β Scribed by J. Gregory Cairncross
No coin nor oath required. For personal study only.
Transderm-V is a scopolamine-containing plastic disk with an adhesive surface which is placed on the skin behind the ear, where it slowly releases medication into the systemic circulation over a 3-day period, the purpose being to treat motion sickness. Ensuing dryness of the mouth and mild drowsiness are common, but more serious complications are possible.
A 67-year-old woman with chronic atrial fibrillation and hypertension was admitted to the hospital because of subacute nausea, vomiting, dizziness, and gait unsteadiness. She was awake and alert with normal intellectual function and speech. Examination disclosed a 2-cm infiltrating adenocarcinoma of the right breast, and a computed tomographic scan showed enhancing mass lesions in the cerebellar vermis and right cerebral hemisphere. Other laboratory studies were normal. The patient was treated with dexamethasone (16 mg a day) and given Transderm-V (scopolamine 1.5 mg) to alleviate her refractory nausea, vomiting, and dizziness. Three days later she was observed to be agitated, confused, and hallucinating. Blood metabolic indices were normal. She was flushed and had widely dilated, reactive pupils, warm, dry skin, and tachycardia, with a pulse of 100 per minute. A presumptive diagnosis of scopolamine intoxication was made, the disk was removed, and the psychosis gradually subsided over 24 to 36 hours. The dose of dexamethasone was not
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The outcome of delusional depression is generally considered as poor when compared to non-delusional depression. We examined the social adjustment of remitted subjects affected by delusional compared to non-delusional mood disorder. Social adjustment of 135 inpatients (81 delusional and 54 non-delus