Delusional states

AMPHETAMINE PSYCHOSIS A delusional state of mind caused by severe amphetamine abuse. Paranoia, hallucinations, and unfounded feelings of persecution are common features. 

DSM-IV has abandoned the terms paranoia and paraphrenia and replaced them with the term delusional disorder to describe non-affective and non-bizarre delusional states. 

Neuroleptics have been the group of drugs most widely recommended for delusional states. Of the first-generation neuroleptics, the sedative, cognitive impairing and extrapyramidal side effects are likely to be particularly prominent in the elderly. The introduction of the atypical neuroleptics should improve the treatment of these disorders as they are generally better tolerated due to their improved side-effect profile. 

Within 1-2 h of exposure to BZ, there is mydriasis, dry mouth and skin, tachycardia, drowsiness, and after about 4 h, CNS anticholinergic effects develop, including a confusional state with delusions, hallucinations, erratic behavior pattern, and interference with cognitive functions that include problem solving, attention, and comprehension. These effects may persist for several days, during which time the subject is susceptible to injury. Memory for this period of confusion may be lost or be fragmentary. The induced delusional state makes it questionable whether BZ should be used in hostage situations. 

Psychiatric A 62-year-old woman treated with oral oseltamivir for HlNl influenza A infection developed acute delusional state after three days of treatment, which required short-term antipsychotic therapy. Symptoms improved after completing 10 days of treatment [350 ]. 

The absence of a history of psychosis and the re-emer-gence of delusional thinking when venlafaxine was prescribed again suggest that venlafaxine played a role in producing this psychotic state. At high doses venlafaxine... 

Like the range of colors seen in a prism, manic depression or bipolar disorder has a spectrum from which psychiatrists make their diagnosis. One of the factors they examine is whether the person is in a depressed, manic, or hypomanic state. A hypomanic state is one in which a person experiences a more controlled mania. The person may become excessively active and feel elated, but does not become disorganized or delusional. People with these symptoms may be cyclothymic, that is they exhibit periods of depression and mania, but for shorter and less intense durations. 

Major depression and bipolar illness (the subject of chapter 6) can, if extremely severe, manifest psychotic symptoms. Typically, the hallucinations and delusions seen in psychotic mood disorders are said to be "mood congruent," which means that the themes of these symptoms are congruent with the dominant mood. For example, a psychotically depressed patient might have delusions that she is the most disgusting or evil person in the world and should be executed. This delusional belief embodies the depressive themes of extremely low self-esteem and guilt. Compare this to schizophrenic symptoms, which most often are bizarre and unconnected to a dominant mood state, for example, the anxious man who believes a radio transmitter has been implanted in his thumb so that neighbors can hear broadcasts of his inner thoughts. 

EXTENSIONS AND COMMENTARY There is a thread of disconnection and of inconsistent reference that pervades most of the reports that I have received concerning the use of DOPR. The word that comes to mind is hypnogogic. There is a drifting into that place that lies between a not-quite-awake and a not-quite-asleep state seems to characterize this compound. There is no question but that it is very potent, and that it is very long-lived. But there is a nagging suggestion of the out-of-body, out-of-center character that is the hallmark of the anesthetic and delusional drugs such as scopolamine or ketamine. With them, the psychedelic effects become clouded with touches of amnesia. 

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