Drug-induced illness

Stetler, C.J., Drug-induced illness (letter), JAMA, 229, 1043-1044, 1974. 

Most drug-induced illness comes about through one of four mechanisms (a) poor prescribing decisions by physicians, despite the availability of clear evidence (b) errors in dispensing or administration... 

One useful approach to tackle this problem of drug-induced illness caused by bad prescribing is known as academic detailing , in which a trained health professional meets with the physician in his or her office and functions as a source of neutral, academically oriented, evidence-based knowledge (see www.RxFacts.org). 

There are many other examples of such a systems approach to reducing drug-induced illness caused by this kind of error. 

Systemic lupus erythematosus and rheumatoid arthritis The possible role of interferon alfa in the development of rheumatoid arthritis or systemic lupus erythematosus has been described in isolated cases (363,364), and confirmed cases of systemic lupus erythematosus have very occasionally been reported (SED-13, 1096) (SEDA-20, 330). In most of these cases, the predominance of young patients and female sex, the presence of renal or skin involvement, the findings of positive antibodies to double-stranded DNA, and the rapid onset after the start of treatment, as well as persistence of symptoms after interferon alfa withdrawal, are more in keeping with unmasking by interferon alfa of idiopathic lupus rather than with a new drug-induced illness. The reactivation or appearance of inflammatory rheumatological disorders consistent with rheumatoid arthritis or lupus-like polyarthritis were... 

The ADR Monitoring Unit was officially announced by the Ministry of Health and put into operation on 2 January 1993. The main objective of the Unit is to collate ADR reports from doctors and pharmacists on a nationwide basis for analysis and further investigation, and for submission to the WHO Collaborating Centre, Sweden, for International Monitoring. These reports are captured in a computer database, analysed and presented to the Ministry s Medicines Advisory Committee for discussion. The ultimate aim is to prevent drug-induced illnesses both locally and internationally and for the licensing authority to take quick action when necessary. 

Jick H, Vessey MP. Case-control smdies in the evaluation of drug-induced illness. Am J Epidemiol 1978 107 1-7. 

For drug-induced illnesses which show the same features whether they occur with or without the heightening effect of a drug (type b situations Table 4), JiCK (1977) has proposed the following schedule ... 

The problem of drug-induced illness is defined in these papers by the magnitude of two risks the added risk of illness experienced by users of a drug, and the baseline risk in the absence of the drug. 

Caranasos, G. J., Stewart, R. B., and Cluff, L. E. Drug-Induced Illness Leading to Hospitalization. the American Medical Association, 1974, 228(f), 713-717. 

Wazny LD, Ariano RE. Evaluation and management of drug-induced thrombocytopenia in the acutely ill patient. Pharmacotherapy 2000 20(3) 292-307. 

The term psychotomimetic was coined to compare the effects of hallucinogens to the symptoms of schizophrenia and other psychotic conditions. However, the effects produced by hallucinogens and mental illness are qualitatively different. While drug-induced hallucinations tend to be more visual, auditory hallucinations are most common in schizophrenia. The hallucinogenic drugs discussed here may induce positive symptoms (e.g., hallucinations), but do not induce the negative symptoms (e.g., cognitive deficits, social withdrawal) of schizophrenia. 

Antidepressants do not prevent relapses into mania and may even precipitate a manic phase. For these reasons, a mood stabilizer (with or without concomitant antidepressants) is the prophylaxis of choice for bipolar depressions. If there is a reasonable hint of bipolarity (e.g., a family history of bipolar illness, a prior hypomanic episode, or drug-induced hypomania), a mood stabilizer should be considered (see Chapter 10 for more detailed discussion). 

During the first half of the twentieth century, subjective experience— both natural and drug-induced—was declared off limits to psychology. The 1953 discovery of REM sleep opened the door to a reconsideration of dreaming and other naturally altered states of consciousness that occurred in mental illness. This discovery coincided with a rise in amateur experimentation with drugs that altered waking consciousness. 

This chapter will describe some of the most common, reversible, drug-induced neurological reactions acute dystonia acute akathisia parkinsonism and a broad, ill-defined category called dysphoria. All of them tend to begin early in treatment but can start later on as well. Chapters 4 and 5 will review the sometimes delayed and often persistent adverse reactions, including irreversible forms of akathisia and dystonia. 

Tardive dystonia can make an individual appear unsympathetic or bizarre, especially to the uninformed observer, who equates the facial grimaces or neck distortions with being crazy. As in all the drug-induced dyskinesias, the individual may try to cover up the disorder with additional movements that make the disorder seem voluntary and therefore not a product of mental illness. The result can be very confusing and even distressing to the observer. I have read several medical records in which... 

I want to reemphasize that drug-induced disturbances in mood or in behavior should be viewed as genuine neurological disorders rather than as vague mental illnesses. The capacity of speculative biochemical imbalances or genetic factors to cause or contribute to mania or depression remains unproven. Nor do we know the specific biochemical or neurological mechanisms whereby psychoactive substances cause mental disturbances. But the capacity for psychoactive substances to disrupt brain function and hence mental function is beyond dispute. Furthermore, a great deal of empirical data confirm their capacity to cause disinhibition, mania, depression, and other mental phenomena associated with violence toward oneself and others, as well as other destructive behaviors. 

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