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Propionic acidemia, an autosomal recessive disorder, is a common form of organic aciduria resulting from the deficiency of propionyl-CoA carboxylase. It is characterized by frequent and potentially lethal episodes of metabolic acidosis often accompanied by hyperammonemia. A wide range of brain abnormalities have been reported in propionic acidemia. We report recurrent visual hallucinations in 2 children with propionic acidemia. Four visual hallucination events were observed in the 2 patients. Three episodes were preceded by an intercurrent illness, and 2 were associated with mild metabolic decompensation. The 2 events in one patient were associated with a seizure disorder with abnormal electroencephalogram. Brain magnetic resonance imaging showed abnormal basal ganglia and faint temporo-occipital swelling bilaterally. This is probably the first report of visual hallucinations in propionic acidemia and should alert the treating clinicians to look for visual hallucinations in patients with organic acidurias, especially in an unusually anxious child.

Despite the known association of folie à deux with low intelligence, very few reports of its occurrence in people with documented mental retardation have been published. A case of folie à deux in a 32 year old man with moderate mental retardation is described and the clinical implications discussed. The need for an increased awareness of the existence of mental illness in the mentally handicapped is also emphasized.

Symptoms resembling mania following withdrawal of diazepam in a mentally handicapped woman are described. The importance of considering benzodiazepine withdrawal in the assessment of acute behavioural disorders of the mentally handicapped is emphasized. Attention is also drawn to the paucity of research regarding the use of antianxiety drugs in the mentally handicapped.

In a study of the prevalence of life events in recurrent depression, 40 patients with recurrent episodes were compared to 33 who were experiencing their first depressive illness. Thirty out of 33 (90.9%) first episode cases experienced life events prior to the onset of illness whereas only 20 out of 40 (50%) of the recurrent group gave such as history. Patients with a first episode had an average of 2.2 life events in the six months prior to onset, whereas recurrent patients experienced average of only 0.8 life events (p less than 0.05). Negative as well as exit events were also significantly more frequent among the first episode group. Although life events, age and sex all contributed to the recurrence of depression, most of the variance was not accounted for by any of these factors.