Suicidal and homicidal behaviors related to dextromethorphan abuse in a middle-aged woman.

Over-the-counter medications available without prescriptions are generally viewed safe for public consumption. However, when used in excess, these medications can lead to adverse consequences. There are multiple over-the-counter medications that have potential for abuse, and dextromethorphan is one such drug. We describe a case of a middle-aged woman who presented to the psychiatric emergency service after recent use of excessive amounts of dextromethorphan. The patient had developed severe psychotic symptoms and had attempted to kill both herself and her relative. This case highlights the importance of careful reviewing of both prescribed and nonprescribed medications that are being used by patients, especially in the emergency care setting.

Coma falsely attributed to Lyme disease.

Neuroborreliosis has very low prevalence in Kentucky and coma due to Lyme disease is uncommon in North America. A patient diagnosed with Lyme disease in Kentucky, based on coma, typical inflammatory changes on brain imaging, and a positive ELISA resulted in an erroneous clinical impression. Diagnosis should have been confirmed by a positive result on Western Blot, polymerase chain reaction (PCR), or real-time polymerase chain reaction (RT-PCR) testing. Physicians must apply careful consideration before diagnosing a rare disease in areas where that condition is uncommon without first eliminating other differential options. Neuroborreliosis clinicalfindings are nonspecific and often require confirmatory testing, especially in nonclassical case presentations.