ABSTRACT
Reports of folie à famille are rare; this may be the first reported case involving a Vietnam veteran. Expression of his paranoid schizophrenia involved delusions and hallucinations relating to Vietnam, and his wife and children shared his paranoia. Typical of folie à famille were the dominant family member, the threat of violence, and the family's social isolation, frequent crises, and stable membership. Although the veteran's intrusive recollections of his Vietnam experience were typical of posttraumatic stress disorder, he acted on rather than avoided them. Treatment focused on the entire family, partly to minimize future problems in the children.
Subject(s)
Paranoid Disorders/genetics , Adolescent , Adult , Child , Combat Disorders/psychology , Delusions/psychology , Female , Hallucinations/psychology , Humans , Male , Paranoid Disorders/psychology , Schizophrenia, Paranoid/genetics , Schizophrenia, Paranoid/psychology , Social Isolation , Veterans/psychology , ViolenceABSTRACT
A 39-year-old man with schizoaffective disorder experienced somnambulism only when taking a combination of lithium carbonate, chlorpromazine, triazolam, and benztropine. This was confirmed in the sleep laboratory. The sleepwalking occurred during Stage 2 sleep; the sleep record showed a marked paucity of REM sleep. The patient's brother had had one episode of somnambulism, also following exposure to a substance affecting the CNS. A role for CNS-active medications in triggering some pathologic sleep phenomena in predisposed individuals is hypothesized. Medications with central anticholinergic activity may be particularly important.
Subject(s)
Psychotic Disorders/drug therapy , Psychotropic Drugs/adverse effects , Somnambulism/chemically induced , Adult , Benztropine/adverse effects , Chlorpromazine/adverse effects , Humans , Lithium/adverse effects , Lithium Carbonate , Male , Psychotic Disorders/psychology , Triazolam/adverse effectsABSTRACT
A middle-aged man, who presented to the emergency room because of bizarre outbursts of laughter, was found to be in partial complex status epilepticus. His seizure disorder had been misdiagnosed, at various times, as a variety of "functional" psychiatric disorders. Despite proper diagnosis and aggressive treatment, management was difficult, being complicated by postictal agitation and confusion, postictal psychosis, and interictal compulsive and paranoid personality features. This case is described, and issues of diagnosis and management in partial complex epilepsy are briefly discussed. The importance of not overlooking organic and especially epileptic factors, despite the presence of prior psychiatric illness, psychologic contributors, and environmental stressors, is emphasized.
Subject(s)
Epilepsy, Temporal Lobe/diagnosis , Laughter , Electroencephalography , Humans , Male , Middle Aged , Status Epilepticus/diagnosisABSTRACT
A 64-year-old woman with major depression developed toxic symptoms while on a regimen of 150 to 200 mg/day of desipramine. Her elimination half-life for desipramine was found to be greatly prolonged, at approximately 150 hours. Her ability to metabolize diphenhydramine and lorazepam was found to be impaired as well. Study of the elimination kinetics of desipramine in three of the patient's sisters provided some support for the existence of a genetically determined metabolic defect. Knowledge of those idiosyncratic pharmacokinetics had important implications for diagnosis and treatment in this case.
