Case Report

Psychotic Mania Associated with Mefloquine in a Bipolar Patient

Authors: Meredith Brumbaugh, PharmD, Paul Price, PharmD, BCPP, Nancy Fagan, PharmD, Hudson Hsieh, MD

Abstract

A 63-year-old male patient with a history of bipolar I disorder presented to the emergency department in an acutely psychotic state. The patient had just returned from vacation in a malarial high-risk area and, as a result, had taken five weekly doses of mefloquine for prophylaxis. The patient’s bipolar disorder was being treated with lithium, and he had been stable for about 8 years. All organic causes of psychosis were ruled out. The patient was admitted to the inpatient psychiatric unit and was treated with quetiapine until he was stable enough to return home.


Key Points


* Mefloquine is commonly used for prophylaxis against malaria when visiting high-risk areas.


* Known side-effects include psychiatric disturbances.


* Patients with a history of mental illness should avoid taking mefloquine.


* This case describes a patient with bipolar disorder by history who destabilized after receiving mefloquine.

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