title: Iatrogenic neuropsychiatric syndromes.
abstract: BACKGROUND
  Although tramadol induced neuropsychiatric toxicity, dependence and withdrawal have been extensively reported in chronic pain sufferers, such cases continue to surface in clinical practice.
  
  
  OBJECTIVE
  We describe two cases of atypical withdrawal after abrupt discontinuation of tramadol and a case of serotonin syndrome. The outcome was favourable in all three cases.
  
  
  CONCLUSIONS
  Patients and prescribers are reminded of the risk of severe morbidity including seizures associated with tramadol withdrawal. Serotonin syndrome can be precipitated with tramadol use especially in combination with other serotonergic drugs.
authors.affiliation: Princess Alexandra Hospital, Department of Clinical Pharmacology, Brisbane, Queensland. keat_choong@health.qld.gov.au
authors.forename: Keat
authors.initials: K
authors.lastname: Choong
authors.forename: Razvan A
authors.initials: RA
authors.lastname: Ghiculescu
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011596:Psychomotor Disorders / Q000139:chemically induced*; D020230:Serotonin Syndrome / Q000175:diagnosis*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*; D014147:Tramadol / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol