PURPOSE: This retrospective study was conducted to follow out acute intoxications with neuroleptics in Varna region, to assess the frequency and proportion depending on other drug and non-pharmacological poisonings. METHODS: The objects of the study are 193 patients with acute neuroleptic intoxications treated in the Clinic of toxicology of the Military Medical Academy-Varna, Bulgaria. The study is retrospective and covers a period of 20 years (1991-2010). RESULTS: The incidence of acute poisonings with neuroleptics was 7.5% of all drug poisonings and 2.5% of general poisonings. Poisoning occurs more commonly in women and the majority of poisonings were in people of working age. CONCLUSION: In recent years, there is a trend for an increase in the absolute number and the proportion of poisonings with neuroleptics. Lethality in these poisonings is not high-0.4 percent.

Lyme disease is a multi-system disorder caused by the spirochete Borrelia burgdoferi. Eye manifestations are a rare involvement. We report two cases of patients who developed a retrobulbar optic neuritis and a cystoid macular edema as a sole clinical presenting in Lyme disease. A 42-year-old female presented with left eye decreased visual acuity and painful ocular movement. Dilated funduscopy and neurological examination were normal. A diagnosis of left eye retrobulbar optic neuritis was made. The brain and spinal cord MRI showed typical lesions characteristic of MS. Serological tests for Lyme disease revealed positive results for IgM ELISA and Western blot. The possible serologically proven Lyme disease was diagnosed. Visual acuity returned to normal following a course of high-dose steroids and intravenous antibiotic, after by oral antibiotic. A 28-year-old male presented with left eye blurred vision and intermittent blurring vision in his right eye. Dilated funduscopy revealed bilateral cystoid macular edema (left more than right). He was positive for Lyme serology, IgM ELISA and Western blot, and intravenous antibiotic therapy was commenced, followed by oral antibiotic. Visual acuity was restored and fuduscopy was normal. In summary, although Lyme disease is an uncommon cause of these neuro-ophthalmic complications, our two patients highlight the importance of considering this disorder as a differential diagnosis and to initiate an early adequate therapy.

Modern psychiatry with its current classification of diseases and symptom-oriented modern pharmacotherapy ousted the concept of classical German psychiatry genesis of diseases and replaces it with the diagnosis of physiological models of disease. Active participation of the patient in the treatment needs a full understanding of the disease. There are two psychotherapeutic techniques to achieve a new perspective and to develop a new attitude: positive reframing (4) and paradoxical intention (1,3).