Recurrent autumnal psychosis

Abstract

Acute confusional states in the older patient often have a remediable cause. Every effort should be made to ascertain the cause so that appropriate treatment can be given and future episodes prevented. A patient is described who presented with recurrent episodes of acute psychosis after ingestion of Atropa belladonna (deadly nightshade).A 70 year old Asian woman with a previous history of "schizophreniform" disorder was admitted with a 24 hour history of confusion associated with inability to concentrate, visual hallucinations, delusions, inappropriate laughter, dizziness, and headache. There was no fever, ear discharge, skin rash, herpetic eruption, or any reported change in medication recently. The patient had been diagnosed with recurrent psychosis on account of three such episodes in the preceding three years; each episode had lasted several days. On examination she was disorientated in time, place, and person. She was afebrile, tachycardic, and her pupils were dilated. Both fundi were normal and signs of meningeal irritation were absent. Routine full blood count, renal and liver function tests, urine dipstick, urine and blood cultures, chest radiography, electrocardiography, and cerebrospinal fluid examination (on two separate occasions) were unremarkable. Computed tomography of the brain, viral and bacterial studies of blood, and cerebrospinal fluid were negative. The symptoms were confirmed to be due to ingestion of berries, which the patient's daughter brought in the next day. The berries grew on a wild shrub close to the patient's residence (fig 1). As on previous occasions the symptoms had followed ingestion of similar berries in the autumn months. The berries were identified as Atropa belladonna or "deadly nightshade". Chemical analysis of her blood and the berries identified high concentrations of L-atropine, DL-hyoscynamine, and hyoscine. Over the next 48 hours she gradually improved with supportive treatment and had returned to normal by the fourth day of her hospital admission. The public health department was duly informed about the presence of the shrubs.

Toxic Plants: Knowledge, Medicinal Uses and Potential Human Health Risks

“…In more severe cases, physostigmine can be administered. [5,6] Due to its hallucinogenic effects, this plant is also used for recreational purposes. In Europe, during the Middle Ages, this plant was widely used for the production of ointments for the practice of witchcraft, and it is also associated with prophecies and divinations due to the fact that hallucinations can be understood and confused with reality.…”

Three Geriatric Patients Presenting with Atropa Belladonna (Deadly Nightshade) Poisoning within 5 Days

“…Bitkinin meyve ve yaprakları yüksek oranda atropin, skopalamin ve hyosiyamin alkaloidlerini içerir (1). Bu bitkiler alındığında, yapısında bulunan alkaloidler, postganglionik muskarinik parasempatik reseptörleri ve merkezi sinir sisteminde bulunan muskarinik reseptörleri kompetitif bloke ederek, ATS'ye yol açarlar (2,3). Bu gibi vakalar akut serebrovasküler olay ile karışabileceği için klinik muayane ve görüntüleme yöntemleri kadar detaylı anamnez alınması hayat kurtarıcı olacaktır.…”

Atropa Belladonna (Deadly Nightshade) Poisoning in Chilhood

“…AB alkaloids lead to anticholinergic syndrome by competitively blocking the postganglionic muscarinic receptors and the binding site of acetylcholine in the central nervous system (3,(7)(8)(9). Due to the fact that children are more sensitive to the alkaloids, a very small amount can lead to serious symptoms of poisoning and death (10).…”