A 74 year old woman became progressively confused and developed visual hallucinations and delusions over a six day period, after the institution of routine oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. The medication was discontinued, and a marked improvement was noted 36 hours later. There was a complete return to normal mental functioning 60 hours after therapy was discontinued. The relationship between the patient's symptoms with the initiation and discontinuation of the medication suggests that the drug had a causal effect.
The diagnosis of manic depressive or bipolar disease is difficult in adolescents. Poorly defined nosology, and a high incidence of schizophrenia-like symptoms contribute to this difficulty. The authors discuss the use of the Dexamethasone Suppression Test (DST) in the diagnosis of bipolar disease in adolescents, presenting three case studies. The existence of phase-dependent DST non-suppression is described for the first time in adolescents.
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