Reversible toxic psychosis after cephalexin

Delirium and Its Pharmacological Causes in Older People, Part Three

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. Part one of this three part series reviewed the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people. Parts two and three continued to review the pharmacological classes of medications that cause or contribute to delirium in older people.

A Case Attributed to Cefazolin and a Review of the Literature

Generalized convulsions developed in a uremic patient who had received massive doses of cefazolin which resulted in a measured serum level of greater than 512 mcg/ml of drug after dialysis. Pathophysiologic mechanisms which could have contributed to the symptoms are discussed. Physicians prescribing cefazolin and other cephalosporins need to be aware of this potential complication of therapy and adjust doses accordingly in renal failure.

Psychiatric side effects of medications prescribed in internal medicine

Several pharmacological treatments used in internal medicine can induce psychiatric side effects (PSEs) that mimic diagnoses seen in psychiatry. PSEs may occur upon withdrawal or intoxication, and also at usual therapeutic doses. Drugs that may lead to depressive, anxious, or psychotic syndromes include corticosteroids, isotretinoin, levo-dopar mefloquine, interferon-a, and anabolic steroids, as well as some over-the-counter medications. PSEs are often difficult to diagnose and can be very harmful to patients. PSEs are discussed in this review, as well as diagnostic clues to facilitate their identification.

Critical care sedation for neuroscience patients

In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) introduced the mandate for the implementation of standards for both pain assessment and need for therapy in hospitalized patients. The need for the appropriate titration of sedation and analgesia is particularly poignant in an intensive care unit (ICU) setting where iatrogenic discomfort often complicates patient management. Neurologically ill patients in ICUs present particularly complex sedation issues, owing to the need to monitor these patients with serial neurological exams. Hence, maximal comfort without diminishing neurological responsiveness is desirable. Here, we review the frequently applied methods of evaluating levels of pain and agitation in critically ill patients as well as discuss the appropriate classes of pharmaceutical agents common to this population, with particular emphasis on the potential neurophysiological impact of such therapy.

Adverse events associated with the use of oral cephalosporins/cephems

Historically, oral cephalosporins represent one of the most widely used and safest classes of antimicrobials available. Typical adverse events have included nausea, vomiting, diarrhea, and hypersensitivity reactions. Other more serious events such as pseudomembranous colitis, although infrequent, may occur. The exact type and incidence of adverse events varies depending on the cephalosporin being administered. Differences in adverse event profiles may also vary by age of the patient. Reactions are usually not severe and often do not require termination of therapy. The purpose of this review is to present to healthcare providers the historical safety profile of the most commonly used oral cephalosporins.

Delirium in an adolescent patient during treatment with cephalexin

Although cephalosporins are generally safe, they have been reported to cause neurotoxic effects in some subjects. We report on a 16-year-old boy with no previous history of psychiatric illness, who developed symptoms of delirium during treatment of paronychia infection with cephalexin. Possible reasons for our patient's particular vulnerability to adverse drug effects in the central nervous system include his young age, a developmental delay, and an earlier head injury.

Myoclonic activity associated with cefmetazole, with a review of neurotoxicity of cephalosporins

We reported a case of a 66-year-old female with uremia who developed myoclonic activity after administration of cefmetazole (4g/2 days). Curiously, the level of the antibiotics (236 micrograms/ml) in the cerebrospinal fluid (CSF) was higher than that in the blood (103 micrograms/ml). Myoclonic activity faded away after cessation of the antibiotics. This is the first case reported developing neurotoxicity associated with intravenous administration of cefmetazole. In addition, the curious pharmacokinetic dynamics of cephalosporin in uremia is discussed.

Psychological effects caused by drugs in overdose

Drug overdose is a common occurrence which accounts for up to 25% of medical inpatient admissions. Intentional overdose or attempted suicide is the most common cause of overdose, but there are other types of overdose which are often unrecognised as are the effects caused by these overdoses. Iatrogenic overdose occurs frequently and is often unavoidable. Many patients will make mistakes with their treatment and unwittingly suffer from the toxic effects of the drugs they are taking. About 7% of intentional overdose patients who are admitted to hospital have taken the drug for some psychological effect they have been seeking and have taken too much. This group is described as those who take 'drugs for kicks'. As many of the drugs taken cross the blood-brain barrier and exert some toxic effect on the cerebral cortex, secondary psychological disturbances frequently occur in all of these groups of patients, and can sometimes be the only sign of dangerous toxicity. It is important to recognise the patient's gross disturbances of behaviour, thinking and perception as a manifestation of drug toxicity which can be life threatening and often requires intense medical treatment. The range of the psychological response is somewhat limited and there is not a specific psychological disturbance characteristic of the toxicity of each group of drugs. However, there are some reactions which, coupled with the physical symptoms shown by the patient, can help to identify the patient as suffering from the toxic effects of drugs and even give some indication as to the type of drugs taken. This article describes the various psychiatric syndromes caused by drugs in overdose and attempts to identify these with most of the commonly encountered groups of drugs.