Serotonin syndrome and fluvoxamine: a case study.

OBJECTIVE: To report a serotonin syndrome reaction in a patient taking fluvoxamine to replace an earlier SSRI agent. CASE REPORT: A female patient with Obsessive Compulsive Disorder on paroxetine after resurgence in her obsessive ruminations was started on fluvoxamine 50 mg daily. One week later she became suicidal and was hospitalized. The fluvoxamine was increased to 50 mg morning and 100 mg bedtime and the paroxetine was discontinued. Over the next few days she began to have trouble with her concentration. A low grade fever set in after she experienced auditory hallucinations. Fluvoxamine was discontinued and she had an uneventful recovery after twenty-four hours. DISCUSSION: Fluvoxamine is a recently approved serotonin selective reuptake inhibitor (SSRI) with few side effect profiles. It is effective in the treatment of Depressive Disorder and Obsessive Compulsive Disorder and is used to potentiate or replace other anti-OCD drugs including already available serotonin specific reuptake inhibitors (SSRI). We wish to draw attention to the potential for serotonin syndrome in patients on fluvoxamine who may have previously been on other SSRIs.

Psychiatric referral pattern in a burn center.

Patients with burn injuries have unique psychologic problems that frequently require psychiatric care. However, little research has been done on specific patterns of psychiatric referral in burn units. This article addresses the pattern of psychiatric referral for 28 patients over a period of 1 year in a regional burn treatment center. Demographics and characteristics of the patient population are summarized, and reasons for psychiatric referral are noted.

Psychotherapy with wives of sexual deviants.

The authors presents three case histories of wives of sexual deviants--two pedophilics and one exhibitionist. Each of these women felt responsible for the deviance of her husband and attempted to control her husband's acts through sexual activity. The authors suggest that these women derived some psychologic gain through the deviant acts of their husbands, having remained with these men during trying times. The ego defense mechanisms utilized by them included denial, intellectualization, isolation of affect and undoing. The wife is recognized as an integral part of the dynamic system involving the man, and as such, the necessity for her participation in the treatment is recognized. By encouraging change in the wives, a measure of change could be induced in their husbands. Myths about these women fitting a stereotype of cold, sexually unresponsive persons, as described in the literature and by their spouses, were not substantiated.

Neuropsychiatric studies of drinkers of denatured alcohol.

The literature on denatured alcohol drinking includes substantial reports on the toxicological aspects of the experimental studies and on acute poisoning of denatured alcohol. However, there is scant mention of the alcoholic's use of denatured alcohol as an alternate source to sustain his addictive habit. We have been repeatedly impressed by reports of consumption of denatured alcohol in histories given by chronic alcoholics. By definition, a drinker of denatured alcohol is a person who, over a period of time, drinks any preparation of rectified spirits which has been denatured for domestic, industrial, or medical use (see Table I). Common denaturants used are methyl alcohol, gasoline, benzene, chloroform, pyridine, and naphthalene, in combination or individually. (see Table I-Glossary). This study was lndertaken to explore the damage, mainly to the central nervous system, caused by the denaturants. Ten cases were studied for neuropsychiatric pathology resulting from drinking denatured alcohol. The duration of their drinking this substance varied from two months to eighteen months. From the clinical data, a personality profile is drawn of these individuals. There is a high incidence of toxicity to the central nervous system of an irreversible nature as well as to the respiratory system. Psychometric tests can be helpful in early detection (with prophylaxis) of damage caused to the higher cerebral process.