Paranoid psychosis after abuse of Actifed.

H1-Receptor Antagonists

“…Occasionally, stimulatory effects such as insomnia, hyperreflexia, irritability, excitement, headaches, muscle twitching, nervousness, tremor, dyskinesia, dystonia and seizures may occur (Bailie et al 1987;Davis 1976;Favis 1976;Gott 1968;King & Weeks 1965;Krenzelok et al 1982;Lavenstein & Cantor 1976;Lee et al 1975;Lewith & Davidson 1981;Magera et al 1981 ;McMahon 1986;Thach Drug Safety 10 (5) 1994Wyngaarden & Seevers 1951). Neuropsychiatric effects such as anxiety, confusion, impaired mental efficiency, impairment judgement, depression, delusions, hallucinations and even psychoses have been reported (Baehr et al 1986;Berger et al 1977;Borman 1947;Dollberg et al 1989;Gott 1968;Jones et al 1986;Leighton 1982;Nigro 1968;Richmond & Seger 1986;Roman 1972;Sachs 1948;Schipior 1967). Peripheral nervous system adverse effects such as areflexia, paralysis, paraesthesias, and toxic neuritis have also been noted (Douglas 1980;Meltzer 1990;Wyngaarden & Seevers 1951).…”

Cervical smears: new terminology and new demands.

“…Endoscopists have reported that endoscopy is better than radiology,' radiologists that radiology is better than endoscopy,2 surgeons that an early operation reduces mortality,3 and physicians that an early operation increases mortality. 4 We must therefore look closely at a claim from an Australian hospitalthat setting up a special multidisciplinary unit reduced mortality from acute upper gastrointestinal bleeding from 15% -to 6% ma few years. 5 Mortality in patients admitted to hospital with acute upper gastrointestinal bleeding has remained fairly constant at around 10% over the past 40 years, although the proportion of elderly patients has increased enormously.6 As many as two thirds of patients are now over 60, and a quarter over 80.7…”

Dextromethorphan Abuse Leading to Assault, Suicide, or Homicide

“…Co‐ingestion of dextromethorphan with other drugs present in cough and cold preparations may add to the general level of impairment and intoxication. Pseudoephedrine has stimulant properties and has specifically been noted as having caused paranoid psychotic states in high overdose (10,11). Chlorpheniramine and diphenhydramine are antihistamines with largely central nervous system depressant activity, which may add to the overall level of sedation.…”