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Research ArticleRegular Article

Psychiatric Side Effects of Mefloquine: Applications to Forensic Psychiatry

Elspeth Cameron Ritchie, Jerald Block and Remington Lee Nevin
Journal of the American Academy of Psychiatry and the Law Online June 2013, 41 (2) 224-235;
Elspeth Cameron Ritchie
Dr. Ritchie is Chief Medical Officer, Department of Mental Health, District of Columbia Department of Health, Washington, DC. Dr. Block is Medical Director, Department of Rural Mental Health, Portland Veterans Affairs Medical Center, Portland, OR. Dr. Nevin is a doctoral student in the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. The views expressed are those of the authors alone and do not necessarily reflect the views of the District of Columbia Department of Mental Health, the Department of Veterans Affairs, or the U.S. Government.
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Jerald Block
Dr. Ritchie is Chief Medical Officer, Department of Mental Health, District of Columbia Department of Health, Washington, DC. Dr. Block is Medical Director, Department of Rural Mental Health, Portland Veterans Affairs Medical Center, Portland, OR. Dr. Nevin is a doctoral student in the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. The views expressed are those of the authors alone and do not necessarily reflect the views of the District of Columbia Department of Mental Health, the Department of Veterans Affairs, or the U.S. Government.
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Remington Lee Nevin
Dr. Ritchie is Chief Medical Officer, Department of Mental Health, District of Columbia Department of Health, Washington, DC. Dr. Block is Medical Director, Department of Rural Mental Health, Portland Veterans Affairs Medical Center, Portland, OR. Dr. Nevin is a doctoral student in the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. The views expressed are those of the authors alone and do not necessarily reflect the views of the District of Columbia Department of Mental Health, the Department of Veterans Affairs, or the U.S. Government.
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Abstract

Mefloquine (previously marketed in the United States as Lariam®) is an antimalarial medication with potent psychotropic potential. Severe psychiatric side effects due to mefloquine intoxication are well documented, including anxiety, panic attacks, paranoia, persecutory delusions, dissociative psychosis, and anterograde amnesia. Exposure to the drug has been associated with acts of violence and suicide. In this article, we discuss the history of mefloquine use and describe plausible mechanisms of its psychotropic action. Mefloquine intoxication has not yet been successfully advanced in legal proceedings as a defense or as a mitigating factor, but it appears likely that it eventually will be. Considerations for the application of claims of mefloquine intoxication in forensic settings are discussed.

Footnotes

  • Disclosures of financial or other potential conflicts of interest: Dr. Nevin has served as paid and pro bono consultant to attorneys representing litigants advancing claims of harm from exposure to mefloquine.

  • © 2013 American Academy of Psychiatry and the Law
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Journal of the American Academy of Psychiatry and the Law Online: 41 (2)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 41, Issue 2
1 Jun 2013
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Psychiatric Side Effects of Mefloquine: Applications to Forensic Psychiatry
Elspeth Cameron Ritchie, Jerald Block, Remington Lee Nevin
Journal of the American Academy of Psychiatry and the Law Online Jun 2013, 41 (2) 224-235;

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Psychiatric Side Effects of Mefloquine: Applications to Forensic Psychiatry
Elspeth Cameron Ritchie, Jerald Block, Remington Lee Nevin
Journal of the American Academy of Psychiatry and the Law Online Jun 2013, 41 (2) 224-235;
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