title: The serotonin syndrome: initial misdiagnosis.
abstract: BACKGROUND
  The selective serotonin reuptake inhibitors are major drugs used in psychiatry today. While serotonin syndrome has become more frequent in an overdose situation and when an interacting drug is given, the toxicity of SSIRs is less than that of most other psychiatric drugs. Although the characteristics of toxicity are defined, it seems that physicians are not aware of the phenomenon.
  
  
  OBJECTIVE
  To investigate patients with serotonin syndrome who were initially misdiagnosed.
  
  
  METHODS
  We conducted a retrospective chart review of seven patients admitted in the last 2 years with mild to severe serotonin syndrome who were initially diagnosed as having other diseases.
  
  
  RESULTS
  Most patients (5/7) were initially diagnosed with exacerbation of their psychiatric disorder. Gastroenteritis was diagnosed in two patients. One patient was suspected of having a metastatic lesion in the brain, and severe drug overdose was diagnosed in one patient. They all recovered after withholding the culprit drugs.
  
  
  CONCLUSIONS
  This report is an addition to the growing literature on misdiagnosis of psychiatric patients. Serotonin toxicity should be considered in patients in whom the combination of mental changes, neuromuscular abnormalities and autonomic hyperactivity are features of acute disease.
authors.affiliation: Department of Medicine E, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Dana
authors.initials: D
authors.lastname: Attar-Herzberg
authors.forename: Arie
authors.initials: A
authors.lastname: Apel
authors.forename: Nelly
authors.initials: N
authors.lastname: Gang
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Haim
authors.initials: H
authors.lastname: Mayan
mesh_terms: D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D003951:Diagnostic Errors; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D020230:Serotonin Syndrome / Q000175:diagnosis*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors