Persistent psychosis after abuse of high dose of zolpidem.

BACKGROUND: Zolpidem is a non-benzodiazepine medication which selectively affects GABA A receptors and treats insomnia. There are numerous reports of psychosis following the consumption of zolpidem all of which recovered after stopping the medication. CASE REPORT: A 27 year old male law student, who was treated with 10 mg zolpidem due to insomnia, increased the dosage to 500 mg during 3 months. Not only was his insomnia remained untreated, but also he gradually became isolated, suspicious, and aggressive, and dropped out of university. He was then hospitalized in a psychiatric ward for 2 months, and was treated with antipsychotics and gradual discontinuation of zolpidem. With no improvement in psychosis and sleep improvement he was discharged. After two weeks he was hospitalized again and went under electroconvulsive therapy (ECT) and antipsychotic therapy, and was discharged with relative improvement. Now, after three years, he is diagnosed with schizophrenia and with modest improvements he is under care and treatment. CONCLUSION: Zolpidem is a fairly useful medication for treating sleep problems, especially improving beginning of sleep. However, physicians ýand clinicians should consider the conditions, predispositions, and personal and family history of types of psychosis, alcohol and drug abuse in the comprehensive assessment and treatment plan for patients with insomnia.

Smoking intensity and its relation to general health of the students of kerman university of medical sciences, iran.

BACKGROUND: Considering the need for a better understanding of smoking among the student population and its impact on their mental health and their success, this study was conducted in Kerman Medical Sciences University. METHODS: This cross-sectional study on 772 students, chosen by random sampling, was conducted in 2007. Subjects were assessed with 28-question questionnaires that included demographic questions, questions about smoking, fagerstrom nicotine dependence test, and a general health questionnaire (GHQ). FINDINGS: The prevalence of smoking was 15. 8%. Records of failing in high school and conditional failures of a university semester in smokers were significantly higher than non-smokers. The average scores of the mental health questionnaires showed a significant difference between smokers and non-smokers (P < 0.001). Based on the results, 35.2% of smokers and 5.9% of non-smokers had mental illnesses. CONCLUSION: Since cigarette dependence in teens and youth are significantly high and failures in education and mental health disorders are more common among them, it is necessary that the authorities pay more attention to the social skill training and timely diagnosis of mental disorders.

Rare variant of lycanthropy and ecstasy.

BACKGROUND: Lycanthropy is an unusual belief or delusion in which the patient thinks that he/she has been transformed into an animal. In rare cases, the patient believes that another person has been transformed into an animal. CASE REPORT: We report a patient with an uncommon variant of lycanthropy is introduced. The symptoms appeared after consumption of ecstasy. This shows the occurrences of uncommon and rare psychosis after ecstasy drug use especially in patients susceptible to schizophrenia. Ecstasy drug can induce paranoid psychosis similar to schizophrenia. In the presented case, ecstasy seemed to have a role in patient's underlying susceptibility to schizophrenia.

Psychosis following Tramadol Withdrawal.

BACKGROUND: Tramadol is a centrally acting opioid analgesic used to treat moderate to sever pain. It has more advantage and less opioid adverse effects than conventional opioid analgesia. CASE REPORT: This article reports a patient with tramadol dependency that had psychosis after tramadol withdrawal. CONCLUSION: By the increase of tramadol usage for relief of chronic pain, tramadol abuse and dependency is increased. Some of tramadol withdrawal symptoms are not related to opioid, for example when the effectiveness is not only on opioid receptors, but on catecholamine and serotonin receptors. So, together with typical symptoms of withdrawal, atypical symptomes had been reported. Psychosis is one of tramadol atypical withdrawal symptoms which subsided a few days after suppression of withdrawal symptoms. In such cases, the diagnosis is substance withdrawal instead of psychotic disorder due to substance withdrawal and treatment is based on this diagnosis.