Alan Byrne

Psychiatric and neurological effects of chronic solvent abuse

This study is a review of the psychiatric and neurological effects of solvent inhalation on a group of 22 patients with chronic histories of solvent abuse, primarily toluene-based solvents. The findings suggest that the chronic inhalation of toluene-based adhesives can produce a paranoid psychosis which may persist. Other findings were a high incidence of temporal lobe epilepsy and decrease in IQ. We suggest that the psychiatric and neurological sequelae of chronic solvent abuse are serious and potentially irreversible. Toluene is felt to be a major factor in the morbidity associated with chronic solvent abuse, and attention is drawn to the necessity for educational programs in this area. The burden caused by the resulting psychiatric problems resulting from solvent abuse may have implications for health care budgets.

DEPRESSION ASSOCIATED WITH ISOTRETINOIN THERAPY

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ISOTRETINOIN THERAPY AND DEPRESSION - EVIDENCE FOR AN ASSOCIATION

Objectives: The object of this paper is to evaluate the evidence suggesting an association between the use of the anti-acne agent isotretinoin and the subsequent development of depression. Method: Three case histories of individuals who had received treatment with isotretinoin and subsequently developed depression are reviewed. Results: All three individuals were noted to have a depressive illness which was notable by the prominence of symptoms of irritability, agitation and aggression. Conclusions: The indications from the three cases described suggest that there appears to be an association between depression and the recent use of isotretinoin. This may relate to the ability of isotretinoin to simulate hypovitaminosis A, with aggression, irritability and depression as a direct result of this effect. Young males may be particularly prone to developing this response.

Regression of thyrotoxic ophthalmopathy following lithium withdrawal.

The case of a bipolar patient who developed thyrotoxicosis with severe exophthalmos while on lithium therapy is described. The patient had required two surgical decompressions of the right orbit to relieve pressure, which occurred secondary to progression of the exophthalmos, and was scheduled for further surgery. Lithium therapy was discontinued because of poor compliance to the medication and intolerable polyuria. The exophthalmos improved dramatically within 72 hours of the withdrawal of lithium. A severe form of exophthalmos resulting from lithium therapy has not been described in the literature. The case described here adds to the body of information about the possible causes of thyrotoxic ophthalmopathy.

Transient neurogenic stuttering

The occurrence of a transient neurogenic stutter in a male anorexic patient is described. The stutter developed following a prolonged period of starvation, and during refeeding the patient recovered from the stuttering behavior. The patient was not receiving any drugs known to cause stuttering, and it is postulated that the stutter developed as a result of the gross impairment of brain function secondary to chronic starvation. A review of the literature has failed to reveal any information on anorexia nervosa as a cause of neurogenic (acquired) stuttering.

Severe hypotension associated with combined lithium and chlorpromazine therapy: a case report and a review.

The case of a patient who developed a severe hypotensive reaction with a persistent hemianaesthesia following the addition of lithium carbonate to her treatment regimen is described. The patient had been receiving chlorpromazine therapy for the management of hypomania and the addition of lithium carbonate to the chlorpromazine produced a severe hypotensive episode which compromised her neurological functioning. Only three doses of lithium carbonate had actually been taken by the patient. This type of hypotensive response associated with the simultaneous use of chlorpromazine and lithium has not previously been noted in the literature.