Transient trazodone-induced hypomanic symptoms occurred in three depressed patients. Trazodone therapy was continued or reinstated shortly after the hypomanic episode without further evidence of hypomania.

A woman with a mental handicap developed SLE. This magnified the level of her handicap, and because of her difficulties in giving a history, mildly abnormal results of tests in any one system were dismissed over long periods of time. This resulted in very late diagnosis of a potentially treatable disease.

In the development and management of a steroid-induced stupor, in a 17–year-old man, the dose and route of administration of steroid medication were felt to be important aetioiogical factors. A co-ordinated plan of management involving the physician, surgeon and psychiatrist is needed in such cases.

British Journal of Psychiatry (1991), 158, 125–127

A patient given bismuth nitrate in the recommended dose range over 16 months developed panic attacks and a major depressive syndrome and, after 15 months, a myoclonic encephalopathy resembling Creutzfeldt–Jakob disease. He recovered four months after bismuth had been discontinued. Bismuth preparations are becoming popular in the treatment of gastritis; close attention to neurological and psychiatric symptoms seems mandatory.

Hypersexuality and fetishism appeared in a patient with multiple sclerosis whose MRI scan showed frontal and temporal lesions. The hypersexuality may have been the presenting symptom of the multiple sclerosis.

Erotomanic delusions occurred in a depressed mentally handicapped woman. Although erotomania is generally classified with paranoid disorders, in people with mental handicap, depression may be the more commonly associated illness.

British Journal of Psychiatry (1991), 158, 127–129