Neuropsychiatric Side-Effects of Lidocaine: Examples from the Treatment of Headache and a Review

Lidocaine has been used in treatment of patients with refractory headache. Personal observations of neuropsychiatric toxicity in these patients led us to review our cases and the literature systematically for lidocaine side-effects, especially neuropsychiatric symptoms. In our series of 20 patients, side-effects were observed in all, the most frequent being neuropsychiatric (75%) and cardiological (50%). When reviewing published series on intravenous lidocaine use, reports of side-effects range from 0 to 100%, with neuropsychiatric symptoms being reported in 1.8–100%. Thirty-six case reports of lidocaine-induced psychiatric symptoms were also analysed. Psychiatric symptoms of toxicity were similar in most patients, despite their differing ages, pathologies, co-therapies and lidocaine dosages. In conclusion, lidocaine neuropsychiatric toxicity has a well-recognized stereotypical clinical presentation that is probably unrecognized in headache series. As lidocaine represents an emerging alternative therapy in headache, particularly in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, clinicians and patients should be aware of the extent of this problem.

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Neuropsychological profile of a male psychiatric patient with a Morgagni-Stewart-Morel syndrome

Acta Neuropsychiatrica ◽

10.1017/neu.2014.32 ◽

2014 ◽

Vol 27 (1) ◽

pp. 60-64 ◽

Cited By ~ 1

Author(s):

Aksel Hansen ◽

Liliana Engelhardt ◽

Wolfgang Pleschutznig ◽

Gerhard Dammann ◽

Stephanie Vietze

Keyword(s):

Case Report ◽

Psychiatric Patient ◽

Neuropsychological Tests ◽

Psychiatric Symptoms ◽

Case Reports ◽

Neuropsychiatric Symptoms ◽

Pain Syndrome ◽

Admission Diagnosis ◽

Neuropsychological Profile ◽

Definition Of

In 1765 Giovanni Morgagni described a syndrome consisting of hyperostosis frontalis interna (HFI), obesity and hirsutism. In 1928 Stewart and in 1930 Morel added neuropsychiatric symptoms, e.g. depression and dementia, which led to the definition of the Morgagni-Stewart-Morel Syndrome (MSM). Although mostly women were characterized in literature no gender specifity is demanded. This case report presents the rare case of a 66 year old male psychiatric patient with Morgagni-Stewart-Morel Syndrome. The patient complained of loss of concentration and difficulties with activities of daily living. Admission diagnosis was an opioid misuse on the basis of a chronic pain syndrome. In this case report we are describing clinical features, the patient history and technical (MRI) and neuropsychological tests. Although severe psychiatric symptoms and neuropsychological deficits are commonly seen in these patients, our patient showed only mild symptoms. This case reports shows the possibility of a male patient with MSM. If MSM is a separate entity or just an epiphenomena of hormone dysregulation should be investigated in further studies.

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Antimicrobial-induced cognitive side effects

Mental Health Clinician ◽

10.9740/mhc.2016.07.207 ◽

2016 ◽

Vol 6 (4) ◽

pp. 207-214 ◽

Cited By ~ 7

Author(s):

Amanda Warstler ◽

Jennifer Bean

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Side Effects ◽

Clinical Symptoms ◽

Case Reports ◽

Time Frame ◽

Drug Induced ◽

Pubmed Search ◽

Neuropsychiatric Side Effects ◽

Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

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Clinical considerations of sleep related amnestic behaviours associated with zolpidem

Pharmacotherapy in Psychiatry and Neurology ◽

10.33450/fpn.2020.04.001 ◽

2020 ◽

Vol 36 (1) ◽

pp. 23-31

Author(s):

Agata M. Grzegorzewska ◽

Jerzy J. Landowski ◽

Wiesław J. Cubała

Keyword(s):

Side Effects ◽

Adverse Reactions ◽

Case Reports ◽

Anterograde Amnesia ◽

Gaba A ◽

Concurrent Use ◽

Comprehensive Search ◽

Insomnia Treatment ◽

Dose Dependent ◽

Neuropsychiatric Side Effects

Objective. Zolpidem is a non-benzodiazepine agonist of GABA-A receptor indicated for the short-term insomnia treatment. Over the years, there have been reports in literature on zolpidem abuse complications and neuropsychiatric side effects involving headache, dizziness, nightmares, confusion, depression, sleepiness, memory deficits as well as hallucinations, sensory distortions, delirium and sleep-related complex behaviours with anterograde amnesia. The aim of this work is to review and highlight the most serious adverse reactions to zolpidem with emphasis on sleep-related amnestic behaviours. We also focus our attention on common traits, patterns and predisposing factors. This paper refers to zolpidem side effects or complex amnestic behaviours, or sleep related amnestic behaviours presented in literature. Literature review. A comprehensive search of PubMed and Google Scholar was conducted to find relevant studies, case reports and literature reviews addressing the zolpidem use in insomniac patients. Conclusions. Zolpidem may pose a risk for serious adverse reactions most common dose-dependent and associated with age, gender, concurrent use of medications and concomitant comorbidities. If severe adverse reactions occur, the drug should be immediately discontinued or switched to another hypnotic. This review indicates an association between psychotic reactions and complex sleep related behavioural abnormalities in patients using zolpidem alone or in combination with other psychotropic medications. Clinicians should adopt a cautious approach prescribing zolpidem and be alert to possible unusual adverse effects of the drug.

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Acute Psychosis in a Child with Severe Dengue

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v37i3.16481 ◽

2018 ◽

Vol 37 (3) ◽

pp. 273-275

Author(s):

Ruchika Bhatnagar ◽

Premlochan Prasad

Keyword(s):

Psychiatric Symptoms ◽

Case Reports ◽

Neuropsychiatric Symptoms ◽

Adult Population ◽

Febrile Illness ◽

Recovery Phase ◽

Severe Dengue ◽

Age Group ◽

Acute Psychosis ◽

Pediatric Age Group

Dengue fever is emerging as an important cause of acute febrile illness with neuropsychiatric symptoms in adult population especially in endemic areas. Numerous case reports and review articles have already been published in past emphasizing on neurological manifestations in dengue but sufficient data on psychiatric symptoms in pediatric age group is still lacking. Acute psychosis in recovery phase of severe dengue is an uncommon phenomenon, thus rarely reported.

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Management of Depression Associated with HIV/AIDS and Antiretrovial Therapy

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2006/254238 ◽

2006 ◽

Vol 17 (suppl d) ◽

pp. 5D-9D

Author(s):

Mark Halman

Keyword(s):

Major Depression ◽

Psychiatric Symptoms ◽

Social Withdrawal ◽

Case Reports ◽

Meta Analysis ◽

Neuropsychiatric Symptoms ◽

Medical Illness ◽

Open Label ◽

Antiretroviral Adherence ◽

Hiv Aids

Depressed mood is a common psychiatric complaint in persons with HIV/AIDS, with a meta-analysis indicating that the rates of depression within this group may be as high as double that of the general population. Depression may result from a biological diathesis to mood disorders, a physiological reaction to a medical illness or its treatment, and/or a psychological reaction to challenging life circumstances. Associated symptoms include sleep, energy and appetite disturbances; social withdrawal; diminished capacity to experience pleasure; diminished concentration; feelings of worthlessness, shame and guilt; and recurrent thoughts of death, including suicidal ideation. The emotionally and physically painful state of major depression is associated with decreased antiretroviral adherence and poorer HIV/AIDS disease outcomes. Neuropsychiatric symptoms have been reported with several of the medications taken by patients with HIV/AIDS, including lamivudine, zidovudine, interferon and, most notably, efavirenz. However, data from several sources demonstrate that neuropsychiatric symptoms associated with efavirenz use are generally transient, with onset early after treatment initiation, peaking after one week and decreasing over the first one to four months of treatment. Recent comparative studies have not found elevated incident rates of major depression in patients treated with efavirenz, but they have confirmed the typical neuropsychiatric symptoms reported in earlier open-label studies and case reports. Becoming skilled in the management of depression and psychiatric symptoms is integral to the provision of comprehensive care for patients with HIV/AIDS.

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Psychiatric side effects induced by chloroquine and hydroxychloroquine: a systematic review of case reports and population studies

10.1101/2020.10.05.20207423 ◽

2020 ◽

Author(s):

Fernanda Talarico ◽

Sucheta Chakravarty ◽

Yang S. Liu ◽

Andrew Greenshaw ◽

Ives Cavalcante Passos ◽

...

Keyword(s):

Systematic Review ◽

Side Effects ◽

Lupus Erythematosus ◽

Psychotic Disorders ◽

Suicide Attempts ◽

Population Studies ◽

Psychiatric Symptoms ◽

Case Reports ◽

Psychomotor Activity ◽

Psychiatric Side Effects

AbstractChloroquine and hydroxychloroquine are commonly used drugs in the treatment of malaria as well as chronic diseases, such as rheumatoid arthritis, and systemic lupus erythematosus. Although various reports on possible psychiatric side effects of these drugs exist, the nature and extent of these effects remain poorly understood. Moreover, the relevance of these drugs in the treatment of early stages of COVID-19 necessitates a careful estimation of their side effects. Here, we provide a systematic review of the psychiatric side effects associated with chloroquine and hydroxychloroquine. We used PubMed, Scopus, and Web of Science platforms to identify relevant literature published between 1962 and 2020. Search terms included chloroquine, hydroxychloroquine, psychiatry, psychosis, depression, anxiety, bipolar disorder, delirium, and psychotic disorders. Only case reports and clinical trials were included. All studies included records of psychiatric side effects induced by either chloroquine or hydroxychloroquine or both. Both retrospective and prospective, randomized as well as non-randomized population studies were included. Overall, the psychiatric side effects are dose- and sex-independent. The most common psychiatric side effects reported are increased speech output/ excessive talking, increased psychomotor activity, irritable mood, auditory hallucinations, delusion of grandiosity, and suicide attempts, likely due to brain intoxicationbe of chloroquine or hydroxychloroquine. The symptoms can develop in a few hours to 11 weeks after drug intake and are normally reversed within a week after the drug withdrawal. We conclude that CQ and HCQ have the potential to induce psychiatric side effects. This study calls for further investigation of psychiatric symptoms induced by these drugs in the short and long term.

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Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis

European Archives of Psychiatry and Clinical Neuroscience ◽

10.1007/s00406-021-01293-5 ◽

2021 ◽

Author(s):

R Rosello ◽

B Girela-Serrano ◽

S Gómez ◽

B Baig ◽

M Lim ◽

...

Keyword(s):

Side Effects ◽

Psychiatric Disorder ◽

Children And Adolescents ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Autoimmune Encephalitis ◽

Emotional Lability ◽

Liaison Psychiatry ◽

Paediatric Cohort ◽

Psychiatric Manifestations

AbstractAutoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

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Frequency and Clinical Aspects of Neurological and Psychiatric Symptoms in Patients with Non-Celiac Wheat Sensitivity

Nutrients ◽

10.3390/nu13061971 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1971

Author(s):

Antonio Carroccio ◽

Maurizio Soresi ◽

Marta Chiavetta ◽

Francesco La Blasca ◽

Stella Compagnoni ◽

...

Keyword(s):

Clinical Presentation ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Duodenal Mucosa ◽

Clinical Aspects ◽

Double Blind ◽

Duration Of Symptoms ◽

Neuropsychiatric Manifestations ◽

Wheat Sensitivity ◽

Clinical Records

Background: Non-Celiac Wheat Sensitivity (NCWS) is characterized by both intestinal and extra-intestinal symptoms. The study aims to investigate the frequency of neuropsychiatric manifestations in NCWS patients and identify their clinical and demographic characteristics. Methods: 278 clinical records of NCWS patients, diagnosed by a double-blind placebo-controlled wheat challenge between 2006 and 2020, were retrospectively revised. Fifty-two patients with Celiac Disease (CD) and 54 patients with Irritable Bowel Syndrome (IBS) served as controls. Results: 87% of the NCWS patients had an IBS-like clinical presentation. The NCWS group showed a longer duration of symptoms, a higher frequency of positive serum anti-nuclear antibodies than CD and IBS patients, and a higher frequency of DQ2/DQ8 haplotypes and duodenal mucosa lymphocytosis than IBS controls. In addition, 50% of NCWS patients showed neuropsychiatric manifestations, while lower percentages were observed in CD (25%) and IBS (28%) controls. Neuropsychiatric symptoms in NCWS were more frequently associated with the male sex, longer duration of symptoms, and IBS-diarrhea-like clinical presentation. Conclusions: Our data suggest that in patients with IBS-like symptoms and neuropsychiatric manifestations of unknown cause, it could be useful to investigate a correlation of these symptoms with wheat ingestion to identify NCWS patients with this ‘atypical’ manifestation.

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Second generation direct-acting antiviral (DAAs) Treatment on HCV+ patients: Patient reported outcomes (PROs) and psychiatric symptoms in a real world setting sample

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.230 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S316-S317

Author(s):

M. Moneglia ◽

A. Santangelo ◽

I. Burian ◽

L. Gragnani ◽

F. Elisa ◽

...

Keyword(s):

Side Effects ◽

Real World ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Multivariate Logistic Regression Analysis ◽

Psychiatric History ◽

Sample Mean ◽

Sf 36 ◽

Significant Difference ◽

Patient Reported

IntroductionAnti-HCV treatments are moving away from interferon-alpha towards DAAs, associated with fewer side effects, better tolerability, and better PROs.AimsTo describe neuropsychiatric symptoms and PROs during DAAs treatment in a group of HCV+ patients.MethodsForty outpatients, scheduled for DAAs treatment, were assessed at enrolment (T0), 4 weeks (T1), at the end of treatment (EOT) and after 12 weeks of follow up (F-UP), by means of MDRS, HAM-D, HAM-A, MRS, Y-BOCS and SF-36. Afterwards the sample was divided into two groups as a function of a positive psychiatric history (19) and compared with each other.ResultsTotal sample mean scores between W0 and F-UP were compared and an improving trend was observed in all administered scales. An SF-36 items analysis showed a statistically significant difference in emotional role functioning between W0 vs EOT and EOT vs F-UP, in change in overall health status between W0 vs EOT and W0 vs F-UP.A multivariate logistic regression analysis showed that a positive psychiatric history was not associated with an improvement in vitality of 4.3 (minimal clinically important difference). Comparing the two groups, no significant fluctuations in SF-36 scores were founded and major deviations score increases were recorded in patients with a psychiatric history in all scales.ConclusionsOur real world data shows that new regimens do not seem to be associated with psychiatric side effects and conversely a clinical improvement compared to baseline was found, suggesting an immediate gain in PROs over the treatment period, particularly the psychiatric subgroup.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment of Delirium in Older Persons: What We Should Not Do!

International Journal of Molecular Sciences ◽

10.3390/ijms21072397 ◽

2020 ◽

Vol 21 (7) ◽

pp. 2397 ◽

Cited By ~ 2

Author(s):

Fulvio Lauretani ◽

Giuseppe Bellelli ◽

Giovanna Pelà ◽

Simonetta Morganti ◽

Sara Tagliaferri ◽

...

Keyword(s):

Side Effects ◽

Older Persons ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Cost Effective ◽

Correct Choice ◽

Point Of View ◽

The Body ◽

Geriatric Syndrome ◽

Visual Spatial

The presentation of common acute diseases in older age is often referred to as “atypical”. Frequently, the symptoms are neither single nor tissue related. In most cases, the onset of symptoms and diseases is the expression of a diminished reserve with a failure of the body system and imbalance of brain function. Delirium is one of the main devastating and prevalent atypical symptoms and could be considered as a geriatric syndrome. It encompasses an array of neuropsychiatric symptoms and represents a disarrangement of the cerebral function in response to one or more stressors. The most recent definition, reported in the DSM-V, depicts delirium as a clear disturbance in attention and awareness. The deficit is to be developed in a relatively short time period (usually hours or days). The attention disorder must be associated with another cognitive impairment in memory, orientation, language, visual-spatial or perception abilities. For the treatment, it is imperative to remove the potential causes of delirium before prescribing drugs. Even a non-pharmacological approach to reducing the precipitating causes should be identified and planned. When we are forced to approach the pharmacological treatment of hyperactive delirium in older persons, we should select highly cost-effective drugs. High attention should be devoted to the correct balance between improvement of psychiatric symptoms and occurrence of side effects. Clinicians should be guided in the correct choice of drugs following cluster symptoms presentation, excluding drugs that could potentially produce complications rather than advantages. In this brief point-of-view, we propose a novel pharmacological flow-chart of treatment in relation to the basic clusters of diseases of an older patient acutely admitted to the hospital and, in particular, we emphasize “What We Should Not Do!”, with the intention of avoiding possible side effects of drugs used.

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