Iatrogenic Psychoses

Iatrogenic psychoses can cause disability, worsen previous disability, and render clinical management extraordinarily difficult. In certain cases, psychosis precedes more severe and overt toxicity, which can lead to encephalopathy or coma. This article offers an overview of iatrogenic (ie, treatment-induced) psychoses. "Pure" psychoses (ie, without confusion or mood disturbance) are emphasized. Shortcomings of available data are highlighted. The epidemiology, definition, diagnosis, differential diagnoses, risk factors, and course are discussed. Therapeutic measures include discontinuation or decreasing the dose of the suspected medication and the administration of neuroleptics, antimanics, and antidepressants. Other general principles of clinical management are given. A brief review of etiopathogenic mechanisms is offered and areas for future research are emphasized.     

Psychoses in identical twins

Psychiatric Quarterly -     

Psychoses following therapeutic abortion

The literature concerning therapeutic abortion suggests that there are few significant psychiatric sequelae of the procedure among women with no previous psychiatric history, and when emotional disturbances do result, they are related to the patient's environment rather than the termination itself. However, 2 case reports are presented in which the patients functioned normally before the abortion but subsequently experienced psychoses precipitated by guilt over the procedure. Both women experienced visual hallucinations and the psychotic thought processes around the time they would have delivered, and had to be hospitalized. These cases suggest that the rationalization and intellectualization of the abortion experience may not constitute adequate defenses aginst guilt, and point to the necessity of physician awareness that the abortion procedure may produce morbidity.     

Psychoses associated with myxedema

Summary The two cases reported represent the two general groups of mental illness associated with myxedema, one group in which myxedema appears to be the primary cause of the psychosis, the other in which myxedema is not directly related to the psychosis or may play only a secondary rôle.In the first case, although the patient had suffered from a myxedematous mental state for a number of years, the psychotic symptoms had a rather sudden onset. They began as a delirious episode with subsequent partial amnesia for this episode, followed by a mild paranoid trend of relatively short duration. Both the physical and the mental symptoms on two different occasions, years apart, responded promptly to thyroid medication with complete remission of the mental illness.In the second case, if the myxedema was in any way associated with mental illness it was only as one of the several contributory factors. The psychosis seems to have resulted primarily from maladjustment of a neurotic personality to difficult life situations.The mental picture was that of a paranoid condition, which ran a continous course. Although the administration of thyroid in this case repeatedly relieved the physical symptoms of the myxedema, it had no material influence on the mental illness except perhaps for producing a slight reduction in the intensity of the symptoms.Read before the interhospital conference held at the New York State Psychiatric Institute and Hospital, New York, N. Y., April 18, 1940.     

Psychoses in Parkinson's Disease

Psychotic symptoms occur in up to 40% of patients with Parkinson's disease (PD) and other degenerative parkinsonian disorders, usually but not exclusively in the context of their pharmacologic treatment. We describe the following six psychotic syndromes in PD based on existing literature: (1) hallucinations with preserved insight; (2) medication-induced psychotic disorders (in clear consciousness); (3) delirium; (4) schizophrenia-like psychotic disorders (in clear consciousness and in the absence of medication treatment); (5) schizophrenia with subsequent development of PD; and (6) other psychotic disorders. Psychosis in PD has been noted to be a marker for illness deterioration. Psychotic symptoms can profoundly affect the quality of life for PD patients and their families and may increase the economic burden of this illness. Various approaches have been used to treat psychotic symptoms in PD. We critically review this literature, which is limited, but includes studies indicating promise for "atypical" antipsychotics in these patients. Further elucidation of the phenomenology, course, pathophysiology, and treatment of the different psychotic disorders in PD is urgently needed.