Psychoses (excitability, mood)

PHT has been reported useful in decreasing irritability and improving sense of well-being in psychotics. In some cases where the psychosis has occurred in association with metabolic disorders or brain injury, the use of PHT has been reported to correct the psychotic state.

Kalinowsky and Putnam, Archives of Neurology and Psychiatry (1943),186 reported on the treatment with PHT of sixty psychotic patients. Improvement occurred in over half of the patients during the period of treatment and usually consisted of diminution of excitement and irritability, almost irrespective of the type of psychosis. Although PHT did not change the basic psychosis, the patientsí mood, behavior and emotions were improved.

186. Kalinowsky, L. B. and Putnam, T. J., Attempts at treatment of schizophrenia and other nonepileptic psychoses with Dilantin, Arch. Neurol. Psychiat., 49: 414-420, 1943.

Freyhan, Archives of Neurology and Psychiatry (1945),110 reported on a group of forty psychiatric patients. PHT therapy, 300-600 mg/day, resulted in positive behavioral changes in certain excited patients.

110. Freyhan, F. A., Effectiveness of diphenylhydantoin in management of nonepileptic psychomotor excitement states, Arch. Neurol. Psychiat., 53: 370-374, 1945.

Kubanek and Rowell, Diseases of the Nervous System (1946),201 used PHT in the treatment of prolonged chronic disturbed behavior in seventy-three psychotic patients unresponsive to other drugs. They found PHT unquestionably valuable for some of these patients.

201. Kubanek, J. L. and Rowell, R. C., The use of Dilantin in the treatment of psychotic patients unresponsive to other treatment, Dis. Nerv. Syst., 7: 1-4, 19`46.

Haward, Proceedings of the Symposium on Aggressive Behavior (1969),697 reported that PHT was effective in reducing aggressive behavior in a double-blind study involving twenty chronic psychotic patients. Although the basic psychoses were not changed, important benefits in mood were noted.

697. Haward, L. R. C., Differential modifications of verbal aggression by psychotropic drugs, Proc. Symp. Aggressive Behavior, Milan, May, 1968, 317-321, S. Garattini and E. B. Sigg, Eds., Excerpta Medica, New York, 1969.

Pinto, Simopoulos, Uhlenhuth and DeRosa, Comprehensive Psychiatry (1974),1415 in a study of thirty-two severely regressed chronic schizophrenic patients, found that PHT in doses of 250-350 mg per day, when added to a phenothiazine, improved conditions such as irritability, aggression and negative behavior. (See also Ref. 1551.)

1415. Pinto, A., Simopoulos, A. M., Uhlenhuth, E. H. and De Rosa, E. R., Responses of chronic schizophrenic females to a combination of diphenylhydantoin and neuroleptics: a double-blind study, Comprehensive Psychiatry, 16(6): 529-536, 1975.
1551. Simopoulos, A. M., Pinto, A., Uhlenhuth, E. H., McGee, J. J., and DeRosa, E. R., Diphenylhydantoin (DPH) effectiveness in the treatment of chronic schizophrenics, Arch. Gen. Psychiat., 30: 106-112, 1974.

Bellak, American Journal of Psychotherapy (1976),2320 in summarizing thirty years of clinical experience, describes the usefulness of PHT in a subgroup of schizophrenics with minimal brain dysfunction. The author noted that these patients do not do well with phenothiazines, but that PHT, alone or in combination with methylphenidate and imipramine, is frequently effective.

2320. Bellak, L., A possible subgroup of the schizophrenic syndrome and implications for treatment, Am. J. Psychother., 30: 194-205, 1976.

Surman and Parker, Psychosomatics (1981),2995 reported three patients with episodic psychotic disturbances associated with renal disease. All responded to PHT with resolution of the psychotic behavior and/or hallucinations.

2995. Surman, 0. S., Parker, S. W., Complex partial seizures and psychiatric disturbance in end-stage renal disease, Psychosomatics, 22; 1077-80, 1981.

Laudadio, Crisci, De Carolis, Pezzoli and Sacquegna, Acta. Neurologica. Scandinavica., (1994), 3132 report on two patients with no history of psychosis or epilepsy presenting with acute psychosis and epileptic seizures as the initial symptom of late-onset epilepsy. One patient, a 70-year-old male, in addition to tonic-clonic seizures, presented features of delirium with persecutory delusion and paranoid ideation. Seizures and psychosis resolved after iv administration of phenytoin (500 mg) and haloperidol (4 mg). After a few days, haloperidol was withdrawn while phenytoin alone continued to control the symptoms. Two months later, upon abrupt withdrawal of PHT, episodes of seizure and psychotic delirium recurred.

With the resumption of PHT, the patient's symptoms resolved. The second patient, a 75-year-old female, was admitted to the hospital with generalized tonic-clonic seizure with subsequent delirium with persecutory delusions. The patient responded, in a few days, to phenytoin therapy (300 mg/die) per os. This dosage has been continued, and the patient remains free of seizures and acute psychosis.

3132. Laudadio, S., Crisci, M., De Carolis, P., Pezzoli, A., and Sacquegna, T., Acute psychosis and epileptic seizures as the presenting symptom of late-onset epilepsy, Acta. Neurol. Scand., 89(1):77-9, 1994.

See also Ref.

3133. Fan, Z., Zhang, Z., Lu, G., and Huang, Z., The effect of phenytoin treated depressive psychosis, Presented at the National Workshop of Clinical Use of Phenytoin, Chengdu, China, 1992.

3134. Sultan, S., Chouinard, G., and Beaudry, P., Antiepileptic drugs in the treatment of neuroleptic-induced supersensitivity psychosis, Prog. Neuropsychopharmacol. Biol. Psychiatry, 14: 431-38, 1990.

See also: Benefits in Epileptics