Faculty Bibliography

Ciprofloxacin hydrochloride is a fluoroquinolone antimicrobial often used in ophthalmic and general medical practice. The October 2002 'Psychopharmacology Journal Watch' column contained a story on an acute psychotic reaction following the use of ciprofloxacin eyedrops. This article presents a report of hallucinations in a 19-year-old male apparently induced by another fluoroquinolone, gatifloxacin.

While the exact pathophysiology of tinnitus remains unknown, possible causes include cochlear deterioration; an extra-auditory response to respiratory, vascular, or muscular stimuli; a drug reaction; microvascular compression of the eighth cranial nerve; and turbulent flow in the ipsilateral internal carotid artery. Regardless of the cause, tinnitus may result in significant diminution of quality of life. Proposed treatments include retraining therapy, maskers, hyperbaric oxygen, carotid artery stenting, selective cochlear neurotomy, and biofeedback, as well as pharmacotherapy with antidepressants, benzodiazepines, lidocaine, the calcium channel blocker nimodipine, or botulinum toxin. The double-blind, placebo-demonstrates the effectiveness of the selective serotonin reuptake inhibitor (SSRI) sertraline for the treatment of severe tinnitus. The findings support a possible role for sertraline, and likely other SSRIs, for the treatment of refractory tinnitus.

Clonidine is an alpha -sub-2 adrenergic receptor agonist often used for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children. Presented here is a study of hyperprolactinemia and gynecomastia in association with the use of clonidine in a 6-year-old male.

Zonisamide is a synthetic 1,2-benzisoxazole derivative and anticonvulsant that was Food and Drug Administration approved in March 2000 for the treatment of partial seizures in adults. An open-label study and a case report suggest that zonisamide may be beneficial as an anti-manic agent. Other evidence suggests that zonisamide may have therapeutic potential in protecting against ischemic cerebral damage such as stroke. In patients with epilepsy, side effects reported in association with zonisamide include dizziness, headache, kidneys stones, diplopia, altered mental status, and even psychosis. Presented here is a study of zonisamide-induced suicidality in a 34-year-old woman with a 20-year history of complex partial seizures.

Oxcarbazepine, an anticonvulsant medication indicated primarily for partial seizures, neuropathic pain, and trigeminal neuralgia, is also used off-label as a mood stabilizer for the treatment of bipolar disorder. One of the reputed advantages of oxcarbazepine, compared with carbamazepine, is that it is free of hematologic toxicity. The package insert of oxcarbazepine mentions the possibility of thrombocytopenia, but states that the information is derived from uncontrolled and open-label trials and that therefore causality cannot be reliably determined. Presented here is the first published case report of oxcarbazepine- induced thrombocytopenia in an adult. The case is of a 63-year-old Asian-American woman with a history of multiple past psychiatric admissions for psychotic depression, brought to the hospital for increasingly disorganized behavior and paranoid ideation.

The following is a report of clozapine-induced pseudomembranous colitis occurring after 9 years of clozapine therapy. A 38-year-old woman with a 20-year history of organic brain syndrome secondary to chicken pox encephalitis presented with disorganized speech and behavior, aggressive episodes neglect of personal hygiene, and social withdrawal. The patient responded poorly and developed extrapyramidal side effects to various trials of conventional antipsychotics as well as to the atypical antipsychotic risperidone. In 1996, the patient was started on clozapine, which was gradually titrated to a dose of 350 mg/day. Throughout this time, she had no history of upper or lower gastrointestinal complaints. Clozapine was discontinued. Subsequently, the patient has remained psychiatrically stable on a regimen of the substituted benzamide D2 antagonist sulpiride 100 mg/day, sodium valproate 2400 mg/day, and fluvoxamine 25 mg/day. This appears to be the first published case of prolonged administration of clozapine resulting in pseudomembranous colitis, which is a gastrointestinal condition that often occurs without a background of chronic enteric disease and which has previously been associated with the use of antituberculous and antibiotic drugs but not neuroleptics.

Venlafaxine is a serotonin norepinephrine reuptake inhibitor widely used for the treatment of depression, generalized anxiety disorder, and social anxiety disorder, as well as a number of other psychiatric conditions for which serotonergic antidepressants are often employed. Reported side effects for venlafaxine include nausea, somnolence, insomnia, dizziness, constipation, sweating, anorexia, asthenia, nervousness, dose-dependent blood pressure elevation, increased urinary frequency, and sexual dysfunction. The following is a report of venlafaxine-induced rapid and severe edema, otherwise known as anasarca.

Baclofen, the Upsilon -aminobutyric acid (GABA)-sub(B) agonist muscle relaxant, has been commonly used to treat muscle spasms associated with various neurologic conditions including spinal injury, hemi-facial spasm, multiple sclerosis, trigeminal neuralgia, and neuroleptic-induced tardive dyskinesias. The usual dosage ranges from 10-200 mg/day. While baclofen is generally well tolerated, adverse effects are not uncommon, especially when higher doses are used. The following is a report of psychosis associated with use of therapeutic doses of baclofen.