A personal story of psychosis 7 days after surgery
Karen Kieve, the 26 year old daughter of the founder of 'APRIL' slipped into postoperative paranoia, leading to a psychotic episode, exactly 7 days after for surgery for the removal of impacted wisdom teeth.
The Dental Surgeon wrote on his notes "This poor girl slipped into paranoia, probably due to the surgery". She was not taking any other medication at the time.
Karen had, seven years previously, experienced adverse reactions to sulphasalazine for a bowel disorder and just one year prior to the surgery, become depressed due to Dianette (cyproterone acetate plus ethynlestradiol) a hormone drug. She had recovered and was, at the time of the surgery, enjoying a challenging and stimulating job.
A personal assistant to the director of a public relations company, in the city of London, Karen was happy, loved her work and was leading a full and sociable life.
Sadly, due to the adverse reaction, she was admitted to a psychiatric hospital and when her boss found out the nature of her post-operative problem, her employment was terminated.
List from the anaethetist, of the drugs used before, during and after the surgery:
Pre-med: Temazepam 20 mg
Anaesthesia:
Fentanyl 50 mcg
Propofol 180 mg
Gallamine 20 mg
Suxamethonium 75 mg
Nitrous Oxide, Oxygen, EnfluraneOther intra- and postoperative drugs:
Benzylpenicillin 600 mg
Flagyl 500 mg
Dexamethazone 8mg + 8mg
Depomedrone 40mg
Codis 2 + 2 tablets
Case of violent behaviour following surgery
It has been brought to our attention that a person who became violent following surgery was suffering from liver failure which would exacerbate or even cause adverse reactions due to toxic levels of drugs building up in his body. We are informed that he recovered mentally and physically following a period in Intensive Care. Many people do recover well as long as they are not overdosed with psychotropic drugs.
ICU psychosis - David Aaronovitch
In a BBC interview David Aaronovitch spoke about his terrifying experience of ICU psychosis
Intrusive memories of hallucinations and delusions in traumatized intensive care patients: pdf of interview study
Antibiotic psychosis following surgery
A case in the British Medical Journal mentioned the antibacterial drug Co-amoxiclav a drug one of our contacts believes led to his own psychotic episode following surgery.
Acute psychosis caused by Co-amoxiclav pdf
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2117 (Published 22 October 2008) Cite this as: BMJ 2008;337:a2117
Claire L Bell, specialist trainee , Bruce Watson, senior clinical pharmacist,
W Stephen Waring, consultant physicianCo-amoxiclav is a fixed dose combination of amoxicillin and clavulanate that offers antibacterial activity against some strains that produce β lactamase. Recognised adverse effects include exfoliative dermatitis, deranged liver biochemistry, and anaphylaxis.1 We report the occurrence of acute psychosis after giving co-amoxiclav, with a strong temporal relationship and recurrence after drug rechallenge.
If you have suffered in any way following surgery, there is a problem in reporting this as the MHRA are reluctant to receive reports showing long lists of drugs that may be implicated. The Royal College of Anaesthetists do not colate any information about adverse effects of drugs and anaesthetics used around surgery.
Immediately following surgery the patient was noted as suffering from an altered mental status consistent with delirium. However, nursing notes suggest that her condition was likely the result of anesthesia. At the time of his surgery, the patient had been prescribed a host of significant medications, including anti depressants and other psychoactive drugs. It is believed that the combination of drugs that the patient had been given, combined with the anesthesia, contributed to his development of enduring mental damage following the surgery.
https://www.theexpertinstitute.com/case-studies/patient-suffers-mental-side-effects-from-anesthesia/
However you can report to the FDA or to RxISK
Be aware of interactions with other medicines
Reporting Adverse Drug Reactions (ADRs)
If you have suffered psychiatric adverse reactions please report them. There may be side effects not mentioned on the data sheets. You can request a list of drugs used pre surgery and during surgery. You should be given patient information for all drugs prescribed as you are discharged from hospital.
Please report Adverse Drug Reactions (ADRs) to:
UK Yellow Card Reporting for Patient and Health Professional reports of Adverse Drug Reactions
USA and worldwide to the Food and Drug Administration for Patients and Healthcare Professionals
Universal free, independent drug safety website - Rxisk
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