Skip to main content
Log in

Drug-induced Psychiatric Disorders

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Summary

This article is a review of the principal drug-induced psychiatric symptoms that are likely to be encountered in daily clinical practice as a result of drug abuse, overdoses or side effects of drugs prescribed for treatment. Many categories of medication have the potential to produce psychiatric symptoms, but antitubercular drugs, hypotensive agents and steroids have the highest incidence in clinical practice. Additionally, the problems of alcohol are all too frequently overlooked. The variety and frequency of secondary psychiatric symptoms which may be drug-related emphasise the importance of a careful consideration of all drugs taken by a patient with psychiatric complaints, to determine causal association with symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Baker, J.P. and Farley, J.D.: Toxic psychosis following atropine eye drops. British Medical Journal 2: 1390 (1958).

    PubMed  CAS  Google Scholar 

  • Batchelor, I.R.C.: Alcoholism and attempted suicide. Journal of Mental Science 100: 451 (1954).

    PubMed  CAS  Google Scholar 

  • Bauer, G.E.; Croll, F.J.T.; Goldrick, R.B.; Jeremy, D.; Raftos, J.; Whyte, H.M. and Young, A.A.: Guanethidine in the treatment of hypertension. British Medical Journal 2: 410 (1961).

    PubMed  CAS  Google Scholar 

  • Baumblatt, M.J. and Winston, F.: Pyridoxine and the pill. Lancet 1: 832 (1970).

    PubMed  CAS  Google Scholar 

  • Bell, D.S.: Comparison of amphetamine psychosis and schizophrenia. British Journal of Psychiatry 111: 701 (1965).

    PubMed  CAS  Google Scholar 

  • Benedetti, G.: Alkoholhalluzinosen. (Thieme, Stuttgart 1952).

    Google Scholar 

  • Biemond, A.: Wernicke’s encephalopathy and Korsakov’s syndrome. Psychiatric Clinical (Basel) 2: 146 (1969).

    CAS  Google Scholar 

  • Blane, H.T.; Overton, W.F. and Chafetz, M.E.: Social factors in the diagnosis of alcoholism. Quarterly Journal of Studies in Alcohol 26: 640 (1963).

    Google Scholar 

  • Brewer, C. and Perrett, L.: Brain damage due to alcohol consumption — an air-encephalographic, psychometric and electroen-cephalographic study. British Journal of Addiction 66: 170 (1971).

    CAS  Google Scholar 

  • British National Formulary. British Medical Association and the Pharmaceutical Society of Great Britain, pp.132–133 (1981).

  • British Tuberculosis Association: A comparison of prothionamide and ethionamide. Tubercle (London) 49: 25 (1968).

    Google Scholar 

  • Brogden, R.N.; Speight, T.M. and Avery, G.S.: Levodopa: a review of its pharmacological properties and therapeutic uses with particular reference to Parkinsonism. Drugs 2: 262 (1971).

    PubMed  CAS  Google Scholar 

  • Bunney, W.E. and Davis, J.M.: Norepinephrine in depressive reactions. Archives of General Psychiatry 13: 483 (1965).

    PubMed  CAS  Google Scholar 

  • Campbell, A.C.P. and Russell, W.R.: Wernicke’s encephalopathy: their clinical features and their probable relationship to Vitamin B deficiency. Quarterly Journal of Medicine 10: 41 (1941).

    CAS  Google Scholar 

  • Chaturachinda, K. and McGregor, E.M.: Wernicke’s encephalopathy and pregnancy. Journal of Obstetrics and Gynaecology of the British Commonwealth, 75: 969 (1968).

    PubMed  CAS  Google Scholar 

  • Connell, P.H.: Amphetamine Psychosis (Maudsley Monograph No. 5). Institute of Psychiatry, London. Chapman (1958).

    Google Scholar 

  • Crowell, E.B. and Ketchum, J.S.: The treatment of scopolamine induced delirium with physostigmine. Clinical Pharmacology and Therapeutics 8: 409 (1967).

    PubMed  Google Scholar 

  • Curran, F.J.: The symptoms and treatment of barbiturate intoxication and psychosis. American Journal of Psychiatry 95: 73 (1938).

    Google Scholar 

  • Curran, F.J.: Current views on neuropsychiatric effects of barbiturates and bromides. Journal of Nervous and Mental Disease 100: 142 (1944).

    CAS  Google Scholar 

  • Dameshek, W. and Feinsilver, O.: The use of acetyl-beta-methyl choline chloride (mecholyl) as a diagnostic test for poisoning by atropine drugs. Journal of the American Medical Association 109: 561 (1937).

    CAS  Google Scholar 

  • Dollery, C.T.; Enslie-Smith, D. and Milne, M.D.: Clinical and pharmacological studies with guanethidine in the treatment of hypertension. Lancet 2: 381 (1960).

    PubMed  CAS  Google Scholar 

  • Drenick, E.J.; Joven, C.B. and Swendseid, M.E.: Occurrence of acute Wernicke’s encephalopathy during prolonged starvation for the treatment of obesity. New England Journal of Medicine 274: 937 (1966).

    PubMed  CAS  Google Scholar 

  • Duvoisin, R.C. and Katz, R.: Reversal of central anticholinergic syndrome in man by physostigmine. Journal of the American Medical Association 206: 1963 (1968).

    PubMed  CAS  Google Scholar 

  • Eastwood, M.R.; Mindham, R.H.S. and Tennent, T.G.: The physical status of psychiatric emergencies. British Journal of Psychiatry 116: 545 (1970).

    PubMed  CAS  Google Scholar 

  • Enoch, M.D.; Trethowan, W.H. and Barker, J.C.: Some Uncommon Psychiatric Syndromes (John Wright, Bristol 1967).

    Google Scholar 

  • Evanson, J.M. and Sears, H.T.N.: Comparison of bretylium tosylate with guanethidine in the treatment of severe hypertension. Lancet 2: 381 (1960).

    Google Scholar 

  • Forrer, G.R. and Miller, J.J.: Atropine coma: a somatic therapy in psychiatry. American Journal of Psychiatry 115: 455 (1958).

    PubMed  CAS  Google Scholar 

  • Frantzen, E.: Wernicke’s encephalopathy. Three cases in connection with severe malnutrition. Acta Neurologica Scandinavica 42: 426 (1966).

    PubMed  CAS  Google Scholar 

  • Eraser, H.F.; Wikler, A.; Essig, C.F. and Isbell, H.: Degree of physical dependence induced by secobarbital or pentobarbital. Journal of the American Medical Association 166: 126 (1958).

    Google Scholar 

  • Freedman, D.X.: On the use and abuse of LSD. Archives of General Psychiatry 18: 330 (1968).

    PubMed  CAS  Google Scholar 

  • Goodwin, D.W.; Crane, J.B. and Guze, S.B.: Alcoholic blackouts: A review and clinical study of 100 alcoholics. American Journal of Psychiatry 126: 191 (1969a).

    PubMed  CAS  Google Scholar 

  • Goodwin, D.W.; Crane, J.B. and Guze, S.B.: Phenomenological aspects of the alcoholic blackout. British Journal of Psychiatry 115: 1033 (1969b).

    PubMed  CAS  Google Scholar 

  • Glatt, M.: Alcoholism and attempted suicide. British Medical Journal 2: 991 (1954).

    Google Scholar 

  • Glatt, M.: Alcoholism and epilepsy. British Medical Journal 2: 737 (1955).

    Google Scholar 

  • Glick, I.D.: Mood and behavioural changes associated with the use of oral contraceptive agents. A review of the literature. Psychopharmacologia 10: 363 (1967).

    PubMed  CAS  Google Scholar 

  • Granville-Grossman, K.: Recent advances in Clinical Psychiatry. (J. & A. Churchill, London 1971).

    Google Scholar 

  • Green, J.R.: The incidence of alcoholism in patients admitted to medical wards of a public hospital. Medical Journal of Australia 1: 465 (1965).

    PubMed  CAS  Google Scholar 

  • Greenberg, R. and Pearlman, C.: Delirium tremens and dreaming. American Journal of Psychiatry 124: 133 (1967).

    PubMed  CAS  Google Scholar 

  • Griffin, J.P. and D’Arcy, P.F.: in Adverse Drug Interactions, p.XIV (Billing and Sons Ltd, Guildford, London and Worcester, 1979).

    Google Scholar 

  • Gross, M.M. and Goodenough, D.R.: Sleep disturbances in the acute alcoholic psychoses. Psychiatric Reports of the American Psychiatric Association 24: 132 (1968).

    CAS  Google Scholar 

  • Greer, H.D.; Ward, H.P. and Corbin, K.B.: Chronic salicylate intoxication in adults. Journal of the American Medical Association 193: 555 (1965).

    PubMed  Google Scholar 

  • Guttman, E.: The effects of benzedrine on depressive states. Journal of Mental Science 82: 618 (1936).

    Google Scholar 

  • Guttman, E. and Sargent, W.: Observations on benzedrine. British Medical Journal 1: 1013 (1937).

    Google Scholar 

  • Harington, M. and Kincaid-Smith, P.: Psychosis and tremor due to mecamylamine. Lancet 1: 499 (1958).

    PubMed  CAS  Google Scholar 

  • Hoefnagel, D.: Toxic effects of atropine and homatropine eye drops in children. New England Journal of Medicine 264: 168 (1961).

    PubMed  CAS  Google Scholar 

  • Hore, B.D.: Alcohol Dependence (Butterworths, London 1976).

    Google Scholar 

  • Isbell, H.; Altschul, S.; Kornetsky, C.H.; Eisenman, A.J.; Flanary, H.G. and Fraser, H.F.: Chronic barbiturate intoxication. Archives of Neurology and Psychiatry 64: 1 (1950).

    PubMed  CAS  Google Scholar 

  • Isbell, H.; Belleville, R.E.; Fraser, H.F.; Wikler, A. and Logan, C.R.: Studies on lysergic acid. Archives of Neurology and Psychiatry 76: 468 (1956).

    PubMed  Google Scholar 

  • Johanson, E.: Acute hallucinosis, paranoic reactions and schizophreniform psychosis in alcoholic patients. Acta Soc. Med. (Uppsala) 66: 105 (1961).

    CAS  Google Scholar 

  • Johnson, D.A.W.: Evaluation of routine physical examination in psychiatric patients. Practitioner 200: 686 (1968).

    PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: Physical illness in psychiatric patients. British Journal of Psychiatry 115: 122 (1969).

    PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: The psychiatric side-effects of drugs. Practitioner 209: 320 (1972).

    PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: An analysis of out-patient services. British Journal of Psychiatry 122: 301 (1973).

    PubMed  CAS  Google Scholar 

  • Johnston, A.W.; Prichard, B.N.C. and Rosenheim, M.C.: The use of bethanidine in the treatment of hypertension. Lancet 2: 659 (1964).

    PubMed  CAS  Google Scholar 

  • Joyce, C.R.D.: Cannabis; in Silverstone and Barraclough (Eds) Contemporary Psychiatry (Headley Bros. Ashford, Kent 1970).

    Google Scholar 

  • Kane, F.J.: Psychiatric reactions to oral contraceptives. American Journal of Obstetrics and Gynaecology 102: 363 (1967).

    Google Scholar 

  • Keeler, M.H.; Reifler, C.B. and Liptzin, M.B.: Spontaneous recurrence of marihuana effect. American Journal of Psychiatry 125: 140 (1968).

    PubMed  CAS  Google Scholar 

  • Kessel, N. and Grossman, G.: Suicide in alcoholics. British Medical Journal 2: 1671 (1961).

    PubMed  CAS  Google Scholar 

  • Lauler, D.P. and Thorn, G.W.: Diseases of the adrenal cortex; In Harrison et al. (Eds) Principles of Internal Medicine, pp.449.484 (New York 1966).

    Google Scholar 

  • Leading Article: Oral contraceptives and depression. British Medical Journal 2: 380 (1969).

    Google Scholar 

  • Lees, A.W.: Ethionamide 1000mg and isoniazid 400mg in previously untreated cases of pulmonary tuberculosis. British Journal of Diseases of the Chest 59: 228 (1965a).

    PubMed  CAS  Google Scholar 

  • Lees, A.W.: Ethionamide 750mg plus isoniazid 450mg in previously untreated cases of pulmonary tuberculosis. American Review of Respiratory Diseases 92: 966 (1965b).

    CAS  Google Scholar 

  • Leishman, A.W.D.; Mathews, H.L. and Smith, A.J.: Guanethidine. Hypotensive drug with a prolonged action. Lancet 2: 659 (1959).

    Google Scholar 

  • Lemieux, G.; Davignon, A. and Genost, J.: Depressive states during rauwolfia therapy for arterial hypertension. A report of 30 cases. Canadian Medical Association Journal 74: 522 (1956).

    PubMed  CAS  Google Scholar 

  • Lewis, W.C.; Calden, G.; Thurston, J.R. and Gibson, W.E.: Psychiatric and neurological reactions to cycloserine in the treatment of tuberculosis. Diseases of the Chest 32: 172 (1957).

    PubMed  CAS  Google Scholar 

  • Lewis, S.A.; Oswald, I. and Dunleavy, D.L.F.: Chronic fenfluramine administration: some cerebral effects. British Medical Journal 3: 67 (1971).

    PubMed  CAS  Google Scholar 

  • Lingjaerde, O.: Tetrabenazine in the treatment of psychoses. Acta Psychiatrica Scandinavica Suppl. (1970).

  • Lishman, W.A.: Organic Psychiatry: Psychological Consequences of Cerebral Disorder. (Blackwell Scientific Publications, Oxford 1978).

    Google Scholar 

  • Lowther, C.P. and Turner, R.W.D.: Guanethidine in the treatment of hypertension. British Medical Journal 2: 776 (1963).

    PubMed  CAS  Google Scholar 

  • Malamud, N. and Skillicorn, S.A.: Relationship between the Wernicke and the Korsakoff syndrome. Archives of Neurology and Psychiatry 76: 585 (1956).

    PubMed  CAS  Google Scholar 

  • Mark, H.H.: Psychotogenic properties of cyclopentolate. Journal of the American Medical Association 186: 430 (1963).

    PubMed  CAS  Google Scholar 

  • Markovitz, M.: Acute intermittent porphyria: a report of five cases and a review of the literature. Annals of Internal Medicine 41: 1170 (1954).

    PubMed  CAS  Google Scholar 

  • Marshall, M.E.S.: Incidence of physical disorders among psychiatric in-patients. British Medical Journal 2: 468 (1949).

    PubMed  CAS  Google Scholar 

  • Martindale Extra Pharmacopoeia (Ed. R.G. Todd) pp.104, 1162–1165 (Pharmaceutical Press, London 1967).

  • Mattingley, D.: Disorders of the adrenal cortex and pituitary gland; in Baron, Compston and Dawson (Eds) Recent Advances in Medicine, pp. 125–169 (Churchill-Livingstone, Edinburgh 1968).

    Google Scholar 

  • May, P.R.A. and Ebaugh, F.G.: Pathological intoxication, alcoholic hallucinosis and other reactions to alcohol: A clinical study. Quarterly Journal of Studies on Alcohol 14: 200 (1953).

    PubMed  CAS  Google Scholar 

  • Mendellson, J.H.; Ogata, M. and Mello, N.K.: Effects of alcohol ingestion and withdrawal on magnesium states of alcoholics — clinical and experimental findings. Annals of New York Academy of Science 162: 934 (1969).

    Google Scholar 

  • Meyer, L. and Herxheimer, A.: in Side-Effects of Drugs, pp. 1–97, 224 (Excerpta Medica, Amsterdam 1972).

    Google Scholar 

  • Meyler, L. and Herxheimer, A.: Side effects of drugs: A survey of unwanted effects of drugs reported 1965–1967, Vol. 6 (Excerpta Medica, Amsterdam 1968).

    Google Scholar 

  • Michael, R.P. and Gibbons, J.L.: Inter-relationships between the endocrine system and neuropsychiatry. International Review of Neurobiology 5: 243 (1963).

    PubMed  CAS  Google Scholar 

  • Morozov, G.V.; Kachaev, A.K. and Lukacher, C.I.: The pathogenesis of pathological inebriation. Zhurnal Neuropatologii i Psikhiatrii Korsakov 73: 1196 (1973).

    CAS  Google Scholar 

  • Murray, R.M.; Greene, J.G. and Adams, J.H.: Analgesic abuse and dementia. Lancet 2: 242 (1971).

    PubMed  CAS  Google Scholar 

  • Nahas, G.G.: Toxicology and pharmacology of cannabis sativa with special reference to 9-THC. Bulletin on Narcotics 24: 11 (1972).

    CAS  Google Scholar 

  • Nielsen, J.B.; Drivsholn, A.; Fischer, F. and Brochner-Mortensen, K.: Long term treatment with corticosteroids in rheumatic arthritis. Acta Medica Scandinavica 173: 177 (1963).

    Google Scholar 

  • Nolan, J.P.: Alcohol as a factor in the illness of university service patients. American Journal of Medical Science 249: 135 (1965).

    CAS  Google Scholar 

  • Olsen, P.V. and Torning, K.: Isoniazid and loss of memory. Scandinavian Journal of Respiratory Disease 49: 1 (1968).

    CAS  Google Scholar 

  • O’Neal, L.W.: Pathologic anatomy in Cushing’s syndrome. Annals of Surgery 160: 860 (1964).

    PubMed  Google Scholar 

  • Oswald, I. and Thacore, V.R.: Amphetamine and phenmetrazine addiction. British Medical Journal 2: 1093 (1963).

    Google Scholar 

  • Pearson, W.S.: The hidden alcoholics in the general hospital. North Carolina Medical Journal 23: 6 (1962).

    PubMed  CAS  Google Scholar 

  • Platt, R. and Sears, H.T.N.: Reserpine in severe hypertension. Lancet 1: 401 (1956).

    Google Scholar 

  • Porteous, H.B. and Ross, D.N.: (1956). Mental symptoms in parkinsonism following benzhexol hydrochloride therapy. British Medical Journal 2: 138 (1956).

    PubMed  CAS  Google Scholar 

  • Prichard, B.N.C.; Johnston, A.W.; Hill, I.D. and Rosenheim, M.L: Bethanidine, guanethidine and methyldopa in treatment of hypertension: a within patient comparison. British Medical Journal 1: 135 (1968).

    PubMed  CAS  Google Scholar 

  • Quetch, R.M.; Achor, R.W.P.; Litin, E.M. and Faucett, R.L.: Depressive reactions in hypertensive patients. A comparison of those treated with rauwolfia and those receiving no specific antihypertensive treatment. Circulation 19: 366 (1959).

    Google Scholar 

  • Rose, D.P.: Oral contraceptives and depression. Lancet 2: 321 (1969).

    Google Scholar 

  • Rosenthal, S.H.: Persistent hallucinosis following administration of hallucinogenic drugs. American Journal of Psychiatry 121: 238 (1964).

    PubMed  CAS  Google Scholar 

  • Ross, E.J.; Marshall-Jones, P. and Friedman, M.: Cushing’s syndrome in diagnostic criteria. Quarterly Journal of Medicine 35: 149 (1966).

    PubMed  CAS  Google Scholar 

  • Ruiz, R.C.: D-cycloserine in the treatment of pulmonary tuberculosis resistant to standard drugs. Diseases of the Chest 45: 181 (1964).

    PubMed  CAS  Google Scholar 

  • Sadove, M.S. and Balagot, R.C.: Double-blind trial of pethidine and pentazocine. Journal of American Medical Association, pp.193 and 887 (1965).

    Google Scholar 

  • Schildkraut, J.J. and Kety, S.S.: Biogenic amines and emotion. Science 156: 21 (1967).

    PubMed  CAS  Google Scholar 

  • Scott, D.F.: Alcoholic hallucinosis — an aetiological study. British Journal of Addiction 62: 113 (1967).

    CAS  Google Scholar 

  • Shader, R.I.: Psychiatric effects of non-psychiatric drugs. Seminars in Psychiatry 3: 401 (1971).

    Google Scholar 

  • Shah, P.M.: Toxic effects of atropine eye drops. Indian Journal of Paediatrics 33: 13 (1966).

    Google Scholar 

  • Simcoe, C.W.: Cyclopentolate (Cyclogyl) toxicity. Archives of Ophthalmology 67: 406 (1962).

    PubMed  CAS  Google Scholar 

  • Smith, S.L.: Mood and Menstrual Cycle; in Sachar (Ed.) Topics in Psychoendocrinology, pp. 19–58 (Grune and Stratton, New York, San Francisco and London 1975).

    Google Scholar 

  • Smith, W.M.; Thurn, R.H. and Bromer, L.: Comparative evaluation of rauwolfia whole root and reserpine. Clinical Pharmacology and Therapeutics 10: 338 (1969).

    PubMed  CAS  Google Scholar 

  • Stephens, D.A.: Psychotoxic effects of benzhexol hydrochloride. British Journal of Psychiatry 113: 213 (1967).

    PubMed  CAS  Google Scholar 

  • Tschudy, D.P.: Porphyrin metabolism and the porphyrias; in Bondy (Ed.) Duncan’s Diseases of Metabolism Vol. 1: Genetics and Metabolism, pp. 600–635 (Saunders, Philadelphia 1969).

    Google Scholar 

  • Ullman, K.C.; Groh, R.H. and Wolff, F.W.: Treatment of scopolamine induced delirium. Lancet 1: 252 (1970).

    PubMed  CAS  Google Scholar 

  • Ungerleider, J.T.; Fisher, D.D. and Fuller, M.: The dangers of L.S.D. Journal of the American Medical Association 197: 389 (1966).

    PubMed  CAS  Google Scholar 

  • Victor, M.: Alcoholism. In Barkers Textbook of Neurology Vol. 2, Chapter 22 (Harper and Row, New York 1962).

    Google Scholar 

  • Victor, M.: Observations on the amnestic syndrome in man and its anatomical basis; in Brazier (Ed.) Brain Function, Vol. 11, RNA and Brain Function, Memory and Learning, pp.36, 40, 687 (University of California Press, Berkley and Los Angeles 1964).

    Google Scholar 

  • Victor, M.: Treatment of alcoholic intoxication and the withdrawal syndrome; in Seixas (Ed.) Treatment of the Alcoholic Withdrawal Syndrome, pp.41–42; 680–687 (National Council on Alcoholism, New York 1971).

    Google Scholar 

  • Victor, M. and Hope, J.M.: The phenomenon of auditory hallucinations in chronic alcoholism. Journal of Nervous and Mental Diseases 126: 451 (1958).

    CAS  Google Scholar 

  • Victor, M.; Adams, R.D. and Collins, G.H.: The Wernicke-Korsakoff syndrome (Blackwell Scientific Publications, Oxford 1971).

    Google Scholar 

  • Walker, W.C. and Murdock, J.M.: Cycloserine in the treatment of pulmonary tuberculosis. Tubercle (London) 38: 297 (1957).

    PubMed  CAS  Google Scholar 

  • Watson, C.J.: Porphyrin Metabolism; in Duncan (Ed.) Diseases of Metabolism, p.850 (Saunders, Philadelphia, 1964).

    Google Scholar 

  • Weinstein, H.J.; Hallett, W.Y. and Sarauw, A.S.: The absorption and toxicity of ethionamide. American Review of Respiratory Diseases 86: 576 (1962).

    CAS  Google Scholar 

  • Weatherall, M.: Drugs and porphyrin metabolism. Pharmacology Review 6: 133 (1954).

    CAS  Google Scholar 

  • World Health Organisation: The use of cannabis: report of WHO scientific group. WHO Technical Report No. 478 (WHO, Geneva 1971).

    Google Scholar 

  • Wolfe, S.M. and Victor, M.: The relationship of hypo-magnesium and alkalosis to alcohol withdrawal symptoms. Annals of New York Academy of Science 162: 973 (1969).

    CAS  Google Scholar 

  • Woodbury, D.M.: Relationship between the adrenal cortex and the central nervous system. Pharmacology Review 10: 275 (1958).

    CAS  Google Scholar 

  • Wynne-Davies, D.: Physical illness in psychiatric out-patients. British Journal of Psychiatry 111: 27 (1965).

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johnson, D.A.W. Drug-induced Psychiatric Disorders. Drugs 22, 57–69 (1981). https://doi.org/10.2165/00003495-198122010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-198122010-00004

Navigation