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Acute mental status changes caused by propranolol

N L Peters, K C Anderson, P R Reid

    The Johns Hopkins Medical Journal
    |November 1, 1978
    PubMed
    Summary
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    Low-dose propranolol can cause disorientation and paranoid delusions in elderly patients with dementia. Symptoms recurred upon rechallenge, indicating a direct link between the medication and adverse mental status changes.

    Area of Science:

    • Geriatric Medicine
    • Psychopharmacology
    • Neurology

    Background:

    • Beta-blockers like propranolol are commonly prescribed for various cardiovascular conditions.
    • Elderly patients, particularly those with cognitive impairments such as dementia, may exhibit unique responses to medications.
    • Understanding medication side effects in this vulnerable population is crucial for safe and effective treatment.

    Observation:

    • A 74-year-old female patient with pre-existing mild dementia experienced acute disorientation and paranoid delusions.
    • These neuropsychiatric symptoms emerged during treatment with low-dose propranolol.
    • No signs of cardiovascular compromise were noted during the adverse event.

    Findings:

    • The patient's mental status changes resolved spontaneously within one week of discontinuing propranolol.

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  • A subsequent rechallenge with propranolol resulted in the recurrence of disorientation and paranoid delusions.
  • This strongly suggests propranolol-induced neuropsychiatric effects in this patient.

    • Implications:

    • Clinicians should exercise caution when prescribing propranolol to elderly patients with dementia.
    • Careful monitoring for central nervous system side effects is warranted in this demographic.
    • This case highlights the potential for low-dose propranolol to trigger significant cognitive and psychiatric disturbances, necessitating a thorough risk-benefit assessment.