Psychosis with paranoid delusions after a therapeutic dose of mefloquine

A case report

Tuan  Tran, Joseph Browning, Mary L. Dell

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Convenient once-a-week dosing has made mefloquine a popular choice as malaria prophylaxis for travel to countries with chloroquine-resistant malaria. However, the increased use of mefloquine over the past decade has resulted in reports of rare, but severe, neuropsychiatric adverse reactions, such as anxiety, depression, hallucinations and psychosis. A direct causality between mefloquine and severe reactions among travelers has been partly confounded by factors associated with foreign travel and, in the case of therapeutic doses of mefloquine, the central nervous system manifestations of Plasmodium infection itself. The present case provides a unique natural history of mefloquine-induced neuropsychiatric toxicity and revisits its dose-dependent nature. Case presentation: This report describes an acute exacerbation of neuropsychiatric symptoms after an unwarranted therapeutic dose (1250 mg) of mefloquine in a 37-year-old male previously on a once-a-week prophylactic regimen. Neuropsychiatric symptoms began as dizziness and insomnia of several days duration, which was followed by one week of escalating anxiety and subtle alterations in behaviour. The patient's anxiety culminated into a panic episode with profound sympathetic activation. One week later, he was hospitalized after developing frank psychosis with psychomotor agitation and paranoid delusions. His psychosis remitted with low-dose quetiapine. Conclusion: This report suggests that an overt mefloquine-induced psychosis can be preceded by a prodromal phase of moderate symptoms such as dizziness, insomnia, and generalized anxiety. It is important that physicians advise patients taking mefloquine prophylaxis and their relatives to recognize such symptoms, especially when they are accompanied by abrupt, but subtle, changes in behaviour. Patients with a history of psychiatric illness, however minor, may be at increased risk for a mefloquine-induced neuropsychiatric toxicity. Physicians must explicitly caution patients not to self-medicate with a therapeutic course of mefloquine when a malaria diagnosis has not been confirmed.

Original languageEnglish (US)
Article number74
JournalMalaria Journal
Volume5
DOIs
StatePublished - Aug 23 2006
Externally publishedYes

Fingerprint

Mefloquine
Paranoid Disorders
Delusions
Psychotic Disorders
Malaria
Anxiety
Therapeutics
Sleep Initiation and Maintenance Disorders
Dizziness
Physicians
Psychomotor Agitation
Panic
Hallucinations
Chloroquine
Natural History
Causality
Psychiatry
Central Nervous System
Depression

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Psychosis with paranoid delusions after a therapeutic dose of mefloquine : A case report. / Tran, Tuan ; Browning, Joseph; Dell, Mary L.

In: Malaria Journal, Vol. 5, 74, 23.08.2006.

Research output: Contribution to journalArticle

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