CNS Drugs

, Volume 9, Issue 1, pp 41–57 | Cite as

Drug- Induced Behavioural Disinhibition

Incidence, Mechanisms and Therapeutic Implications
  • Alyson J. BondEmail author
Adverse Effects


Behavioural disinhibition implies the loss of restraint over some form of social behaviour. Such disinhibition can be drug induced and, on rare occasions, lead to extreme acts of aggression or violence. Examples of behavioural disinhibition are often considered paradoxical and rare reactions to drugs, but they may in fact be a more severe behavioural manifestation of a general effect that the drug has on emotions and behaviour. However, the incidence of drug-induced behavioural disinhibition varies considerably and cannot be estimated accurately, as accounts stem mainly from case reports rather than from controlled clinical trials. Adverse effects of drugs are rarely, if ever, the sole focus of clinical studies, although they are now monitored more rigorously in controlled trials.

There are numerous anecdotal case reports in the literature of behavioural disinhibition occurring during administration of benzodiazepines, and recent controlled trials have addressed this issue. The incidence varies with the population studied, but tends to be higher in patients with pre-existing poor impulse control. Alcohol (ethanol) potentiates the disinhibiting effect of benzodiazepines. Aberrant forms of disinhibited behaviour may be accompanied by memory loss.

Disinhibition has also been reported after treatment with tricyclic antidepressants, and reports are now appearing that describe disinhibition in patients who have been treated with selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors. These include incidents of akathisia, suicidal urges, agitation, hyperactivity and mania. They are more prevalent in children and those with learning disabilities.

Disinhibition is rare with antipsychotics and non-benzodiazepine anticonvulsants but some isolated case reports contain descriptions of such reactions with newer compounds.

The most important drug variable in drug-induced behavioural disinhibition is dosage, although mode of administration is also important. Discontinuation of the drug is usually expected to resolve behavioural reactions, but in certain cases drug withdrawal may precipitate a reaction. In order to minimise drug-induced behavioural disinhibition, it is essential to always use the minimum dosage necessary, to increase the dosage gradually and to monitor the effects carefully. Multiple drug use should be avoided whenever possible.


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  1. 1.
    Room R, Collins G, editors. Alcohol and disinhibition: nature and meaning of the link. NIAAA Research Monograph No. 12, DHSS Publications No. (ADM) 83-1246. Washington DC: Government Printing Office, 1983Google Scholar
  2. 2.
    Jeavons CM, Taylor SP. The control of alcohol-related aggression: redirecting the inebriate’s attention to socially appropriate conduct. Aggress Behav 1985; 11: 93–101Google Scholar
  3. 3.
    Kukopulos A, Reginaldi D, Ladomada P, et al. Course of the manic-depressive cycle and changes caused by treatments. Pharmakopsychiatr Neuropsychopharmakol 1980; 13: 156–67PubMedGoogle Scholar
  4. 4.
    Schou M. Is there a lithium withdrawal syndrome? An examination of the evidence. Br J Psychiatry 1993; 163: 514–8PubMedGoogle Scholar
  5. 5.
    Gorenstein EE, Newman JP. Disinhibitory psychopathology: a new perspective and a model for research. Psychol Rev 1980; 87: 301–15PubMedGoogle Scholar
  6. 6.
    Gray JA. Elements of a two-process theory of learning. New York: Academic Press, 1975Google Scholar
  7. 7.
    Gray JA. The psychology of fear and stress. 2nd ed. New York: Cambridge University Press, 1987Google Scholar
  8. 8.
    Gray JA. The neuropsychology of anxiety. Br J Psychol 1978; 69: 417–34PubMedGoogle Scholar
  9. 9.
    Patterson CM, Newman JP. Reflectivity and learning from aversive events: toward a psychological mechanism for the syndromes of disinhibition. Psychol Rev 1993; 100: 716–36PubMedGoogle Scholar
  10. 10.
    Megargee EI. Undercontrolled and overcontrolled personality types in extreme antisocial aggression. Psychol Monogr 1966; 80(3): 1–29PubMedGoogle Scholar
  11. 11.
    Tyrer P. The benzodiazepine bonanza. Lancet 1974; I: 709–10Google Scholar
  12. 12.
    Lader M. Benzodiazepines — the opium of the masses. Neuroscience 1978; 3: 159–65PubMedGoogle Scholar
  13. 13.
    The sudden withdrawal of triazolam — reasons and consequences. Drug Ther Bull 1991; 29: 89–90Google Scholar
  14. 14.
    Seivewright NA, Dougal W. Benzodiazepine misuse. Curr Opin Psychiatry 1992; 5: 408–11Google Scholar
  15. 15.
    Bond A, Seijas D, Dawling S, et al. Systemic absorption and abuse liability of snorted flunitrazepam. Addiction 1994; 89: 821–30PubMedGoogle Scholar
  16. 16.
    Griffiths RR, McCleod DR, Bigelow GE, et al. Relative abuse liability of diazepam and oxazepam: behavioural and subjective dose effects. Psychopharmacology 1984; 84: 147–54PubMedGoogle Scholar
  17. 17.
    Hindmarch I, Fairweather DB, Rombaut N. Adverse events after triazolam substitution [letter]. Lancet 1993; 341: 55PubMedGoogle Scholar
  18. 18.
    Rothschild AJ, Bessette MP, Carter-Campbell J. Triazolam and disinhibition [letter]. Lancet 1993; 341: 186PubMedGoogle Scholar
  19. 19.
    Adam K, Oswald I. Can a rapidly-eliminated hypnotic cause daytime anxiety? Pharmacopsychiatry 1989; 22: 115–9PubMedGoogle Scholar
  20. 20.
    Kochansky GE, Salzman C, Shader RI, et al. The differential effects of chlordiazepoxide and oxazepam on hostility in a small group setting. Am J Psychiatry 1975; 132: 861–3PubMedGoogle Scholar
  21. 21.
    Bond A, Lader M. Differential effects of oxazepam and lorazepam on aggressive responding. Psychopharmacology 1988; 95: 369–73PubMedGoogle Scholar
  22. 22.
    Rothschild AJ. Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature. J Clin Psychiatry 1992; 53 Suppl.: 69–79PubMedGoogle Scholar
  23. 23.
    Regestein QR, Reich P. Agitation observed during treatment with newer hypnotic drugs. J Clin Psychiatry 1985; 46: 280–3PubMedGoogle Scholar
  24. 24.
    Dietch JT, Jennings RK. Aggressive dyscontrol in patients treated with benzodiazepines. J Clin Psychiatry 1988; 49:184–8PubMedGoogle Scholar
  25. 25.
    Hall RCW, Zisook S. Paradoxical reactions to benzodiazepines. Br J Clin Pharmacol 1981; 11 Suppl.: 45–9Google Scholar
  26. 26.
    Fava M, Borofsky GF. Sexual disinhibition during treatment with a benzodiazepine: a case report. Int J Psychiatry Med 1991; 21: 99–104PubMedGoogle Scholar
  27. 27.
    Fiset L, Milgrom P, Beirne OR. Disinhibition of behaviors with midazolam: report of a case. J Oral Maxillofac Surg 1992; 50: 645–9PubMedGoogle Scholar
  28. 28.
    Reiter S, Kutcher SP. Disinhibition and anger outbursts in adolescents treated with clonazepam [letter]. J Clin Psychopharmacol 1991; 11: 268PubMedGoogle Scholar
  29. 29.
    French AP. Dangerously aggressive behavior as a side effect of alprazolam [letter]. Am J Psychiatry 1989; 146: 276PubMedGoogle Scholar
  30. 30.
    Terrell HB. Behavioural dyscontrol associated with combined use of alprazolam and ethanol [letter]. Am J Psychiatry 1988; 145:1313PubMedGoogle Scholar
  31. 31.
    Medawarn C, Rassaby E. Triazolam overdose, alcohol, and manslaughter. Lancet 1991; 339: 1515–6Google Scholar
  32. 32.
    Garza-Trevino ES, Overall JE, Hollister LE, et al. Disinhibition after lorazepam augmentation of antipsychotic medication [letter]. Am J Psychiatry 1991; 148: 1099–100Google Scholar
  33. 33.
    Little JD, Taghavi EH. Disinhibition after lorazepam augmentation of antipsychotic medication [letter]. Am J Psychiatry 1991; 148: 1099PubMedGoogle Scholar
  34. 34.
    Menkes DB. Triazolam-induced nocturnal bingeing with amnesia. Aust NZ J Psychiatry 1992; 26: 320–1Google Scholar
  35. 35.
    Joseph AB, Wroblewski BA. Paradoxical akathisia caused by clonazepam, clorazepate and lorazepam in patients with traumatic encephalopathy and seizure disorders: a subtype of benzodiazepine-induced disinhibition. Behav Neural 1993; 6: 221–3Google Scholar
  36. 36.
    Wolf P. Forced normalization. In: Trimble MR, Bolwig TG, editors. Aspects of epilepsy and psychiatry. Chichester: John Wiley, 1986: 101–15Google Scholar
  37. 37.
    Trimble MR, Cull CA. Antiepileptic drugs, cognitive function and behavior in children. Cleve Clin J Med 1989; 56 Suppl. Pt 1: 140–9Google Scholar
  38. 38.
    Rosenbaum JF, Woods SW, Groves JE, et al. Emergence of hostility during alprazolam treatment. Am J Psychiatry 1984; 141: 792–3PubMedGoogle Scholar
  39. 39.
    Pyke RE, Kraus M. Alprazolam in the treatment of panic attack patients with and without major depression. J Clin Psychiatry 1988; 49: 66–8PubMedGoogle Scholar
  40. 40.
    Greenblatt DJ, Shader RI, Divoll M, et al. Adverse reactions to triazolam, flurazepam and placebo in controlled clinical trials. J Clin Psychiatry 1984; 45: 192–5PubMedGoogle Scholar
  41. 41.
    Gardner DL, Cowdry RW. Alprazolam-induced dyscontrol in borderline personality disorder. Am J Psychiatry 1985; 142: 98–100PubMedGoogle Scholar
  42. 42.
    Noyes R, DuPont RL, Pecknold JC. Alprazolam in panic disorder and agoraphobia: results from a multicentre trial. II. Patient acceptance, side effects and safety. Arch Gen Psychiatry 1988; 45: 423–8PubMedGoogle Scholar
  43. 43.
    Cassano GB, Toni C, Petracca A, et al. Adverse effects associated with the short-term treatment of panic disorder with imipramine, alprazolam or placebo. Eur Neuropsychopharmacol 1994; 4: 47–53PubMedGoogle Scholar
  44. 44.
    O’Sullivan GH, Noshirvani H, Basoglu M, et al. Safety and side-effects of alprazolam: controlled study in agoraphobia with panic disorder. Br J Psychiatry 1994; 165: 79–86PubMedGoogle Scholar
  45. 45.
    Lapierre YD, Labelle A. Manic-like reaction induced by lorazepam withdrawal. Can J Psychiatry 1987; 32: 697–8PubMedGoogle Scholar
  46. 46.
    Rigby J, Harvey M, Davies DR. Mania precipitated by benzodiazepine withdrawal. ActaPsychiatr Scand 1989; 79:404–7Google Scholar
  47. 47.
    Ghaziuddin N, Ghaziuddin M. Mania-like reaction induced by benzodiazepine withdrawal in a patient with mental retardation. Can J Psychiatry 1990; 35: 612–3PubMedGoogle Scholar
  48. 48.
    Risse SC, Whitters A, Burke J, et al. Severe withdrawal symptoms after discontinuation of alprazolam in eight patients with combat-induced posttraumatic stress disorder. J Clin Psychiatry 1990; 51: 206–9PubMedGoogle Scholar
  49. 49.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  50. 50.
    Zisook S, De Vaul RA. Adverse behavioral effects of benzodiazepines. J Fam Pract 1977; 5: 963–6PubMedGoogle Scholar
  51. 51.
    Cole JO, Bodkin JA. Antidepressant drug side effects. J Clin Psychiatry 1990; 51 Suppl.: 21–6PubMedGoogle Scholar
  52. 52.
    Zubenko GS, Cohen BM, Lipinski JF. Antidepressant-related akathisia. J Clin Psychopharmacol 1987; 7: 254–7PubMedGoogle Scholar
  53. 53.
    Rampling D. Aggression as paradoxical response to tricyclic antidepressants. Am J Psychiatry 1978; 135: 117–8PubMedGoogle Scholar
  54. 54.
    Edwards G. Antidepressants and murder. Psychiatr Bull 1992; 16: 537–9Google Scholar
  55. 55.
    Wehr TA, Goodwin FK. Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry 1988; 144: 1403–11Google Scholar
  56. 56.
    Kupfer DJ, Carpenter LL, Frank E. Possible role of antidepressants in precipitating mania and hypomania in recurrent depression. Am J Psychiatry 1988; 145: 804–8PubMedGoogle Scholar
  57. 57.
    McElroy SL, Keck PE, Friedman LM. Minimizing and managing antidepressant side effects. J Clin Psychiatry 1995; 56 Suppl.: 49–55PubMedGoogle Scholar
  58. 58.
    Fava GA. Holding on: depression, sensitization by antidepressant drugs, and the prodigal experts. Psychother Psychosom 1995; 64: 57–61PubMedGoogle Scholar
  59. 59.
    Mirin SM, Schatzberg AF, Creasy DE. Hypomania and mania after withdrawal of tricyclic antidepressants. Am J Psychiatry 1981; 138: 87–9PubMedGoogle Scholar
  60. 60.
    Arana GW, Kaplan GB. Trazodone-induced mania following desipramine-induced mania in major depressive disorders [letter]. Am J Psychiatry 1985; 142: 386PubMedGoogle Scholar
  61. 61.
    Rouillon F, Serrurier D, Miller HD, et al. Prophylactic efficacy of maprotiline on unipolar depressive relapse. J Clin Psychiatry 1991; 52: 423–31PubMedGoogle Scholar
  62. 62.
    Himmelhoch JM, Thase ME, Mallinger AG, et al. Tranylcypromine versus imipramine in anergic bipolar depression. Am J Psychiatry 1991; 148: 910–6PubMedGoogle Scholar
  63. 63.
    Edwards JG. Drug choice in depression: selective serotonin reuptake inhibitors or tricyclic antidepressants? CNS Drugs 1995; 4: 141–59Google Scholar
  64. 64.
    Simon GE, VonKorff M, Heiligenstein JH, et al. Initial antidepressant choice in primary care: effectiveness and cost of fluoxetine vs tricyclic antidepressants. JAMA 1996; 275: 1897–902PubMedGoogle Scholar
  65. 65.
    D’Arcy PG. Dystonia and withdrawal symptoms with paroxetine [letter]. Int Pharm J 1993; 7: 140Google Scholar
  66. 66.
    Committee on Safety of Medicines. Medicines Control Agency. Dystonia and withdrawal symptoms with paroxetine. Curr Probl 1993; 19: 1Google Scholar
  67. 67.
    Lejoyeux M, Rouillon F, Ades J, et al. Neural symptoms induced by tricyclic antidepressants: phenomenology and pathophysiology. Acta Psychiatr Scand 1992; 85: 249–56PubMedGoogle Scholar
  68. 68.
    Baldwin D, Fineberg N, Montgomery S. Fluoxetine, fluvoxamine and extrapyramidal tract disorders. Int Clin Psychopharmacol 1991; 6: 51–8PubMedGoogle Scholar
  69. 69.
    Ramos RT, Gentil V, Gorenstein C. Clomipramine and initial worsening in panic disorder: beyond the ‘jitteriness syndrome’. J Psychopharmacol 1993; 7: 265–9PubMedGoogle Scholar
  70. 70.
    Teicher MH, Glod CA, Cole JO. Antidepressant drugs and the emergence of suicidal tendencies. Drug Saf 1993; 8: 186–212PubMedGoogle Scholar
  71. 71.
    Rothschild AJ, Locke CA. Re-exposure to fluoxetine after serious suicide attempts by 3 patients: the role of akathisia. J Clin Psychiatry 1991; 52: 491–3PubMedGoogle Scholar
  72. 72.
    Wirshing WC, VanPutten T, Rosenberg J, et al. Fluoxetine, akathisia and suicidality: is there a causal connection? Arch Gen Psychiatry 1992; 49: 580–1PubMedGoogle Scholar
  73. 73.
    Healy D. The fluoxetine and suicide controversy. CNS Drugs 1994; 1: 223–31Google Scholar
  74. 74.
    Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry 1990; 147: 207–10PubMedGoogle Scholar
  75. 75.
    Beasley CM, Dornseif BE, Bosomworth JC, et al. Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression. BMJ 1991; 303: 685–92PubMedGoogle Scholar
  76. 76.
    Fava M, Rosenbaum JF. Suicidality and fluoxetine: is there a relationship? J Clin Psychiatry 1991; 52: 108–11PubMedGoogle Scholar
  77. 77.
    Detre TP, Jarecki H. Modern psychiatric treatment. Philadelphia: Lippincott, 1971Google Scholar
  78. 78.
    Fava GA. The concept of recovery in affective disorders. Psychother Psychosom 1996; 65: 2–13PubMedGoogle Scholar
  79. 79.
    King RA, Riddle MA, Chappell PB, et al. Emergence of self destructive phenomena in children and adolescents during fluoxetine treatment. J Am Acad Child Adolesc Psychiatry 1991; 30: 179–86PubMedGoogle Scholar
  80. 80.
    Masand P, Gupta S, Dewan M. Suicidal ideation related to fluoxetine treatment [letter]. N Engl J Med 1991; 324: 420PubMedGoogle Scholar
  81. 81.
    Creaney W, Murray I, Healy D. Antidepressant-induced suicidal ideation. Hum Psychopharmacol 1991; 6: 329–32Google Scholar
  82. 82.
    Grounds D, Stocky A, Evans P, et al. Antidepressants and side effects. Aust NZ J Psychiatry 1995; 29: 156–7Google Scholar
  83. 83.
    Troisi AE, Vicario F, Nuccetelli N, et al. Effects of fluoxetine in aggressive behavior of adult inpatients with mental retardation and epilepsy. Pharmacopsychiatry 1995; 28: 73–6PubMedGoogle Scholar
  84. 84.
    Lebegue B. Mania precipitated by fluoxetine [letter]. Am J Psychiatry 1987; 144: 1620PubMedGoogle Scholar
  85. 85.
    Bryois C, Ferrero F. Mania induced by citalopram. Arch Gen Psychiatry 1994; 51: 664–5PubMedGoogle Scholar
  86. 86.
    Hon D, Preskorn SH. Mania during fluoxetine treatment for recurrent depression. Am J Psychiatry 1989; 146: 1638–9PubMedGoogle Scholar
  87. 87.
    Laporta M, Chouinard G, Goldbloom D, et al. Hypomania induced by sertraline, a new serotonin reuptake inhibitor. Am J Psychiatry 1987; 144: 1513–4PubMedGoogle Scholar
  88. 88.
    Burrai C, Bocchetta A, Del Zompo M. Mania and fluvoxamine. Am J Psychiatry 1991; 148: 1263–4PubMedGoogle Scholar
  89. 89.
    Turner SM, Jacob RG, Beidel DC, et al. Fluoxetine treatment of obsessive-compulsive disorder. J Clin Psychopharmacol 1985; 5: 207–12PubMedGoogle Scholar
  90. 90.
    Diaferia G, Mundo E, Bianchi Y. Behavioral side effects in obsessive-compulsive patients treated with fluvoxamine: a clinical description. J Clin Psychopharmacol 1994; 14: 78–9PubMedGoogle Scholar
  91. 91.
    DeVane CL, Sallee FR. Serotonin selective reuptake inhibitors in child and adolescent psychopharmacology: a review of published experience. J Clin Psychiatry 1996; 57: 55–66Google Scholar
  92. 92.
    Gammon GD, Brown TE. Fluoxetine and methylphenidate in combination for treatment of attention deficit disorder and comorbid depressive disorder. J Child Adolesc Psychopharmacol 1993; 3: 1–10PubMedGoogle Scholar
  93. 93.
    Simeon J, Dinicola V, Phil M, et al. Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsych Biol Psychiatry 1990; 14: 791–5Google Scholar
  94. 94.
    Jain U, Birmaher B, Garcia M, et al. Fluoxetine in children and adolescents with mood disorders: a chart review of efficacy and adverse effects. J Child Adolesc Psychopharmacol 1992; 2: 259–65PubMedGoogle Scholar
  95. 95.
    Riddle MA, King RA, Hardin MT, et al. Behavioral side effects of fluoxetine in children and adolescents. J Child Adolesc Psychopharmacol 1991; 1: 193–8Google Scholar
  96. 96.
    Cook Jr EH, Rowlett R, Jaselskis C, et al. Fluoxetine treatment of children and adults with autistic disorder and mental retardation. J Am Acad Child Adolesc Psychiatry 1992; 31:739–45PubMedGoogle Scholar
  97. 97.
    Boulos C, Kutcher S, Gardner D, et al. An open naturalistic trial of fluoxetine in adolescents and young adults with treatment-resistant major depression. J Child Adolesc Psychopharmacol 1992; 2: 103–11PubMedGoogle Scholar
  98. 98.
    Riddle MA, Scahill L, King RA, et al. Double-blind trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1992; 31: 1062–9PubMedGoogle Scholar
  99. 99.
    Jerome L. Hypomania with fluoxetine. J Am Acad Child Adolesc Psychiatry 1991; 30: 850–1PubMedGoogle Scholar
  100. 100.
    Achamallah NS, Decker DH. Mania induced by fluoxetine in an adolescent patient [letter]. Am J Psychiatry 1991; 148:1404PubMedGoogle Scholar
  101. 101.
    Jafri AB, Greenberg WM. Fluoxetine side effects [letter]. J Am Acad Child Adolesc Psychiatry 1991; 30: 852PubMedGoogle Scholar
  102. 102.
    Venkataraman S, Naylor MW, King CA. Mania associated with fluoxetine treatment in adolescents. J Am Acad Child Adolesc Psychiatry 1992; 31: 276–81Google Scholar
  103. 103.
    Rosenberg DR, Johnson K, Sahl R. Evolving mania in an adolescent treatment with low-dose fluoxetine. J Child Adolesc Psychopharmacol 1992; 2: 299–306PubMedGoogle Scholar
  104. 104.
    Ghaziuddin M. Mania induced by sertraline in a prepubertal child [letter]. Am J Psychiatry 1994; 151: 944PubMedGoogle Scholar
  105. 105.
    Joffe RT, Schuller DR. An open study of buspirone augmentation of serotonin reuptake inhibitors in refractory depression. J Clin Psychiatry 1993; 54: 269–71PubMedGoogle Scholar
  106. 106.
    Lebert F, Pasquier F, Goudemand M. Euphoria with buspirone after fluoxetine treatment [letter]. Am J Psychiatry 1993; 150: 167PubMedGoogle Scholar
  107. 107.
    Fawcett J, Marcus RN, Anton SF, et al. Response of anxiety and agitation symptoms during nefazodone treatment of major depression. J Clin Psychiatry 1995; 56 Suppl.: 37–42PubMedGoogle Scholar
  108. 108.
    Jeffries JJ, Al-Jeshi A. Nefazodone-induced mania [letter]. Can J Psychiatry 1995; 40: 218PubMedGoogle Scholar
  109. 109.
    Shammi C. Antidepressant-induced mania. Can J Psychiatry 1995; 40: 635–6PubMedGoogle Scholar
  110. 110.
    Smith B, Prockop DJ. Central nervous system effects of ingestion of L-tryptophan by normal subjects. N Engl J Med 1962; 267: 1338–41PubMedGoogle Scholar
  111. 111.
    Egan GP, Hammad GEM. Sexual disinhibition with L-tryptophan [letter]. BMJ 1976; 2: 701PubMedGoogle Scholar
  112. 112.
    Greenwood MH, Friedel J, Bond AJ, et al. The acute effects of intravenous infusion of L-tryptophan in normal subjects. Clin Pharmacol Ther 1974; 16: 455–64PubMedGoogle Scholar
  113. 113.
    Rodenburg M, Sheldon L, Owen JA. Sexual disinhibition with L-tryptophan. Can J Psychiatry 1992; 37: 666–7PubMedGoogle Scholar
  114. 114.
    Livingston M. Risperidone: a novel drug for schizophrenia. Prescriber 1993; 5: 19–25Google Scholar
  115. 115.
    Dwight MM, Keck Jr PE, Stanton SP, et al. Antidepressant activity and mania associated with risperidone treatment of schizoaffective disorder. Lancet 1994; 344: 554–5PubMedGoogle Scholar
  116. 116.
    O’Croinin F, Zibin T, Holt L. Re: hypomania associated with risperidone [letter]. Can J Psychiatry 1995; 40: 51PubMedGoogle Scholar
  117. 117.
    Koek RJ, Kessler CC. Probable induction of mania by risperidone. J Clin Psychiatry 1996; 57: 174–5PubMedGoogle Scholar
  118. 118.
    Jones H. Risperidone: a review of its pharmacology and use in the treatment of schizophrenia. J Serotonin Res 1997; 4:17–28Google Scholar
  119. 119.
    Short C, Cooke L. Hypomania induced by gabapentin. Br J Psychiatry 1995; 166: 679–80PubMedGoogle Scholar
  120. 120.
    Pakalnis A, Drake Jr ME, John K, et al. Forced normalization: acute psychosis after seizure control in seven patients. Arch Neurol 1987; 44: 289–92PubMedGoogle Scholar
  121. 121.
    Scull DA, Trimble MR. Mania precipitated by carbamazepine withdrawal [letter]. Br J Psychiatry 1995; 167: 698PubMedGoogle Scholar
  122. 122.
    Depue RA, Spoont MR. Conceptualizing a serotonin trait: a behavioural dimension of constraint. Ann NY Acad Sci 1986; 487: 47–62PubMedGoogle Scholar
  123. 123.
    Spoont MR. Modulatory role of serotonin in neural information processing: implications for human psychopathology. Psychol Bull 1992; 112: 330–50PubMedGoogle Scholar
  124. 124.
    Friedman JH. Punding on levodopa. Biol Psychiatry 1994; 36: 350–1PubMedGoogle Scholar
  125. 125.
    Lejoyeux M, Ades J, Rouillon F. Serotonin syndrome: incidence, symptoms and treatment. CNS Drugs 1994; 2: 132–43Google Scholar
  126. 126.
    Cain JW. Poor response to fluoxetine: underlying depression, serotonergic overstimulation, or a ‘therapeutic window’? J Clin Psychiatry 1992; 53: 272–7PubMedGoogle Scholar
  127. 127.
    Norman TR, Leonard BE. Fast-acting antidepressants: can the need be met? CNS Drugs 1994; 2: 120–31Google Scholar
  128. 128.
    Lieberherr S, Scollo-Lavizzari G, Battegay R. Confusional states following administration of short-acting benzodiazepines. Schweiz Rundsch Med Prax 1991; 80: 673–5PubMedGoogle Scholar
  129. 129.
    Phelan MC.Beclomethasone mania. Br J Psychiatry 1989; 155: 871–2Google Scholar
  130. 130.
    Martin W, Unlautzer J, Szuba MR Exacerbation of psychosis associated with inhaled albuterol. J Clin Psychopharmacol 1995; 15: 446–7PubMedGoogle Scholar
  131. 131.
    Pensabeni-Jasper T, Panush RS. Corticosteroid usage: observations at a community hospital. Am J Med Sci 1996; 311:234–9PubMedGoogle Scholar
  132. 132.
    Lasher TA, Fleishaker JC, Steenwuk RC, et al. Pharmacokinetic and pharmacodynamic evaluation of the combined administration of alprazolam and fluoxetine. Psychopharmacology 1991; 104: 323–7PubMedGoogle Scholar
  133. 133.
    Berry M. Criminal behavior following drug treatment for psychiatric disorders: medicolegal and ethical issues. CNS Drugs 1994; 2(4): 301–12Google Scholar
  134. 134.
    Stein G. Physical treatments of the personality disorders. Curr Opin Psychiatry 1994; 7: 129–36Google Scholar

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© Adis International Limited 1998

Authors and Affiliations

  1. 1.Section of Clinical Psychopharmacology, Department of Psychiatry, Institute of PsychiatryUniversity of LondonLondonEngland

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