ABSTRACT
BACKGROUND: This study describes the case of a 57 year old gentleman with a previous severe brain injury who developed a severe psychotic disorder 19 years after the injury. This appears to have been precipitated by heavy psychedelic substance use, including cannabis, salvia divinorum, ketamine, LSD, cocaine and DMT amongst others. The psychosis remained in the absence of drug intoxication and was associated with prominent apathy, lack of concern and abulia. CASE STUDY: This study discusses the heavy psychedelic substance misuse possibly potentiating a transition to psychosis in this individual. Little work has been undertaken in this area as substance misuse has traditionally been an exclusion criteria for investigating psychosis in this patient group. CONCLUSIONS: It is suggested that psychedelic substance misuse should be investigated as a risk factor for psychotic illness in patients with brain injury, as this case clearly suggests.
Subject(s)
Brain Injuries/complications , Hallucinogens/adverse effects , Psychotic Disorders/etiology , Brain Injuries/psychology , Drug Users , Follow-Up Studies , Humans , Male , Middle Aged , Risk FactorsABSTRACT
We describe a case of a man with chronic myeloid leukaemia who achieved remission through dasatinib therapy after being unable to tolerate several tyrosine kinase inhibitor (TKI) regimens due to severe physical side effects. However, this coincided with the onset of distressing agitation, insomnia and motor restlessness leading him to take a large zopiclone overdose. Start of appropriate therapy with a clonazepam, venlafaxine and mirtazapine combination led to a rapid improvement in symptomatology. We discuss the differential diagnosis and review the literature of neuropsychiatric complications of TKIs. This case serves as an illustrative reminder that in cases of complicated agitation referral to specialist mental health teams for rational psychopharmacological management is advised.
Subject(s)
Depression/complications , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Psychomotor Agitation/etiology , Pyrimidines/adverse effects , Thiazoles/adverse effects , Azabicyclo Compounds/administration & dosage , Dasatinib , Depression/diagnosis , Depression/drug therapy , Diagnosis, Differential , Dose-Response Relationship, Drug , Humans , Hypnotics and Sedatives/administration & dosage , Magnetic Resonance Imaging , Male , Middle Aged , Piperazines/administration & dosage , Protein-Tyrosine Kinases/antagonists & inhibitors , Psychomotor Agitation/diagnosis , Psychomotor Agitation/drug therapy , Pyrimidines/therapeutic use , Thiazoles/therapeutic use , Tomography, X-Ray ComputedABSTRACT
There have been reports of clozapine being used in the treatment of neuroleptic-induced akathisia. However, due to clozapine's side effects, its use has been limited. Olazapine has been shown to have a similar receptor occupancy to that of clozapine and also a similar chemical structure. We present three case histories where the commencement of olanzapine has had a dramatic improvement of in the symptoms of akathisia induced by other neuroleptics.
