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The scopolamine patch is usually used to reduce postoperative nausea and vomiting associated with anesthesia and/or surgery. It is also commonly used for the prevention of motion sickness. Transdermal scopolamine patches have been used for decades and there are few reports in the literature of toxic psychosis associated with the product. Most documented cases of acute psychosis following administration of scopolamine or other anticholinergic agents have been from the adult population. Here we present a 4-year-old boy with deteriorated cognitive function and changed mental status acutely. Besides flushing skin and psychotic behaviors including bizarre actions, hallucinations, aggressive behavior, hyperactivity, and incoherent speech were also noticed. Symptoms and signs were resolved after removal of scopolamine patch and conservative management. This case is possibly one of the youngest patients to exhibit such toxic effects. We hope to relay information about common agents with anticholinergic effects to clinical practitioners and remind that drug-induced psychosis should be considered in children with acute changes in behavior., (Copyright © 2011 Formosan Medical Association & Elsevier. Published by Elsevier B.V. All rights reserved.)

Background/purpose: Cyclic vomiting syndrome (CVS) is a periodic and Stereotypic pattern of intractable nausea or vomiting episodes, which has been well-recognized in previous decades, although the actual pathogenesis is still unclear. Recurrent, discrete, but self-limited symptoms of nausea and vomiting bother children, and increase the cost of family and health care. This report described the clinical features of patients who fulfill the diagnostic criteria for CVS., Methods: This was a retrospective study that reviewed the medical records of children with CVS in our department from 1992 to 2008. The clinical features and results of long-term follow-up of these children were analyzed., Results: Twenty-four patients (16 boys and 8 girls) were enrolled in this study. The mean age of onset was 6.8 ± 3.3 years (2.2-15.4 years), and the mean interval from onset to proper diagnosis was 2.1 ± 2.2 years. Comparing initial presentation and latest condition, the duration of attack was 4.1 ± 2.2 days and 0.8 ± 1.4 days, respectively, and the admission/emergency department visit dropped from 2.3 ± 2.0 to 0.6 ± 1.1 times per year. Twenty-three of 24 patients had been treated with amitriptyline, cyproheptadine, or propranolol. Nine patients (38%) had no symptoms in the past 12 months., Conclusion: The diagnosis of CVS must be based on the detailed history of the clinical manifestations of vomiting pattern, complete symptom-free intervals between the attacks, and absence of neurological, gastrointestinal, or metabolic abnormalities. Most of our patients improve when they grow up, but prompt diagnosis and early intervention may improve quality of life., (Copyright © 2011 Formosan Medical Association & Elsevier. Published by Elsevier B.V. All rights reserved.)