Neuropsychiatric manifestations following the use of 3,4-methylenedioxymethamphetamine (MDMA: "Ecstasy").

1. The recurring side-effects associated with MDMA consumption are reviewed. 2. The recreational use of "Ecstasy" has been implicated in the onset of various psychological, neurological, and organic complications. A table has been employed to depict the deleterious reactions that have occurred following MDMA ingestion. 3. An original case report is presented in which an individual developed perpetual neuropsychiatric symptomatology after having consumed MDMA. This case indicates that MDMA may induce long lasting effects, even after one exposure.

Nicotine dependence. Diagnosis and treatment.

Psychiatrists must become more involved in the engagement and treatment of nicotine-dependent patients in their clinical practice because it is the number one killer in the DSM-III-R. There is no single treatment that will fit all psychiatric patients. Instead, a carefully tailored treatment plan is generated using the seven tier system to fit each patient and their psychosocial profile. Psychiatrists have the medical, social, and psychological training needed to manage nicotine-dependent patients. Although further research is needed, psychiatrists should no longer ignore their responsibility to treat nicotine dependence.

Nicotine dependence: diagnosis, pharmacology and treatment.

Nicotine dependence has been clearly documented as an addiction to nicotine. The development of tolerance and dependence to nicotine has been documented as well in studies in animals and humans. The morbidity and mortality from nicotine dependence continues to be widespread and significant in spite of some reduction in the prevalence of use. Various modalities of pharmacological and nonpharmacological treatments have been developed in recent years. These treatment methods may be used singularly or in combination. Although some success has been claimed with each form of treatment, more studies are needed to confirm their full efficacy.

The prevalence of marijuana (cannabis) use and dependence in cocaine dependence.

In a retrospective and prospective study using DSM-III-R criteria for substance dependence in 232 inpatients and 51 outpatients, the clinical suspicion that cocaine addicts use other drugs including marijuana was confirmed. As many as 53% of cocaine addicts diagnosed by DSM-III-R criteria for cocaine dependence qualified for a diagnosis of cannabis dependence. The reports regarding marijuana and other drug dependence among cocaine addicts have been few and inconclusive. The diagnosis of other drug use and dependence in cocaine dependence has importance with regard to prognosis and treatment. This study found a high prevalence of marijuana (cannabis) dependence in patients with cocaine dependence.

Cannabis diagnosis of patients receiving treatment for cocaine dependence.

In three separate samples using DSM-III-R criteria for substance dependence in 232 inpatients and 51 outpatients, we confirm the clinical suspicion that many cocaine dependents qualify for the diagnosis of cannabis dependence. As many as 53% of cocaine dependents diagnosed by DSM-III-R criteria have the concurrent diagnosis of cannabis dependence. The reports regarding cannabis dependence among cocaine dependents are few and inconclusive. The diagnosis of cannabis dependence in cocaine dependents has important consequences on etiology, prognosis, and treatment.

Sexual dysfunction in abusers of cocaine and alcohol.

Sexual dysfunction is not uncommon in alcoholics and in cocaine addicts. Alcohol abuse frequently develops along with cocaine dependence and the reverse is also common. We examined the sexual history of this common dually-addicted population. Sexual dysfunction was found in 62% (N = 50) of male cocaine and alcohol abusers consecutively admitted to a substance disorder treatment unit. The influence of cocaine and alcohol on commonly studied neurotransmitters and hormones along with their influence on sexual function are discussed.

Cocaine abuse and adult attention deficit disorder.

Cocaine increases dopaminergic tone in the central nervous system, and hyperprolactinemia has been found in chronic cocaine abusers. Dopamine depletion is believed to result from chronic cocaine abuse. Dopamine deficiency has also been associated with attention deficit disorder (ADD) in adults, and dopamine agonists have been effective in the treatment of ADD. Four case reports of cocaine addiction and ADD are presented. ADD was assumed to play an etiologic role in cocaine abuse, and it was postulated that the patients might in part have been self-medicating a dopamine-deficient state. In addition, cocaine addicts without a premorbid history of ADD may experience a temporary cocaine-induced ADD state. In both cases, the dopamine agonist bromocriptine was highly effective for treating ADD and promoting cocaine abstinence. Restoration of the presumed dopamine deficit may permit an easier course of rehabilitation by improving the patient's ability to participate in therapeutic programs.

Cocaine abuse, attention deficit disorder, and bipolar disorder.

Cocaine is a potent dopamine agonist that frequently stimulates the central nervous system and is often manifested by increased psychomotor activity, impulsivity, euphoria, and rapid thoughts. Attention deficit disorder (ADD) and bipolar disorder also present with physical restlessness, racing thoughts, distractibility, and mood instability. Although these three disorders rarely appear in the same individual, they are important differential diagnoses when considering any one illness with the above symptom complexes. We report two cases of cocaine abuse with ADD residual type in patients who were previously diagnosed as having atypical bipolar disorder. The adverse effects were reversed by the dopamine agonist bromocriptine.

Sexual dysfunction secondary to cocaine abuse in two patients.

Hyperprolactinemia and sexual dysfunction occurred in 7 of 10 chronic cocaine users. Two of these 7 patients who underwent rehabilitation for cocaine abuse and developed hyperprolactinemia and decreased libido are described. One patient developed galactorrhea. These adverse effects were reversed by bromocriptine. The pathophysiology of cocaine abuse and the central dopaminergic influence on sexual function are discussed.

A review of the EEG literature on Ganser's syndrome.

Ganser's syndrome has been classified as a histrionic disorder, a psychotic illness, a dissociative disorder, a factitious disorder, and an organic illness. The possibility of an underlying organic component to Ganser's syndrome is often implicated. A case which includes CT scan and EEG tests is presented and the EEG data in patients with Ganser's syndrome are reviewed. The majority of EEG data was not suggestive of any specific organic illness.

Multiple personality, seizure disorder, and the electroencephalogram.

The electroencephalogram (EEG) in a case of multiple personality was described. Despite conflicting reports in the literature we found no changes in the EEG which could not be ascribed to the normal changes seen in transitions from various states of alertness. The problems of differentiating multiple personality as a psychiatric entity in itself from those cases arising as a result of chronic partial or partial-complex epilepsy are discussed. Further research with more sophisticated electrophysiological data acquisition and data reduction equipment is suggested.

The Ganser syndrome: evidence suggesting its classification as a dissociative disorder.

The past and present nosology of Ganser's syndrome is discussed. The anomaly is defined as the presence of approximate answers with hallucinations, clouded sensorium, somatic conversion, and amnesia. The characteristic symptom of the syndrome, paralogia, is appreciated as an associated feature of Factitious Disorder with Psychological Symptoms. It is suggested that Ganser syndrome may be linked inappropriately with the concept of factitious illness. Two new cases of the Ganser syndrome are presented, and an additional forty-one case reports are reviewed. A high correlation between the presence of paralogia and amnesia is revealed, which suggests that paralogia and related psychological symptoms are better classified as associated features of Atypical Dissociative Disorder.