(I have written about this experience in a vague and slightly disguised form with
the permission of the individual about whom I am writing.)

Day 1:

Patient, a male in his mid-twenties, woke up feeling nauseous.  He was also
sweating and feeling extremely hot, even though it wasn't all that hot, and even
after taking a cool shower.  He began to feel anxious, restless, "shaky," and
disoriented as well, and he reports having experienced visual and auditory
illusions (e.g., "tracers").  He had a headache as well, which is unusual for him
(he says he has only mild allergies).  He also said that his toes, fingers, and
scalp, and the left side of his face, were tingling.  His respirations were rapid
and shallow.  

He took Compazine 5mg for the nausea, then went out and attempted to have
something bland to eat.  When he was outside he noticed that his surroundings
seemed "unreal" or unfamiliar.  He also experienced what he believes to have been
hysterical aphonia (i.e., he could not speak, and he felt that it was probably
"because I was so anxious;" he relates his anxiety to the headache, nausea,
paresthesias, illusions, etc. that he was experiencing, which of course made him
very uncomfortable).

That evening, he threw up (in a public place) and was taken to a hospital
emergency room.  While in the hospital, he threw up a second time (although this
time, he made it to a bathroom).  Most of his other symptoms persisted for the
remainder of the evening, although he felt only mildly queasy after vomiting the
second time.

While he was waiting to be seen at the hospital, he began to feel extremely
restless.  He says that he was writing down every thought he had, and that this
produced copious notes, some of which later seemed irrelevant and even
incoherent.  He did not show his notes to anyone.  He later began to scratch his
head "compulsively" (it did not itch).  This excoriation produced no bleeding.

His {*filter*} pressure was noted to be fluctuating between quite low and moderately
high.  His EKG was normal.  The doctor examining him noted that his pupils were
quite dilated, but he denied taking {*filter*}.  (His urine and {*filter*} had tested
negative for {*filter*}.)

He appeared to be rational, although somewhat overstimulated.  He was quite
friendly and open, and he seemed to place his trust in the hospital staff,
although he was troubled by what seemed to be happening to him.  At the time, I
felt that the hospital staff were overly concerned about his mental status:
although he was quite distractible and his short-term memory was somewhat
impaired, he was alert and oriented and seemed to be thinking quite clearly.  I
expected that the next day he would be doing better and could be discharged.

Day 2:

The next day I learned that the patient had become {*filter*} the previous evening
after I had left.  I was thoroughly suprised by this; he had seemed like an
exuberant but harmless and clear-thinking person who was able to take gracefully
comments that seemed to me to be insulting or condescending.

At that point the patient was sedated and in restraints.  I was told that he had
deteriorated into a state of total disorientation late the previous night, and
that he had {*filter*}ed one of the nurses.

After he woke it became apparent that, while his mood state was still somewhat
hypomanic, his psychomotor agitation had dissipated.  He was no longer
experiencing the paresthesias, illusions, headache, and nausea of the previous
day, although he did feel at least as "shaky" as he had the day before.  He had
several obvious bruises which were presumably from his struggle with the hospital
security guards the night before; he did not have any obvious open wounds.  He
did not recall anything about the {*filter*} episode, although he did not seem too
troubled by it (or anything else).  He said he could not pin down a specific last
thing he remembered, although it became clear that he did remember much of what
had happened, including feeling sick when he woke up, being taken to the
hospital, and some of his experiences at the hospital.

The doctor assigned to him at the hospital wanted to put him on a mood
stabilizer, which he refused.  He did agree to take something to help him sleep.

So, what do you think happened (and why)?

(This is not a trick question!)

-elizabeth
(remove spamblock to reply)

--
Carey Gregory

anyone who remotely agrees with the above should not be a doctor. you are a consumer and most prolly a female consumer
who has had your illnesses discounted easily.

--

   Need to Know what makes Rosaphilia Tick?
click on: http://www.***.com/ ~rugosa/index.html
      Better Living Thru Better Living

1)  "Temp{*filter*}Lobe" epilepsy most likely:   Aruras,  hallucinations of the
special senses, automatisms (often picking at the clothes-  scratching the
scalp not too different), hypergraphia, memory problems post-ictally,
derealization.  That's  practically a laundry list of TLE symptoms.  Further,
the compazine lowers seizure threshold!   maybe your friend shoulda accepted
the mood stabilizer,  especially if the drug was tegretol or depakote (both
good for said seizures, especially the teg.)

Other ideas:  hyperthyroidism, pheochromocytoma, carcinoid, cooking.net">food poisoning, MS,
demonic posession.

-Bolt

Two speculations:

Seizure disorder? (e.g. continuous partial epilepsy,aka TLE aka
psychomotor seizure)  If so, might respond to tegretol or valproate??

"Migraine equivalent"?  May or may not involve actual headache, but
might be more llikely in person with migraine history (personal or
familial)--cf. "confusional migraine", etc.  If so, might respond to
dihydroergotamine (better than Cafergot, I hear), or perhaps
Sumatriptin (latter newer, more agressively marketed, but other with
longer and perhaps better track record?  Used IV in difficult cases).

Not an expert, but to me more of the symptoms seem consonant with
migraine equivalent than with seizure.

F. LeFever
New York Neuropsychlogy Group

--
Jonathan R. Fox, M.D.

The time frame did make me wonder about the possibility of intoxication.  The
patient remained hypomanic for several days after the episode, though.  The
amnestic episode with {*filter*} behaviour doesn't seem to fit with any drug of
which I am aware, though.

I didn't get to look at this patient's labs, but I am naturally curious, even
though LSD would not show up.  (I'm not sure if 5-HIAA CSF levels are an accurage
guage of serotonin toxicity, but in any case they didn't do anything like that.)

-elizabeth
(remove spamblock to reply, or reply to newsgroups)

[snipped more symptoms suggestive of a panic attack]

[snipped]

The amnesia again suggests that delirium was the cause of the change in
his mental state. The underlying cause of this is unclear. Many
illnesses can cause delirium, some of which were mentioned by other
repies.

Interesting story. How about some feedback if anything turns up?

BTW, did you know that delirium literally means, from Latin, "out of
one's furrow"?

--

-e

It's amusing to me that you suggested ergot alkaloids, because a "zebra" that
someone came up with for this was ergot poisoning!

-elizabeth

The guy had eaten a bagel and cream cheese for breakfast, from a reasonably
reputable local cafe.  It doesn't seem likely they were laced with something.
Also, the fact that the symptoms were occurring when he woke up but not when he
went to bed the night before, given the fairly rapid onset of action of common
hallucinogens, seems to cast doubt on this thought.

The time frame was around 15 hours (it might have been longer had he not been
sedated) - a little long for LSD but not unreasonably so.  It did seem odd that
he was at his worst about 14 hours after waking - isn't the pattern with LSD and
other hallucinogens that the "trip" reaches its zenith around 2 hours after
ingestion?

Is there _any_ screen that detects LSD?  (Would mescaline have shown up as
amphetamine?)

Another thing I wondered about was whether he might have taken a less common drug
(e.g., scopolamine).

Oh, there's one thing I forgot to mention that might be important.  The patient
was on Effexor, an antidepressant, which was withdrawn gradually subsequent to
this episode.  He had been taking it for some time.

-elizabeth

|The time frame was around 15 hours (it might have been longer had he not been
|sedated) - a little long for LSD but not unreasonably so.  It did seem odd that
|he was at his worst about 14 hours after waking - isn't the pattern with LSD and
|other hallucinogens that the "trip" reaches its zenith around 2 hours after
|ingestion?
|
|Is there _any_ screen that detects LSD?  (Would mescaline have shown up as
|amphetamine?)
|
|Another thing I wondered about was whether he might have taken a less common drug
|(e.g., scopolamine).

I when I first started reading this thread I thought it was LSD, but 14 is
a bit long.  

When you mentioned scopolamine you made me think of some two {*filter*}.  Both
of the are readily availible, Jimson Weed (Datura Stramonium I believe) is
a common flowering house plant.  I believe it is anticholinergic.

Another possibility is Nutmeg.  Nutmeg really messes you up, and it takes
a long time for it to take effect.  

here is a reference:

+ MACMILLAN DICTIONARY OF TOXICOLOGY:

  myristicin
    A naturally occurring methylenedioxyphenyl compound found in
    nutmeg. It has been suggested that myristicin may be
    responsible, in whole or in part, for the toxicity of nutmeg.
    The spice (5-15g) causes symptoms similar to atropine
    poisoning: flushing of skin, tachycardia, absence of
    salivation, and excitation of the central nervous system.
    Euphoria and hallucinations have given rise to abuse of this
    material. As a methylenedioxyphenyl compound, myristicin
    gives rise to a type III spectrum with reduced cytochrome
    P-450 and can inhibit monooxygenations catalyzed by this
    cytochrome. See also AMPHETAMINES; CYTOCHROME P-450, OPTICAL
    DIFFERENCE SPECTRA; HALLUCINOGENS.

My vote is that he was too scared to say that he had tried something
stupid, like one of the above.

-------------
  "you can not wake a man who is pretending to be asleep"