Paradoxical reaction: Difference between revisions
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===Antipsychotics=== |
===Antipsychotics=== |
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[[Chlorpromazine]], an [[antipsychotic]] and [[antiemetic]] drug which is classed as a "major" [[tranquilizer]], may cause paradoxical effects such as agitation, hallucinations, excitement, insomnia, bizarre dreams, aggravation of psychotic symptoms and toxic confusional states.<ref>[ |
[[Chlorpromazine]], an [[antipsychotic]] and [[antiemetic]] drug which is classed as a "major" [[tranquilizer]], may cause paradoxical effects such as agitation, hallucinations, excitement, insomnia, bizarre dreams, aggravation of psychotic symptoms and toxic confusional states.<ref>[https://adhdscan.com/blog/chlorpromazine/ Chlorpromazine - Adverse Effects- Behavioral Reactions]</ref> |
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These may be more common in elderly dementia patients. |
These may be more common in elderly dementia patients. The apparent worsening of [[dementia]] may be due to the [[anticholinergic]] side effects of many antipsychotics.<ref>{{Cite journal |last1=Singh |first1=R.R. |last2=Nayak |first2=R. |date=June 2012 |title=PMH76 Impact of Fda Black Box Warning on the Prescribing of Atypical Antipsychotics in Non-Institutionalized Dementia Patients |journal=Value in Health |volume=15 |issue=4 |pages=A95 |doi=10.1016/j.jval.2012.03.521 |issn=1098-3015|doi-access=free }}</ref> |
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===Barbiturates=== |
===Barbiturates=== |
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[[Phenobarbital]] can cause hyperactivity in children. This may follow after a small dose of 20 mg, on condition of no phenobarbital administered in previous days.<ref>{{cite web | title = Professional Health Care Providers | url = http://professionals.epilepsy.com/medications/p_phenobarbital_commonside.html | work = Epilepsy Foundation }}</ref> |
[[Phenobarbital]] can cause hyperactivity in children. This may follow after a small dose of 20 mg, on condition of no phenobarbital administered in previous days.<ref>{{cite web | title = Professional Health Care Providers | url = http://professionals.epilepsy.com/medications/p_phenobarbital_commonside.html | work = Epilepsy Foundation }}</ref> Prerequisite for this reaction is a continued sense of tension. The mechanism of action is not known, but it may be started by the anxiolytic action of the phenobarbital.{{citation needed|date=June 2024}} |
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[[Barbiturate]]s such as [[pentobarbital]] have been shown to cause paradoxical hyperactivity in an estimated 1% of children, who display symptoms similar to the hyperactive-impulsive subtype of [[attention deficit hyperactivity disorder]]. Intravenous [[caffeine]] administration can return these patients' |
[[Barbiturate]]s such as [[pentobarbital]] have been shown to cause paradoxical hyperactivity in an estimated 1% of children, who display symptoms similar to the hyperactive-impulsive subtype of [[attention deficit hyperactivity disorder]]. Intravenous [[caffeine]] administration can return these patients' behavior to baseline levels.<ref>{{Cite journal|last1=Rubin|first1=Joan T|last2=Towbin|first2=Richard B|last3=Bartko|first3=MaryBeth|last4=Baskin|first4=Kevin M|last5=Cahill|first5=Anne Marie|last6=Kaye|first6=Robin D|date=2004|title=Oral and intravenous caffeine for treatment of children with post-sedation paradoxical hyperactivity|journal=Pediatric Radiology|volume=34|issue=12|pages=980–984|doi=10.1007/s00247-004-1303-8|issn=1432-1998|pmid=15365651|s2cid=19473461}}</ref> Some case reports postulate a high rate (10-20%) of paradoxical response to anesthesia in ADHD patients, though this has not been objectively corroborated in controlled studies.<ref>{{Cite journal |last=Langguth |first=Berthold |last2=Bär |first2=Rüdiger |last3=Wodarz |first3=Norbert |last4=Wittmann |first4=Markus |last5=Laufkötter |first5=Rainer |date=August 2011 |title=Correspondence (letter to the editor): Paradoxical Reaction in ADHD |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163785/ |journal=Deutsches Ärzteblatt International |volume=108 |issue=31-32 |pages=541 |doi=10.3238/arztebl.2011.0541a |issn=1866-0452 |pmc=3163785 |pmid=21886668}}</ref> |
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===Benzodiazepines=== |
===Benzodiazepines=== |
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[[Benzodiazepine]]s, a class of psychoactive drugs called the "minor" [[tranquilizer]]s, have varying [[hypnotic]], [[sedative]], [[anxiolytic]], [[anticonvulsant]], and [[muscle relaxant|muscle relaxing]] properties, but they may create the exact opposite effects. Susceptible individuals may respond to benzodiazepine treatment with an increase in [[anxiety]], [[aggressiveness]], [[psychomotor agitation|agitation]], [[confusion]], [[paradoxical disinhibition|disinhibition]], loss of [[impulse control]], [[talkativeness]], [[violent]] behavior, and even [[convulsions]]. Paradoxical adverse effects may even lead to [[criminal |
[[Benzodiazepine]]s, a class of psychoactive drugs called the "minor" [[tranquilizer]]s, have varying [[hypnotic]], [[sedative]], [[anxiolytic]], [[anticonvulsant]], and [[muscle relaxant|muscle relaxing]] properties, but they may create the exact opposite effects. Susceptible individuals may respond to benzodiazepine treatment with an increase in [[anxiety]], [[aggressiveness]], [[psychomotor agitation|agitation]], [[confusion]], [[paradoxical disinhibition|disinhibition]], loss of [[impulse control]], [[talkativeness]], [[violent]] behavior, and even [[convulsions]]. Paradoxical adverse effects may even lead to [[criminal behavior |criminal behavior]].<ref>{{cite journal | vauthors = Bramness JG, Skurtveit S, Mørland J | title = Flunitrazepam: psychomotor impairment, agitation and paradoxical reactions | journal = Forensic Science International | volume = 159 | issue = 2–3 | pages = 83–91 | date = June 2006 | pmid = 16087304 | doi = 10.1016/j.forsciint.2005.06.009 }}</ref> Severe behavioral changes resulting from benzodiazepines have been reported including [[mania]], [[hypomania]], [[psychosis]], anger and impulsivity.<ref>{{cite journal | vauthors = Cole JO, Kando JC | title = Adverse behavioral events reported in patients taking alprazolam and other benzodiazepines | journal = The Journal of Clinical Psychiatry | volume = 54 | issue = Suppl | pages = 49–61; discussion 62–3 | date = October 1993 | pmid = 8262890 }}</ref> |
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Paradoxical rage reactions due to benzodiazepines occur as a result of an altered level of consciousness, which generates [[automatic behaviors]], [[anterograde amnesia]] and uninhibited aggression. These aggressive reactions may be caused by a disinhibiting [[Serotonin|serotonergic]] mechanism.<ref>{{cite journal | vauthors = Senninger JL, Laxenaire M | title = [Violent paradoxal reactions secondary to the use of benzodiazepines] | language = fr | journal = Annales médico-psychologiques | volume = 153 | issue = 4 | pages = 278–81; discussion 281–2 | date = April 1995 | pmid = 7618826 | trans-title = Violent paradoxical reactions secondary to the use of benzodiazepines }}</ref> |
Paradoxical rage reactions due to benzodiazepines occur as a result of an altered level of consciousness, which generates [[automatic behaviors]], [[anterograde amnesia]] and uninhibited aggression. These aggressive reactions may be caused by a disinhibiting [[Serotonin|serotonergic]] mechanism.<ref>{{cite journal | vauthors = Senninger JL, Laxenaire M | title = [Violent paradoxal reactions secondary to the use of benzodiazepines] | language = fr | journal = Annales médico-psychologiques | volume = 153 | issue = 4 | pages = 278–81; discussion 281–2 | date = April 1995 | pmid = 7618826 | trans-title = Violent paradoxical reactions secondary to the use of benzodiazepines }}</ref> |
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Paradoxical effects of benzodiazepines appear to be dose |
Paradoxical effects of benzodiazepines appear to be dose-related, that is, likelier to occur with higher doses.<ref name="pmid15460178">{{cite journal | vauthors = Mancuso CE, Tanzi MG, Gabay M | title = Paradoxical reactions to benzodiazepines: literature review and treatment options | journal = Pharmacotherapy | volume = 24 | issue = 9 | pages = 1177–85 | date = September 2004 | pmid = 15460178 | doi = 10.1592/phco.24.13.1177.38089 | s2cid = 38614605 | url = http://www.medscape.com/viewarticle/489358 | access-date = 2007-04-18 | url-status = live | archive-url = https://web.archive.org/web/20121213142837/http://www.medscape.com/viewarticle/489358 | archive-date = 2012-12-13 }}</ref> |
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In a letter to the ''[[British Medical Journal]]'', it was reported that a high proportion of parents referred for actual or threatened [[child abuse]] were taking medication at the time, often a combination of [[benzodiazepines]] and [[tricyclic antidepressants]]. Many mothers described that instead of feeling less anxious or depressed, they became more hostile and openly aggressive towards the child as well as to other family members while consuming tranquilizers. The author warned that environmental or social stresses such as difficulty coping with a crying baby combined with the effects of tranquilizers may precipitate a child abuse event.<ref>{{cite journal | vauthors = | title = Letter: Tranquilizers causing aggression | journal = British Medical Journal | volume = 1 | issue = 5952 | pages = 266 | date = February 1975 | pmid = 234269 | pmc = 1672080 | doi = 10.1136/bmj.1.5952.266 }}</ref> |
In a letter to the ''[[British Medical Journal]]'', it was reported that a high proportion of parents referred for actual or threatened [[child abuse]] were taking medication at the time, often a combination of [[benzodiazepines]] and [[tricyclic antidepressants]]. Many mothers described that instead of feeling less anxious or depressed, they became more hostile and openly aggressive towards the child as well as to other family members while consuming tranquilizers. The author warned that environmental or social stresses such as difficulty coping with a crying baby combined with the effects of tranquilizers may precipitate a child abuse event.<ref>{{cite journal | vauthors = | title = Letter: Tranquilizers causing aggression | journal = British Medical Journal | volume = 1 | issue = 5952 | pages = 266 | date = February 1975 | pmid = 234269 | pmc = 1672080 | doi = 10.1136/bmj.1.5952.266 }}</ref> |
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[[Self-harm|Self |
[[Self-harm|Self-aggression]] has been reported and also demonstrated in laboratory conditions in a clinical study. Diazepam was found to increase people's willingness to harm themselves.<ref>{{cite journal | vauthors = Berman ME, Jones GD, McCloskey MS | title = The effects of diazepam on human self-aggressive behavior | journal = Psychopharmacology | volume = 178 | issue = 1 | pages = 100–6 | date = February 2005 | pmid = 15316710 | doi = 10.1007/s00213-004-1966-8 | s2cid = 20629702 }}</ref> |
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Benzodiazepines can sometimes cause a paradoxical worsening of [[EEG]] readings in patients with seizure disorders.<ref>{{cite journal | vauthors = Perlwitz R, Grimmberger E, Schmidtsdorf R | title = [Immediate effect of intravenous clonazepam on the EEG] | journal = Psychiatrie, Neurologie, und Medizinische Psychologie | volume = 32 | issue = 6 | pages = 338–44 | date = June 1980 | pmid = 7403357 }}</ref> |
Benzodiazepines can sometimes cause a paradoxical worsening of [[EEG]] readings in patients with seizure disorders.<ref>{{cite journal | vauthors = Perlwitz R, Grimmberger E, Schmidtsdorf R | title = [Immediate effect of intravenous clonazepam on the EEG] | journal = Psychiatrie, Neurologie, und Medizinische Psychologie | volume = 32 | issue = 6 | pages = 338–44 | date = June 1980 | pmid = 7403357 }}</ref> |
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=== Naltrexone === |
=== Naltrexone === |
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[[Naltrexone]] blocks the opioid receptors, acting opposite to most opioid pain medications.<ref>{{Citation |last=Wright |first=Tricia E. |title=Pharmacotherapy for Opioid Use Disorders in Special Populations |date=September 2020 |url=http://dx.doi.org/10.1093/med/9780190920197.003.0011 |work=Substance Use Disorders |pages=185–202 |publisher=Oxford University Press |doi=10.1093/med/9780190920197.003.0011 |isbn=978-0-19-092019-7 |access-date=2023-01-15}}</ref> It can be used to negate the effects of opioid painkillers. At doses around one-tenth of the typical dose, naltrexone has been used for pain relief. [[Low-dose naltrexone]] is believed to have an anti-inflammatory effect. This is an off |
[[Naltrexone]] blocks the opioid receptors, acting opposite to most opioid pain medications.<ref>{{Citation |last=Wright |first=Tricia E. |title=Pharmacotherapy for Opioid Use Disorders in Special Populations |date=September 2020 |url=http://dx.doi.org/10.1093/med/9780190920197.003.0011 |work=Substance Use Disorders |pages=185–202 |publisher=Oxford University Press |doi=10.1093/med/9780190920197.003.0011 |isbn=978-0-19-092019-7 |access-date=2023-01-15}}</ref> It can be used to negate the effects of opioid painkillers. At doses around one-tenth of the typical dose, naltrexone has been used for pain relief. [[Low-dose naltrexone]] is believed to have an anti-inflammatory effect. This is an off-label use and not widely accepted by the medical and scientific community.<ref>{{Cite journal |last1=Younger |first1=Jarred |last2=Parkitny |first2=Luke |last3=McLain |first3=David |date=2014-02-15 |title=The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain |url=http://dx.doi.org/10.1007/s10067-014-2517-2 |journal=Clinical Rheumatology |volume=33 |issue=4 |pages=451–459 |doi=10.1007/s10067-014-2517-2 |pmid=24526250 |pmc=3962576 |s2cid=16191753 |issn=0770-3198}}</ref> |
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===Diphenhydramine=== |
===Diphenhydramine=== |
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[[Diphenhydramine]] (often referred to by the trade name [[Benadryl]]) is an [[anticholinergic]] [[antihistamine]] medicine commonly used to treat allergic reactions and symptoms of a [[common cold]], such as [[cough]]ing. Its central antihistaminergic properties also cause it to act as a [[sedative]], and for this reason it is also used to treat [[insomnia]].<ref>{{Cite web |date=2018-09-21 |title=Diphenhydramine: drowsy (sedating) antihistamine |url=https://www.nhs.uk/medicines/diphenhydramine/ |access-date=2024-01-11 |website=nhs.uk |language=en}}</ref> Diphenhydramine is also used off-label for its sedative properties, particularly by parents seeking to make their children sedated or sleep during [[long-haul flight]]s. This use of diphenhydramine has been |
[[Diphenhydramine]] (often referred to by the trade name [[Benadryl]]) is an [[anticholinergic]] [[antihistamine]] medicine commonly used to treat allergic reactions and symptoms of a [[common cold]], such as [[cough]]ing. Its central antihistaminergic properties also cause it to act as a [[sedative]], and for this reason it is also used to treat [[insomnia]].<ref>{{Cite web |date=2018-09-21 |title=Diphenhydramine: drowsy (sedating) antihistamine |url=https://www.nhs.uk/medicines/diphenhydramine/ |access-date=2024-01-11 |website=nhs.uk |language=en}}</ref> Diphenhydramine is also used off-label for its sedative properties, particularly by parents seeking to make their children sedated or sleep during [[long-haul flight]]s. This use of diphenhydramine has been criticized for a number of reasons, ranging from ethical to safety concerns,<ref>{{Cite web |title=Why It's Time to Rethink Our Use of Benadryl |url=https://www.nationwidechildrens.org/family-resources-education/700childrens/2020/04/benadryl |access-date=2024-01-11 |website=www.nationwidechildrens.org |language=en}}</ref> but also due to the risk of diphenhydramine's paradoxical reaction, which induces hyperactivity and [[irritability]].<ref>{{Cite web |last=Shubailat |first=Nadine |title=Benadryl Baby: Should You Give Allergy Drugs to Calm Kids Before Flying? |url=http://abcnews.go.com/blogs/lifestyle/2012/05/benadryl-baby-should-you-give-allergy-drugs-to-calm-kids-before-flying |access-date=2024-01-11 |website=ABC News |language=en}}</ref> This phenomenon can also be observed in adults who use the medication as a sleep aid. The prevalence of this paradoxical reaction is unknown, but research into the phenomenon suggests that it may be as a result of the medicine's interactions with the [[CYP2D6|CYP2D6 enzyme]], and that a [[metabolite]] of diphenhydramine may be to blame.<ref>{{Cite journal |last1=de Leon |first1=Jose |last2=Nikoloff |first2=D. Michele |date=February 2008 |title=Paradoxical excitation on diphenhydramine may be associated with being a CYP2D6 ultrarapid metabolizer: three case reports |url=https://pubmed.ncbi.nlm.nih.gov/18227744/ |journal=CNS Spectrums |volume=13 |issue=2 |pages=133–135 |doi=10.1017/s109285290001628x |issn=1092-8529 |pmid=18227744|s2cid=10856872 }}</ref> |
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==Causes== |
==Causes== |
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The mechanism of a paradoxical reaction has as yet (2019) not been fully clarified, in no small part due to the fact that signal transfer of single [[neuron]]s in [[subcortical]] areas of the human brain is usually not accessible.{{citation needed|date=June 2024}} |
The mechanism of a paradoxical reaction has as yet (2019) not been fully clarified, in no small part due to the fact that signal transfer of single [[neuron]]s in [[subcortical]] areas of the human brain is usually not accessible.{{citation needed|date=June 2024}} |
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There are, however, multiple indications that paradoxical reactions upon – for example – benzodiazepines, barbiturates, [[inhalational anesthetic]]s, [[propofol]], [[neurosteroid]]s, and [[Alcohol (drug)|alcohol]] are associated with structural deviations of [[GABAA receptor|GABA<sub>A</sub> receptor]]s. The combination of the five subunits of the receptor (see image) can be altered in such a way that for example the receptor's response to GABA remains unchanged but the response to one of the named substances is dramatically different from the normal one.{{citation needed|date=June 2024}} |
There are, however, multiple indications that paradoxical reactions upon – for example – benzodiazepines, barbiturates, [[inhalational anesthetic]]s, [[propofol]], [[neurosteroid]]s, and [[Alcohol (drug)|alcohol]] are associated with structural deviations of [[GABAA receptor|GABA<sub>A</sub> receptor]]s. The combination of the five subunits of the receptor (see image) can be altered in such a way that for example, the receptor's response to GABA remains unchanged but the response to one of the named substances is dramatically different from the normal one.{{citation needed|date=June 2024}} |
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Latest revision as of 17:13, 28 October 2024
A paradoxical reaction (or paradoxical effect) is an effect of a chemical substance, such as a medical drug, that is opposite to what would usually be expected. An example of a paradoxical reaction is pain caused by a pain relief medication.
Substances
[edit]Amphetamines
[edit]Amphetamines are a class of psychoactive drugs that are stimulants. Paradoxical drowsiness can sometimes occur in adults.[1] Research from the 1980s popularized the belief that ADHD stimulants such as amphetamine have a calming effect in individuals with ADHD, but opposite effects in the general population.[2] New research however disputes this claim, suggesting that ADHD stimulants have similar effects in adults with and without ADHD.[3][4]
Antibiotics
[edit]The paradoxical effect or Eagle effect (named after Harry Eagle, who first described it) refers to an observation of an increase in survivors, seen when testing the activity of an antimicrobial agent.[5] Initially when an antibiotic agent is added to a culture media, the number of bacteria that survive drops, as one would expect. But after increasing the concentration beyond a certain point, the number of bacteria that survive, paradoxically, increases.[citation needed]
Antidepressants
[edit]In a minority of cases, antidepressants can lead to violent thoughts of suicide or self-harm, as observed in some patients during and after treatment, which is in marked contrast to their intended effect.[6] A 1991 study found that children and adolescents were more sensitive to paradoxical reactions of self-harm and suicidal ideation while taking fluoxetine (commonly known as Prozac).[7] This can be regarded as a paradoxical reaction but, especially in the case of suicide, may in at least some cases be merely due to differing rates of effect with respect to different symptoms of depression: If generalized overinhibition of a patient's actions enters remission before that patient's dysphoria does and if the patient was already suicidal but too depressed to act on their inclinations, the patient may find themself in the situation of being both still dysphoric enough to want to commit suicide but newly free of endogenous barriers against doing so.[citation needed]
Antipsychotics
[edit]Chlorpromazine, an antipsychotic and antiemetic drug which is classed as a "major" tranquilizer, may cause paradoxical effects such as agitation, hallucinations, excitement, insomnia, bizarre dreams, aggravation of psychotic symptoms and toxic confusional states.[8]
These may be more common in elderly dementia patients. The apparent worsening of dementia may be due to the anticholinergic side effects of many antipsychotics.[9]
Barbiturates
[edit]Phenobarbital can cause hyperactivity in children. This may follow after a small dose of 20 mg, on condition of no phenobarbital administered in previous days.[10] Prerequisite for this reaction is a continued sense of tension. The mechanism of action is not known, but it may be started by the anxiolytic action of the phenobarbital.[citation needed]
Barbiturates such as pentobarbital have been shown to cause paradoxical hyperactivity in an estimated 1% of children, who display symptoms similar to the hyperactive-impulsive subtype of attention deficit hyperactivity disorder. Intravenous caffeine administration can return these patients' behavior to baseline levels.[11] Some case reports postulate a high rate (10-20%) of paradoxical response to anesthesia in ADHD patients, though this has not been objectively corroborated in controlled studies.[12]
Benzodiazepines
[edit]Benzodiazepines, a class of psychoactive drugs called the "minor" tranquilizers, have varying hypnotic, sedative, anxiolytic, anticonvulsant, and muscle relaxing properties, but they may create the exact opposite effects. Susceptible individuals may respond to benzodiazepine treatment with an increase in anxiety, aggressiveness, agitation, confusion, disinhibition, loss of impulse control, talkativeness, violent behavior, and even convulsions. Paradoxical adverse effects may even lead to criminal behavior.[13] Severe behavioral changes resulting from benzodiazepines have been reported including mania, hypomania, psychosis, anger and impulsivity.[14]
Paradoxical rage reactions due to benzodiazepines occur as a result of an altered level of consciousness, which generates automatic behaviors, anterograde amnesia and uninhibited aggression. These aggressive reactions may be caused by a disinhibiting serotonergic mechanism.[15]
Paradoxical effects of benzodiazepines appear to be dose-related, that is, likelier to occur with higher doses.[16]
In a letter to the British Medical Journal, it was reported that a high proportion of parents referred for actual or threatened child abuse were taking medication at the time, often a combination of benzodiazepines and tricyclic antidepressants. Many mothers described that instead of feeling less anxious or depressed, they became more hostile and openly aggressive towards the child as well as to other family members while consuming tranquilizers. The author warned that environmental or social stresses such as difficulty coping with a crying baby combined with the effects of tranquilizers may precipitate a child abuse event.[17]
Self-aggression has been reported and also demonstrated in laboratory conditions in a clinical study. Diazepam was found to increase people's willingness to harm themselves.[18]
Benzodiazepines can sometimes cause a paradoxical worsening of EEG readings in patients with seizure disorders.[19]
Caffeine
[edit]Caffeine is believed by many to cause paradoxical calmness or sedation in individuals with ADHD.[20] There is insufficient evidence to determine if sedation caused by caffeine is due to a true paradoxical reaction, or rather from dehydration and sleep deprivation caused by the caffeine.[21] Furthermore, there are no conclusive studies showing a differential effect of caffeine in individuals with ADHD compared to the general population.
Naltrexone
[edit]Naltrexone blocks the opioid receptors, acting opposite to most opioid pain medications.[22] It can be used to negate the effects of opioid painkillers. At doses around one-tenth of the typical dose, naltrexone has been used for pain relief. Low-dose naltrexone is believed to have an anti-inflammatory effect. This is an off-label use and not widely accepted by the medical and scientific community.[23]
Diphenhydramine
[edit]Diphenhydramine (often referred to by the trade name Benadryl) is an anticholinergic antihistamine medicine commonly used to treat allergic reactions and symptoms of a common cold, such as coughing. Its central antihistaminergic properties also cause it to act as a sedative, and for this reason it is also used to treat insomnia.[24] Diphenhydramine is also used off-label for its sedative properties, particularly by parents seeking to make their children sedated or sleep during long-haul flights. This use of diphenhydramine has been criticized for a number of reasons, ranging from ethical to safety concerns,[25] but also due to the risk of diphenhydramine's paradoxical reaction, which induces hyperactivity and irritability.[26] This phenomenon can also be observed in adults who use the medication as a sleep aid. The prevalence of this paradoxical reaction is unknown, but research into the phenomenon suggests that it may be as a result of the medicine's interactions with the CYP2D6 enzyme, and that a metabolite of diphenhydramine may be to blame.[27]
Causes
[edit]
The mechanism of a paradoxical reaction has as yet (2019) not been fully clarified, in no small part due to the fact that signal transfer of single neurons in subcortical areas of the human brain is usually not accessible.[citation needed]
There are, however, multiple indications that paradoxical reactions upon – for example – benzodiazepines, barbiturates, inhalational anesthetics, propofol, neurosteroids, and alcohol are associated with structural deviations of GABAA receptors. The combination of the five subunits of the receptor (see image) can be altered in such a way that for example, the receptor's response to GABA remains unchanged but the response to one of the named substances is dramatically different from the normal one.[citation needed]
See also
[edit]References
[edit]- ^ Tecce JJ, Cole JO (August 1974). "Amphetamine effects in man: paradoxical drowsiness and lowered electrical brain activity (CNV)". Science. 185 (4149): 451–3. Bibcode:1974Sci...185..451T. doi:10.1126/science.185.4149.451. PMID 4841149. S2CID 26068007.
- ^ Segal, D. S.; Kuczenski, R. (1987-09-01). "Individual differences in responsiveness to single and repeated amphetamine administration: behavioral characteristics and neurochemical correlates". Journal of Pharmacology and Experimental Therapeutics. 242 (3): 917–926. ISSN 0022-3565. PMID 3656119.
- ^ Arnsten, Amy F. T. (November 2006). "Stimulants: Therapeutic Actions in ADHD". Neuropsychopharmacology. 31 (11): 2376–2383. doi:10.1038/sj.npp.1301164. ISSN 1740-634X. PMID 16855530. S2CID 36283770.
- ^ Rapoport, J. L.; Inoff-Germain, G. (April 2002). "Responses to methylphenidate in Attention-Deficit/Hyperactivity Disorder and normal children: Update 2002". Journal of Attention Disorders. 6 (1_suppl): 57–60. doi:10.1177/070674370200601S07. ISSN 1087-0547. PMID 12685519. S2CID 24320882.
- ^ Eagle H, Musselman AD (July 1948). "The rate of bactericidal action of penicillin in vitro as a function of its concentration, and its paradoxically reduced activity at high concentrations against certain organisms". The Journal of Experimental Medicine. 88 (1): 99–131. doi:10.1084/jem.88.1.99. PMC 2135799. PMID 18871882.
- ^ Teicher MH, Glod C, Cole JO (February 1990). "Emergence of intense suicidal preoccupation during fluoxetine treatment". The American Journal of Psychiatry. 147 (2): 207–10. doi:10.1176/ajp.147.2.207. PMID 2301661.
- ^ King RA, Riddle MA, Chappell PB, Hardin MT, Anderson GM, Lombroso P, Scahill L (March 1991). "Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment". Journal of the American Academy of Child and Adolescent Psychiatry. 30 (2): 179–86. doi:10.1097/00004583-199103000-00003. PMID 2016219.
- ^ Chlorpromazine - Adverse Effects- Behavioral Reactions
- ^ Singh, R.R.; Nayak, R. (June 2012). "PMH76 Impact of Fda Black Box Warning on the Prescribing of Atypical Antipsychotics in Non-Institutionalized Dementia Patients". Value in Health. 15 (4): A95. doi:10.1016/j.jval.2012.03.521. ISSN 1098-3015.
- ^ "Professional Health Care Providers". Epilepsy Foundation.
- ^ Rubin, Joan T; Towbin, Richard B; Bartko, MaryBeth; Baskin, Kevin M; Cahill, Anne Marie; Kaye, Robin D (2004). "Oral and intravenous caffeine for treatment of children with post-sedation paradoxical hyperactivity". Pediatric Radiology. 34 (12): 980–984. doi:10.1007/s00247-004-1303-8. ISSN 1432-1998. PMID 15365651. S2CID 19473461.
- ^ Langguth, Berthold; Bär, Rüdiger; Wodarz, Norbert; Wittmann, Markus; Laufkötter, Rainer (August 2011). "Correspondence (letter to the editor): Paradoxical Reaction in ADHD". Deutsches Ärzteblatt International. 108 (31–32): 541. doi:10.3238/arztebl.2011.0541a. ISSN 1866-0452. PMC 3163785. PMID 21886668.
- ^ Bramness JG, Skurtveit S, Mørland J (June 2006). "Flunitrazepam: psychomotor impairment, agitation and paradoxical reactions". Forensic Science International. 159 (2–3): 83–91. doi:10.1016/j.forsciint.2005.06.009. PMID 16087304.
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