Confusional episode associated with digoxin intoxication. Case report
GKOLIA L, BOUKTSI M, AGELIDIS G, PAVLIDES L, KANISTRAS A
Psychiatric Hospital of Thessaloniki

The 70 year old woman, in this case report, developed paranoid delusions and visual hallucinations as a consequence of hyperdosage of daily treatment of digoxin for seven months. For the psychiatric symptomatology, she was admitted to the 3rd acute ward of the Psychiatric Hospital of Thessaloniki, as an emergency case. The patient was disoriented to the time and place and had short term memory deficits. She was agitated and had some paranoid delusions the last month. She also reported visual hallucinations. She had a history of atrial fibrillation and was receiving 0,125 mg of digoxine per day. Her deaf-problems were account for the wrong doses of digoxine intake. There was no previous history of psychiatric illness, or metabolic abnormalities to account for her psychiatric symptoms. The symptoms displayed by this patient were probably due to an effect of digoxin on the Central Nervous System. The occurrence of symptoms several w®eks after the hyperdosage of digoxin and their disappearance within four days after the cessation of digoxin therapy are strong evidence of an etiological role for digoxin. Her mental status rapidly returned to normal as digoxin intake was controlled. Six months follow-up revealed no subsequent abnormalities of her mental status. Although the cardiological side -effects of digoxin are easily recognised, little attention has been given to the side- effects of the C.N.S. Psychiatric clinical descriptions as confusional state, disorientation, impaired cognition, delusions or hallucinations have reported. They tend to affect elderly people and they can sometimes consist primary symptoms of digoxin intoxication.

Key words: Psychosis, digoxin intoxication, confusion.