Acute Changes in Mentation in a Patient with Hepatic Cirrhosis Treated with High Doses of Dexamethasone.

Despite the anti-inflammatory benefits of steroids in the management of multiple medical conditions, they are associated with undesired metabolic and psychiatric side effects. We present a case of a 57-year-old Hispanic man with hepatic cirrhosis due to hepatitis C and no past medical history of psychiatric illnesses who became delirious after treatment with high doses of intravenous Dexamethasone. The patient presented to Larkin Community Hospital, USA with complaints of lower back pain requiring treatment with steroids for severe lumbar central canal stenosis. After three days of treatment, the patient became disoriented to time and place, grossly psychotic with auditory hallucinations and disorganized behavior, manic, aggressive, combative, restless, hard to redirect, and unable to follow commands. He met the criteria for a diagnosis of substance-induced psychotic disorder according to Diagnostic and Statistical Manual of Mental Disorders (DSM) V. Furthermore, the patient had worsening hepatic profile, a high ammonia level of 125 umol/L, and clinical findings consistent with West Haven classification grade 2 encephalopathy. Head computed tomography (CT) scan was normal. He was treated with discontinuation of steroids, lactulose, and Haloperidol returning to baseline mental status after 48 hours. The patient's hospitalization was complicated with a prolonged hospital stay after lumbar surgery. This case illustrates that treatment with high doses of Dexamethasone in a patient with hepatic cirrhosis can cause acute changes in mental status by (i) inducing delirium, and (ii) precipitating hepatic encephalopathy.

Synthetic Cannabis Overdose and Withdrawal in a Young Adult: A Case Report, Commentary on Regulation, and Review of the Literature.

Introduction. Marijuana has been used for its psychotropic effects including enhanced relaxation and perceptual alterations. However, the use of synthetic marijuana (SM) leads to more frequent and drastic side effects than the typical use of regular marijuana, owing to the fact that SM has a shorter duration and an earlier peak of action. Despite all the potential adverse health effects associated with SM use, current health policies on SM are very limited. It is believed that the popularity of SM has increased, due to its easy accessibility in the US and lack of detection in typical urine drug screens for THC. Case Report. One case presented is of a young adult patient, with histories of recurrent synthetic cannabis and recreational cannabis use, who had developed drastic physiological and psychiatric symptoms, including the development of acute-onset psychosis. Conclusion/Discussion. This case, as many others nationwide, exemplifies the impact of synthetic cannabinoid use and abuse in adolescents. Side effects and adverse health consequences of synthetic cannabinoid use warrant stricter regulations and policies in order to decrease psychiatric hospital admissions and associated healthcare costs.

Predictors of binge drinking in elderly Americans.

BACKGROUND: The increasing trend in elderly binge drinking in the U.S. is cause for alarm. We sought to describe the predictors of binge drinking in elderly men and women and evaluate the relationship between binge drinking and mental health disorders in this population. METHODS: The 2008 Centers for Disease Control's Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 4,815 individuals in the U.S. of age 65 or older. The primary outcome of interest was self-reported binge drinking, defined as an affirmative response to the question: "How many times in the past 30 days have you had more than five drinks (in men) or more than four drinks (in women) on an occasion?" RESULTS: Among 4,815 elderly participants studied, a total of 466 (9.7%) participants reported binge drinking over the past 30 days while 4,349 (90.3%) participants reported no binge drinking. Binge drinking was not associated with anxiety or depressive disorders in the overall population, however, elderly women reporting binge drinking had higher rates of depressive disorders. In multivariate analysis, independent predictors of binge drinking in elderly participants included younger age, male gender, smoking, absence of college education, lower annual income, and absence of coronary artery disease. Predictors of binge drinking differed in elderly men and women. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Younger age, male gender, smoking, lack of college education, lower annual income, and absence of coronary artery disease are independently associated with higher rates of binge drinking among elderly Americans. Elderly men and women had disparate predictors of binge drinking. This study provides valuable information to be applied to the substance abuse screening process in elderly men and women.