Faculty Bibliography

The fluoroquinolone ciprofloxacin is among the most frequently prescribed antibiotics. As a class, the fluoroquinolones are an under-recognized cause of drug-induced neuropsychiatric effects, with cases reported of psychotic reactions to ciprofloxacin both orally and topically in the form of eye drops. A newer fluoroquinolone, gatifloxacin, has also been associated with delirium and psychosis. The following is the first published report of ciprofloxacin-induced mania

Non-nucleoside reverse transcriptase inhibitors such as zidovudine, didanosine, lamivudine, and stavudine have all been associated with precipitating mania. Presents a case report of abacavir sulfate-induced mania in a 47-year-old man infected with human immunodeficiency virus (HIV).

Aripiprazole is an atypical neuroleptic indicated for the treatment of schizophrenia and acute manic and mixed episodes associated with bipolar disorder. A potent dopamine partial agonist, aripiprazole acts as an antagonist at dopamine (D)2 receptors under hyperdopaminergic conditions and as a D2 agonist under hypodopaminergic conditions. It has been theorized that dopamine partial agonists may be able to stabilize the dopaminergic system without inducing a hypodopaminergic state, thereby reducing the risk of side effects associated with pure blockade of 'dopamine receptors. In addition to these effects, aripiprazole also acts as a partial agonist at serotonin (5-HT)-sub(1A) and as an antagonist at 5-HT-sub(2A) receptors. Aripiprazole has a low incidence of clinically significant weight gain and hyperlipidemia.

Pica, defined as the ingestion of nonfood items, likely represents a form of obsessive-compulsive disorder (OCD). Predisposing factors include developmental disabilities, seizure disorders, depression, and OCD. Medication treatments for pica include selective serotonin reuptake inhibitors, tricyclic antidepressants, carbamazepine, and haloperidol. The following is a report on the successful use of the aminoketone norepinephrine and dopamine reuptake inhibitor, bupropion, for the treatment of chronic, persistent, severe nicotine-craving pica in a developmentally disabled adult. (journal abstract)

Rabbit syndrome is characterized by involuntary, rapid, fine, rhythmic vertical movements of the perioral muscles resembling the chewing movements of a rabbit. It usually occurs after long-term treatment with antipsychotics, including atypicals such as risperidone. Historically, rabbit syndrome has been reported with a variety of neuroleptic agents but not with other classes of psychotropic medications. Usually, patients with rabbit syndrome manifest other Parkinsonian signs such as rigidity, bradykinesia, or tremor. Methylphenidate is a psychostimulant agent that blocks catecholamine reuptake and directly stimulates the release of dopamine and norepinephrine. The following is the first published report of rabbit syndrome in association with the use of methylphenidate in an 8-year-old male with attention-deficit/hyperactivity disorder (ADHD). (journal abstract)

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.

Attention-deficit/hyperactivity disorder (ADHD), once considered to be a childhood disorder, is diagnosed in -7 million adults in the United States, as reported by The National Comorbidity Study. Although it is now recognized that ADHD often persists into adulthood, the current diagnostic criteria is geared toward symptom identification in children. Symptoms of inattention, impulsivity, and hyperactivity evolve over the life cycle and present differently in adults. Further complicating diagnosis is that ADHD is associated with multiple functional impairments and comorbid psychiatric disorders. The Multi-Modal Treatment Study of ADHD reported that only 32% of the study population had ADHD alone; 29% had ADHD plus oppositional defiant disorder and/or conduct disorder, 14% had ADHD plus anxiety or depression, and 25% had all three disorders. Optimal treatment utilizes a multimodal approach including behavioral treatments combined with pharmacologic treatment strategies. Food and Drug Administration-approved medications for ADHD include the stimulants and nonstimulants, although tricyclic antidepressants and bupropion are also commonly used. In this monograph, Craig L. Donnelly, MD, reviews the history of ADHD and discusses the pathophysiologic progression of childhood symptoms into those commonly exhibited by adults. Next, Frederick W. Reimherr, MD, reviews comorbidity of ADHD and describes the Utah Criteria as a method of diagnosing adults through recollection of childhood problems. Finally, Joel L. Young, MD, reviews treatment approaches to adult ADHD and its comorbid conditions. (journal abstract)