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ObjectiveWe present a case of psychosis in an individual with known HIV infection whose symptoms developed approximately 1 month following the commencement of combination antiretroviral therapy consisting of abacavir (ABC), nevirapine and combivir. She presented with severe persecutory delusions, accompanied by mutism, posturing and catatonia. Following cessation of therapy and the introduction of a low-dose antipsychotic, her mental state resolved to a stable premorbid level, and no further disturbances of behaviour were noted. Furthermore, when re-challenged with the above combination minus ABC, there were no further episodes of psychosis. It is proposed that the aetiology of the psychosis was related to her antiretroviral therapy. MethodsCessation of antiretroviral medication and initiation of antipsychotic medication with appropriate monitoring and assessment. ResultsSubjective and objective improvements in psychotic symptoms and presentation. ConclusionThe current case suggests that sudden onset psychotic disturbances in HIV-infected individuals in the absence of other known organic or other causal factors could be related to treatment with antiretroviral therapy, and that cessation of this can markedly improve psychiatric morbidity. Furthermore, treatment with antipsychotic medication can lead to alleviation of psychotic symptoms and enable the re-introduction of antiretroviral medication.

In order to establish any psychotropic effects of the angiotensin-converting enzyme inhibitor enalapril, the drug was administered in doses of 20 mg every morning for 14 days to 12 normal subjects, and compared with placebo on a battery of physiological, psychological and subjective tests, before and after the dose on the 1st and 14th days. Diastolic blood pressure was significantly reduced and heart-rate increased by enalapril as compared with placebo; one component (P1-N1) of the auditory evoked EEG response was increased and tapping rate quickened. The commonest side effect was tiredness. It was concluded that enalapril (unlike most other antihypertensive agents) did not lower mood but could enhance attention and alertness.

SynopsisDepression following withdrawal from long- or short-term use of benzodiazepines is not uncommon, yet it is under-reported in the benzodiazepine withdrawal literature. Four cases of depressive illness supervening during benzodiazepine withdrawal are reported. Depression may, it is suggested, be an integral part of the benzodiazepine withdrawal syndrome.

Priapism is a urological emergency defined as persistent penile erection that is unrelated to sexual stimulation and typically involving only the corporal cavernosa. It can occur as a rare side effect of antipsychotic medications and is mediated via their α-adrenergic antagonist effect. In this paper we describe a case of priapism in a patient started on risperidone and sodium valproate. We also review the South London and Maudsley Case Register Interactive Search database to assess how many other cases of priapism were reported in patients taking risperidone. We add this information to a literature review of cases of priapism associated with risperidone.