[Central nervous system side effects due to anti-arrhythmia therapy. Psychotic depression due to flecainide]

A 69-year-old man, who had undergone an aortic-valve replacement for aortic regurgitation and aortoplasty for an aortic aneurysm with re-implantation of the coronary arteries, was given flecainide 100 mg twice daily during the rehabilitation period because of atrial fibrillation and multiple ventricular extrasystoles (Lown 4b). Within a few days he developed a severe depressive psychosis with delusions and acoustic hallucinations which failed to respond to psychoactive drugs. After admission to a psychiatric hospital the anti-arrhythmia drugs were discontinued, drug-induced exogenous psychosis having been diagnosed. A few days later all psychiatric symptoms disappeared without any further complications. Other possible causes of the psychiatric syndrome were excluded.