIVES: The present study is a qualitative exploration of the impact of intrathecal pump implantation on cancer patients, and also the impact of the intervention on the staff caring for those patients.METHODS: Palliative care unit patients who received an implanted intrathecal pump or dome catheter for intractable cancer pain participated in multiple semistructured interviews. Doctors and nurses caring for each patient were also interviewed. Interviews were recorded and analyzed for themes. The study terminated when saturation was reached.RESULTS: Six patients participated, with up to three interviews each. Twenty-four staff interviews took place. Patients’ hopes and expectations were not always fully met, but the infusions had a profound positive effect on quality of life. Patients expressed anxiety about dependence on the device, and also on a few highly skilled individuals. Staff interviews revealed a significant impact on the ‘culture’ of the palliative care unit. Clear communication of the rationale for infusion was very important, as was regular education about infusion management.CONCLUSIONS: Implanted intrathecal infusion devices are a necessary part of a tertiary level cancer pain management service for the unfortunate minority with intractable pain. Practical recommendations for care are made for palliative care programs contemplating offering intrathecal infusions.

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Experiences of international travel in patients with psychotic illness: a case series

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2019.52 ◽

2020 ◽

pp. 1-7

Author(s):

S. Maher ◽

Z. Mikic ◽

C. McDonald ◽

G. T. Flaherty ◽

B. Hallahan

Keyword(s):

Case Series ◽

Structured Interview ◽

International Travel ◽

Recent Experience ◽

Psychotic Illness ◽

Mental Health Team ◽

Travel Planning ◽

Health Team ◽

Affective Symptoms ◽

Minute Duration

Objectives To identify factors influencing successful international travel among patients with psychotic illness. Methods Eight individuals participated in a semi-structured interview of 15–20-minute duration with a clinician in relation to their recent experience of international travel. Clinical files were reviewed and a case series was compiled. Results Four individuals engaged in international travel without any adverse effects. Four other individuals experienced significant psychotic and/or affective symptoms while travelling. Treatment non-adherence, a lack of awareness of how to obtain support and limited or no pre-travel planning were noted in these individuals. Conclusions Pre-travel counselling, treatment adherence, provision of information packages relating to their mental illness and having contact details of their treating mental health team increase the likelihood of successful international travel in patients with psychotic illness. Travelling with a companion may reduce fear of relapse.

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Treatment of cycloserine induced psychosis - a case series

European Psychiatry ◽

10.1016/s0924-9338(11)72932-7 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1227-1227

Author(s):

S. Bangar

Keyword(s):

Case Series ◽

Multi Drug Resistance ◽

Psychotic Symptoms ◽

Drug Resistant ◽

Anti Psychotic ◽

Psychotic Illness ◽

Resistant Tuberculosis ◽

Life Threatening Illness ◽

Multi Drug Resistant Tuberculosis ◽

Life Threatening

IntroductionCycloserine is a highly effective second line anti-tuberculosis medication, the use of which has increased in recent times due to emergence of multi-drug resistance. One of the side-effects is psychosis characterized by paranoia, hallucinations and affective instability. These symptoms are usually reported within the first 2 weeks of therapy in 30–50% of patients receiving Cycloserine 500 mg. At a dose of 100mg and above it leads to a hyperdopaminergic state which in turn could lead to psychosis. However, as this is a very effective treatment in people with multi-drug resistant tuberculosis, it is not always possible to omit treatment due to remergence of life threatening illness. We present findings from few patients on this medication who were referred to us for management of psychotic symptoms.Aims and objectivesTo treat the psychotic symptoms with anti-psychotic which would enable patient to continue Cycloserine. Also to monitor the response to an anti-psychotic.MethodsData was collected from the patient’s case notes, full psychiatric assessment and interviewing the relative. Patient was followed up in the out-patient clinic to monitor response to anti-psychotic medication.ResultsPatients were treated with both typical and atypical medication with good response and it was possible to continue with Cycloserine in one case.ConclusionCycloserine induced psychosis can mimic any other psychotic illness and can be effectively treated with anti-psychotics.

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Frontotemporal dementia presenting as schizophrenia-like psychosis in young people: clinicopathological series and review of cases

The British Journal of Psychiatry ◽

10.1192/bjp.bp.108.057034 ◽

2009 ◽

Vol 194 (4) ◽

pp. 298-305 ◽

Cited By ~ 94

Author(s):

D. Velakoulis ◽

M. Walterfang ◽

R. Mocellin ◽

C. Pantelis ◽

C. McLean

Keyword(s):

Frontotemporal Dementia ◽

Clinical Course ◽

Case Series ◽

Pathological Findings ◽

Psychotic Illness ◽

Dementia Diagnosis ◽

Genetic Characteristics ◽

Young Onset ◽

The Relationship ◽

Local Brain

BackgroundFew studies have investigated the relationship between schizophrenia and frontotemporal dementia.AimsTo investigate this relationship through a clinicopathological investigation of young-onset frontotemporal dementia and a review of the case literature.MethodCases of young-onset frontotemporal dementia were identified within the local brain bank. The clinical course and pathological findings were collated. For the literature review, cases of frontotemporal dementia identified through Medline were selected according to defined criteria. The demographic, clinical, pathological and genetic characteristics of cases presenting with a psychotic illness were identified.ResultsIn the case series, 5 of 17 patients with frontotemporal dementia had presented with a psychotic illness (schizophrenia/schizoaffective disordern=4, bipolar disordern=1) an average of 5 years prior to the dementia diagnosis. Patients with schizophrenia exhibited changes consistent with TDP-43 and ubiquitin-positive frontotemporal dementia. In the cases review, a third of patients aged 30 years or under and a quarter of those aged 40 years or under had been diagnosed with psychosis at presentation.ConclusionsPatients with young-onset frontotemporal dementia may be diagnosed with a psychotic illness years before the dementia diagnosis is made. These findings have implications for clinicians and for our further understanding of the neurobiology of psychotic illness.

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