Case report

Manic psychosis after coffee and phenylpropanolamine

A widely held belief is that amphetamine-like stimulants have abuse potential, but addiction to these drugs is seldom mentioned. We describe seven patients who fulfilled criteria for amphetamine-like abuse or dependence, based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. This case series lends. clinical support to the research findings that amphetamine-like drugs are reinforcing and therefore can be addictive.. The use of standardized criteria to classify excessive over-the counter stimulant use as abuse or dependence distinguishes these case reports from others in the medical literature, Public concern about the misuse of this class of drugs is discussed. We propose that clinicians use standardized criteria to diagnose accurately abuse of or dependence on over-the-counter stimulants for a better understanding of the extent of this problem.

Reading this article will reinforce the reader's awareness of the adverse effects of medications used for the treatment of rhinitis.

Articles on therapy of rhinitis and reports of associated side effects were reviewed. A MEDLINE database using subject keywords was searched from 1992 through 1997.

Pertinent articles were chosen. A distinction was made in the text between controlled studies and case reports.

Antihistamines, decongestants, anticholinergic agents, and corticosteroids, alone or in combination are used in the treatment of rhinitis. Reported side effects include sedation, psychosis, impaired learning and memory, and cardiac arrhythmias.

Rhinitis and its complications are important medical conditions. Adverse reactions are often difficult to diagnose and assess. Side effects may arise from the use of individual drugs or from drug combinations. There is insufficient cause to abandon these medications, but physicians must be mindful of the inherent risks of the drugs that they prescribe and of others that their patients may be taking without the physicians' knowledge or approval.

J Allergy Clin Immunol 1995;95:523-8

Mania occurs sometimes in association with an organic condition affecting the brain. A case of a 15-year-old girl with secondary mania related to multiple sclerosis is described, along with a selective review of the subject. The English-language literature published from 1986 to 1994 was reviewed, but geriatric and mentally retarded cases were excluded. This case points out that organic causes, often multifactorial, have to be kept in mind when treating patients who have mania.

Phenylpropanolamine (PPA) is a sympathomimetic drug contained in numerous over-the-counter and prescription decongestants and appetite suppressants. A range of adverse effects have been reported, including neuropsychiatric reactions in patients known to be taking recommended doses. Given that psychiatric symptoms are not included in the manufacturer's lists of adverse drug reactions, the incidence may be significantly higher. We report a case of paranoid psychosis following use of a decongestant containing PPA and summarize the case report literature of psychiatric adverse effects to PPA in which doses were known and stated to be within recommended guidelines. A pattern of possible risk factors emerges from these reports. These may include 1) symptoms or history of mood spectrum disorder, 2) history of psychosis, 3) female sex, 4) family history of psychiatric disorder. The possibility that a higher incidence of adverse events occurs in a vulnerable population has not been systematically addressed, and seems called for. We recommend that physicians specifically inquire about patients' use of decongestants and diet aids. In half of the above cases, symptoms resolved without the use of antipsychotics.

This chapter discusses several central nervous system stimulants and drugs that suppress appetite. Caffeine is useful in preventing idiopathic apnea in premature infants. The magnitude and significance of caffeine intake continues to elicit research interest, especially in evaluating its potential for abuse. Another study has drawn attention to caffeine abuse as a very common problem in patients with chronic headache. Acebrophylline is a new bronchodilator that reduces the secretion of mucus. In a multicenter trial in Brazil on 4500 children suffering from acute bronchitis, acebrophylline given orally twice a day was effective in ameliorating bronchospasm and dyspnea and in reducing cough and sputum production. In a double-blind, placebo-controlled, parallel group trial, the therapeutic efficacy and central effects of propentofylline were studied in 190 elderly outpatients with mild-to-moderate cognitive disturbances. Doxofylline is a xanthine derivative with bronchodilator activity but a low incidence of central and peripheral extrapulmonary adverse effects.