Psychoses symptomatic

Typical side effects are constitutional in nature, including a flu-like syndrome within 6 hours after dosing in more than 30% of patients that tends to resolve upon continued administration. Other potential adverse effects include thrombocytopenia, granulocytopenia, elevation in serum aminotransferase levels, induction of autoantibodies, nausea, fatigue, headache, arthralgias, rash, alopecia, anorexia, hypotension, and edema. Severe neuropsychiatric side effects may occur. Absolute contraindications to therapy are psychosis, severe depression, neutropenia, thrombocytopenia, symptomatic heart disease, decompensated cirrhosis, uncontrolled seizures, and a history of organ transplantation (other than liver). Alfa interferons are abortifacient in primates and should not be administered in pregnancy. 

McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller T, et al. 2006. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 163 790-799. 

Daily doses of 1 000 000 pg RE of vitamin A can cause acute symptomatic psychosis, with striking disturbances in the electroencephalogram and pathological changes in the cerebrospinal fluid (677). After withdrawal of vitamin A and administration of low doses of neuroleptic drugs the psychotic symptoms disappeared within a week. 

Haupt R. Akute symptomatische Psychose bei Vitamin A-Intoxikation. [Acute symptomatic psychosis in vitamin A intoxication.] Nervenarzt 1977 48(2) 91-5. 

The clinical effects following overdose depend on the receptor selectivity (alpha and/or beta effect). Most patients require only observation for a period of 4-8 h. Pharmacologic intervention is required only in severely symptomatic patients (cardiac arrhythmias, hypertensive crisis, seizures, hyperthermia). Severe overdose effects may most commonly result in hypertension, tachycardias, followed by bradycardia, and arrhythmias, seizures, cerebral hemorrhages and ischemia or vasoconstriction, psychosis, and hyperthermia. 

Absolute contraindications to use of interferon include current or past psychosis or severe depression, neutropenia or thrombocytopenia, organ transplant (except liver), symptomatic heart disease, decompensated cirrhosis, and uncontrolled seizures. Relative contraindications to interferon include uncontrolled diabetes and autoimmune disorders. 

Be aware that the symptoms of central antimuscarinic psychosis can be confused with the basic psychotic symptoms of the patient. Withdrawal of one or more of the drugs, or a dosage reduction and/or appropriate symptomatic treatment can be used to control these interactions. 

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