Amantadine may facilitate detoxification of cocaine addicts.

The effectiveness of amantadine hydrochloride was evaluated in a double-blind placebo controlled drug trial. The subjects were 42 cocaine dependent men enrolled in a day hospital program. Twenty-one patients were prescribed 100 mg/bid of amantadine to be taken over 10.5 days and 21 were prescribed an equivalent amount of placebo. The primary outcome measures were the Addiction Severity Index at 1 month after study entry and urines during the drug trial (end of weeks 1 and 2) and 1 month after study entry. Urines obtained at the end of the drug trial (2 weeks) indicated that the subjects receiving amantadine (93%) were more likely (P = 0.040) to be free of cocaine than the placebo (60%) subjects. Urine toxicology data at 1-month follow-up again indicated that more of the amantadine subjects (83%) were free of cocaine than the placebo (53%) subjects (p = 0.049); although no differences were found in self-reports of cocaine or other substance use in the past 30 days. The urine findings provided preliminary indication that amantadine may have some effectiveness in reducing cocaine use in cocaine dependent patients.

Delusion of parasitosis or chronic tactile hallucinosis: hypothesis about their brain physiopathology.

The abnormal belief of having the skin infested by parasites is a syndrome with different etiologies. Approximately 12% of cases are induced by another patient with the same syndrome. In noninduced cases, two physiopathological brain mechanisms have been proposed: a delusion, or a primary abnormal tactile sensation with a secondary delusional elaboration. These two hypotheses have been characterized by Berrios as cognitive and sensorialist approaches, respectively. Although modern literature defines this syndrome as a delusion, early literature, particularly German, described both approaches, and even emphasized the sensorialist approach, classifying it as a chronic tactile hallucinosis. A thorough review of the literature suggests both mechanisms may be possible.

Progression of symptoms in neuroleptic malignant syndrome.

The neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disorder characterized by mental-status changes, muscle rigidity, hyperthermia, and autonomic dysfunction. Systematic examination of early signs and the progression of symptoms in NMS may be worthwhile to facilitate prompt recognition and interventions to abort the syndrome in its incipient stage. The authors present the results of a preliminary review of the temporal sequence of the four predominant signs of NMS as described in 340 clinical reports of NMS in the literature. Of all order implications, 70.5% were consistent with the sequence of mental-status changes, rigidity, hyperthermia, and autonomic dysfunction. Changes in either mental status or rigidity were the initial manifestations of NMS in 82.3% of cases with a single presenting sign and were significantly more likely to be observed before hyperthermia and autonomic dysfunction. Methodological limitations of these data and clinical implications are discussed.