Several reports suggested that DDS could induce psychosis, whereas it seems that there are no clear descriptions about dosage, clinical course, symptomatology and prognosis. The author reported three cases of toxic psychosis in non-lepreus Fersons following massive adminstraticn of DDS giving emphasis to clinical characteristics.
The first case, a F0 year old rrale, pre,-ented definite psychotic symptoms with paranoid picture after daily administration of ~CCmg of DDS for 40days. The second case, a 13Year old male, had mental symptoms similar to those of the first case 2 days after the administration of 1,2CCmg of DDS in 3 days. In l=oth cases, such symptcw.s as slowly increasing irritability, anorexia and insomnia were presented prior to the development of definite psychosis. The last case, a 21 year old female, took more than 1, 000mg of DDS at once. Several hours after ingestion, acute intoxication symptoms such as nausea, vomiting, cyanosis and loss of consciousness appeared. Ten days later, she improved in her mental state except fatigability and visual disturbance. But after 30 days of lucid period, psychotic symptoms with hysterical picture were manifested.
In all cases, there was no neurological abnormality except typical organic brain syndrome such as disorientation, distractability, disturbance of calculation and recent memory, and exacerbating tendency at night.
Antipsychotics were used for the treatment of psychotic symptoms, which were gradually alleviated after at least 2 months of treatment.
The following facts could be extracted from the clinical experiences with these patients.
1). Psychotic symptoms were presented by both single and repeated administration of DDS.
2) Acute brain syndrome was observed in all cases, whereas it´s mental symptom clearly reflected premorbid personalily of the patients.
3) There was a lucid period before the onset of psychotic symptom in the case of acute intoxication by single dose. In this case, visual disturbance with retinal hemorrage and macular degeneration was noticed.
4) Methemoglobinemia was not found in all cases, suggesting that psychotic manifestation might not be related to cellular hypoxia due to the methemoglobinemia but to the scrum concentration and toxicity of the sulfone per se.
5) Recovery seemed to be the rule but required prolonged treatment.
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