Serotonin toxicity: a practical approach to diagnosis and treatment

@article{Isbister2007SerotoninTA,
  title={Serotonin toxicity: a practical approach to diagnosis and treatment},
  author={Geoffrey K. Isbister and Nicholas Alan Buckley and Ian M. Whyte},
  journal={Medical Journal of Australia},
  year={2007},
  volume={187}
}
Excess serotonin in the central nervous system leads to a condition commonly referred to as the serotonin syndrome, but better described as a spectrum of toxicity — serotonin toxicity. Serotonin toxicity is characterised by neuromuscular excitation (clonus, hyperreflexia, myoclonus, rigidity), autonomic stimulation (hyperthermia, tachycardia, diaphoresis, tremor, flushing) and changed mental state (anxiety, agitation, confusion). Serotonin toxicity can be: mild (serotonergic features that may… Expand
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References

SHOWING 1-10 OF 32 REFERENCES
The Pathophysiology of Serotonin Toxicity in Animals and Humans: Implications for Diagnosis and Treatment
TLDR
This review primarily addresses the serotonin receptor subtypes that underlie the clinical manifestations of excess CNS serotonin in humans and animals, and their implications for diagnosis and treatment. Expand
The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity.
TLDR
Decision rules (the Hunter Serotonin Toxicity Criteria) were developed that were simpler, more sensitive to serotonin toxicity and less likely to yield false positives. Expand
An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria.
TLDR
The detailed analysis of the SS cases published so far suggests that 'the diagnostic criteria for SS' also require further revision, and these are presented here. Expand
Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity.
TLDR
Moclobemide overdose in combination with a serotonergic agent (even in normal therapeutic doses) can cause severe serotonin toxicity, and the elimination half-life is prolonged by two to four times in overdose, compared with that found in healthy volunteers given therapeutic doses. Expand
Relative Toxicity of Selective Serotonin Reuptake Inhibitors (SSRIs) in Overdose
TLDR
This study shows SSRIs are relatively safe in overdose despite serotonin syndrome being common, and believes that cardiac monitoring should be considered in citalopram overdose, particularly with large ingestions and patients with associated cardiac disease. Expand
The serotonin syndrome and its treatment
  • P. Gillman
  • Medicine, Psychology
  • Journal of psychopharmacology
  • 1999
TLDR
There is some evidence suggesting the efficacy of chlorpromazine and cyproheptadine in the treatment of serotonin syndrome, but the evidence for cypro heptamines is less substantial than that for chlor Promazine, perhaps because the dose necessary to ensure blockade of brain 5-HT2receptors is higher than that used in the cases reported to date. Expand
The serotonin syndrome scale: first results on validity
TLDR
The relationships between the serotonin syndrome score (SSS) and both the paroxetine plasma levels and the loudness dependence of the auditory evoked potentials (LDAEP) were investigated in depressed patients treated with paroxettine, supporting the validity of the Serotonin syndrome scale. Expand
Toxic ictal delirium
TLDR
This paper focuses on toxic delirium associated with prominent paroxysmal electroencephalogram (EEG) dysfunction occurring in nonepileptic patients and the informative value of the EEG in the differential diagnosis of acute confusional states is emphasized. Expand
Serotonin syndrome resulting from drug interactions
TLDR
Six patients diagnosed with serotonin syndrome after exposure to drugs with serotonergic activity were diagnosed and management included supportive care and the use of non‐specific serotonin antagonists. Expand
Nonconvulsive status epilepticus as a cause of confusion in later life: a report of 5 cases.
TLDR
Five patients presented with an acute confusional episode for the first time between the ages of 53 and 76 and their EEGs showed generalized paroxysmal activity indicating a diagnosis of nonconvulsive generalized status epilepticus (absence status), which was never made on admission. Expand
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