The serotonin syndrome: initial misdiagnosis

Area of Science:

• Psychiatry
• Clinical Toxicology

Background:

• Selective serotonin reuptake inhibitors (SSRIs) are widely used psychiatric medications.
• While SSRI toxicity is generally lower than other psychiatric drugs, serotonin syndrome can occur.
• Physician awareness of serotonin syndrome characteristics appears limited.

Observation:

• A retrospective chart review examined seven patients with serotonin syndrome over two years.
• All patients presented with symptoms initially misdiagnosed as other conditions.
• Misdiagnoses included psychiatric exacerbations, gastroenteritis, brain metastasis, and drug overdose.

Findings:

• Five out of seven patients were initially misdiagnosed with exacerbation of their psychiatric disorder.
• Two patients were misdiagnosed with gastroenteritis.
• One patient was suspected of having a metastatic brain lesion, and another of severe drug overdose.

Implications:

• This study highlights the frequent misdiagnosis of serotonin syndrome in psychiatric patients.
• Serotonin toxicity should be suspected in acute conditions presenting with mental changes, neuromuscular abnormalities, and autonomic hyperactivity.
• Prompt identification and discontinuation of causative SSRIs lead to patient recovery.