Withdrawal reactions in patients dependent on opioids and physiological reactions to drugs such as insulin have also been omitted. The table is limited to psychiatric symptoms reported with single drugs, but drug interactions can also cause such symptoms The Medical Letter Adverse Drug Interactions Program. Recent references and a few older ones are cited; additional older references are available in an earlier issue. Drugs that may cause psychiatric symptoms.
Med Lett Drugs Ther ; The most commonly implicated nonpsychiatric agents include antiparkinsonian agents, cardiac medications, and corticosteroids. Pharmacists must be familiar with the neuropsychiatric adverse effects of many common prescription and nonprescription medications so that they can educate patients and caregivers about this potential adverse effect and develop strategies to minimize risk.
Adverse drug events ADEs affect millions of people each year. ADEs have been identified as the most common cause of postdischarge complications and account for more than 3. The term psychosis was first used in the 19th century to describe an abnormal state of mind. Visual hallucinations with or without delirium are most frequently reported; auditory hallucinations, which are less common, are usually accompanied by visual hallucinations.
Digoxin has the potential to cause delirium, depression, and psychosis, most likely due to electrolyte imbalances and cerebral hypoxia. Beta 1 -adrenergic receptor blockers are known to cause central nervous system CNS effects, including bizarre or vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations. Neuropsychiatric effects of ACE inhibitors are limited; however, visual hallucinations associated with use of these agents have been reported, primarily in elderly patients.
Other cardiac agents that may induce psychosis include diuretics, calcium channel blockers, and several antiarrhythmic agents. Since the s, corticosteroids have been utilized for the treatment of a variety of immunologic disorders. The reported incidence of corticosteroid-associated psychiatric reactions ranges from 1. Antimicrobials: Antibiotics are frequently used and are generally well tolerated, but some antibiotics have been associated with neuropsychiatric adverse effects that are usually less recognized.
A few case reports have linked amoxicillin to the development of acute psychosis. Symptoms developed within 2 hours to 10 days after therapy initiation and resolved completely upon cessation. Antiretrovirals: The prevalence of new-onset psychosis in HIV-infected patients ranges from 0.
Nonprescription Medications: Many nonprescription medications can cause psychotic symptoms. Sympathomimetics in most cold products and nasal sprays have been associated with psychotic symptoms, even at usual dosages.
Medication-induced psychosis may present in a similar manner as idiopathic psychosis. There are no definitive tests to determine whether a patient is experiencing medication-induced psychosis. A thorough history is needed to help establish a temporal relationship. It is important to determine the onset of psychotic symptoms; medication-induced psychosis is usually related to an increase in dosage or changes to medication regimens, with symptoms appearing within days of drug initiation, dosage change, or discontinuation.
In addition, a complete medication history including all prescription and nonprescription drugs, herbal products, and supplements is essential. Illicit drug use and alcohol consumption must be addressed as well. Polypharmacy, especially in the elderly, may be associated with an increased risk of medication-induced psychosis; this population is more likely to be treated for parkinsonism, cardiovascular disease, and other conditions that have the potential to induce psychosis.
Awareness of potential drug interactions also is important for preventing medication-induced psychosis. Medication-induced psychosis is typically self-limiting, usually resolving within a day in some cases, several days after discontinuation of the offending agent. In PD-treated patients, the drug with the greatest psychosis-inducing potential and the least antiparkinsonian activity should be eliminated first.
Typical antipsychotics and most atypical antipsychotics are not recommended for this reason. The most promising medications are the cholinesterase inhibitors rivastigmine and donepezil.
Keeping the patient safe is an important aspect of treating acute illness. Ideally, the patient should be in an environment where he or she can be observed and contained, if necessary, to avoid self-harm or harm to others. Short-term treatment with antipsychotics or benzodiazepines during a period of psychosis may be warranted for patients in danger of harming themselves or others.
Medication-induced psychosis has been associated with many nonpsychiatric medications. It is important to be aware of the psychotropic ADEs of many common nonprescription and prescription medications. Educating patients and caregivers about potential ADEs of psychotomimetic drugs and inquiring about ADEs at each patient encounter will aid in the early detection and prevention of medication-induced psychosis.
The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. Adverse drug events in the outpatient setting: an year national analysis. Pharmacoepidemiol Drug Saf. National surveillance of emergency department visits for outpatient adverse drug events.
Ashton CH. Psychiatric effects of drugs for other disorders. Desai AK. Psychotropic side effects of commonly prescribed medications in the elderly. Primary Psychiatry. Goren JL. Sleep disturbance. Reduced emotional expression. More items…. Schizophrenia appears to be associated with pronounced thought disorder, negative symptoms more generally and cognitive deficits mediated by the parietal cortex, such as difficulties with selective visual attention, while visual and tactile hallucinations appear to be more prevalent in acute METH-induced psychosis.
Schizophrenia and bipolar disorder are two mental illnesses associated with psychosis, but severe anxiety can trigger it as well. Some people who suffer from severe anxiety and have panic attacks or anxiety attacks as a result experience symptoms of psychosis.
These can be extremely frightening, or make someone feel confused or threatened. The diagnoses in which psychosis often occurs are schizophrenia, characterized by a lifelong mental psychotic condition, bipolar disorder, in which primarily affect, disturbance occurs mania or depression , and dementia, in which loss of cognitive capacity can be confounded by paranoia and thought disorder. Brief psychotic disorder, by definition, lasts for less than 1 month, after which most people recover fully.
If symptoms last for more than 6 months, doctors may consider a possible diagnosis of schizophrenia. Typically, a psychotic break indicates the first onset of psychotic symptoms for a person or the sudden onset of psychotic symptoms after a period of remission.
Symptoms may include delusional thoughts and beliefs, auditory and visual hallucinations, and paranoia.
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