Vol 5 n° 2 - Psychiatric disorders in somatic medicine
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sychiatric side effects (PSEs) can be induced by the pharmacological treatment of physical illnesses. The clinical presentation of PSEs often resembles sponta- neous psychiatric syndromes (ie, noniatrogenic, naturally occurring diseases). PSEs can occur at usual doses, in cases of intoxication, or during the days following with- drawal of a given treatment. PSEs range from short-last- ing anxiety to severe confusion, and alleged cases of sui- cide have even been reported. The Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition (DSM-IV)1 defines some dozens of cate- gories of PSE, according to the disorder and to the incrim- inated substance, eg,“persisting dementia induced by seda- tives, hypnotics or anxiolytics.” The DSM-IV categories include drugs for therapeutic purposes, medication taken abusively,   and   other   substances.   The   International Classification of Diseases2 is very similar to DSM-IV in its categorization, with minor differences in terms of category codes. The challenge of PSEs in everyday practice is the diffi- culty in recognizing these frequent and potentially dan- gerous situations. The diagnosis of PSEs raises the same questions  as  the  diagnosis  of  any  psychiatric  sign  or symptom, which means that the clinician has to consider a rather long list of differential diagnoses. The following concepts refer to PSEs, as well as to other kinds of side effects: • Exposure: The period of time the patient received the drug suspected of inducing a side effect. • Dechallenge: The interruption of the suspected med- ication, regardless of the remission of adverse effects. Positive dechallenge means that remission was tempo- rally associated with the interruption of medication. • Rechallenge:The reintroduction of the suspected drug. Positive rechallenge means that symptom reappearance was temporally associated with suspected drug rein- troduction. P h a r m a c o l o g i c a l   a s p e c t s 1 5 5 Psychiatric side effects of medications prescribed in internal medicine Rodrigo Casagrande Tango, MD P Several pharmacological treatments used in internal med- icine can induce psychiatric side effects (PSEs) that mimic diagnoses seen in psychiatry. PSEs may occur upon with- drawal  or  intoxication,  and  also  at  usual  therapeutic doses. Drugs that may lead to depressive, anxious, or psy- chotic syndromes include corticosteroids, isotretinoin, levo- dopa, mefloquine, interferon- , and anabolic steroids, as well as some over-the-counter medications. PSEs are often difficult to diagnose and can be very harmful to patients. PSEs are discussed in this review, as well as diagnostic clues to facilitate their identification. Dialogues Clin Neurosci. 2003;5:155-165. Keywords: adverse effect; psychiatry; mechanism; risk factor; diagnosis; meflo- quine; chloroquine; metronidazole; isotretinoin; interferon; steroid; -blocker Author   affiliations:   Unité   de   Psychopharmacologie   Clinique,   Hôpitaux Universitaires de Genève, Chêne-Bourg, Switzerland Address  for  correspondence:   Unité  de  Psychopharmacologie  Clinique,  2, chemin du Petit Bel-Air 1225 Chêne-Bourg, Switzerland
(e-mail: rctango@web.de)