Mefloquine Increases the Risk of Serious Psychiatric Events During Travel Abroad: A Nationwide Case-Control Study in the Netherlands
J Clin Psychiatry 2005;66(2):199-204
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Psychiatric events during travel
abroad account for a large percentage of medical repatriations
arranged by insurance companies. Several risk factors have been
proposed for such events, one of these being use of mefloquine.
We investigated the risk of psychiatric events during use of
Method: We performed a nationwide case
control study using medical records from 4 large alarm centers in
the Netherlands. Cases were patients contacting the alarm centers
because of psychiatric events, according to International Code
Primary Care code P (all psychiatric symptoms) or International
Classification of Diseases, Ninth Edition, codes 290-319 (all
psychiatric syndromes). To every case we matched up to 6 controls
by alarm center, calendar time, and continent of travel. All
controls had contacted the alarm centers because of
nonpsychiatric medical reasons. Shortly after the anticipated day
of return, cases and controls received a questionnaire regarding
travel characteristics, gender, age, marital status, education,
weight, height, general health, history of psychiatric diseases,
use of medicines, smoking status, alcohol intake, coffee intake,
and use of malaria prophylaxis. Dates of travel for the source
population were between September 1, 1997, and June 1, 2000.
Results: The study population consisted
of 111 cases and 453 controls. The risk of psychiatric events
during the use of mefloquine was 3.5 (95% CI = 1.4 to 8.7). In
females, the risk was strongly increased, with an odds ratio of
47.1 (95% CI = 3.8 to 578.6). Stratification for history of
psychiatric diseases showed that the risk of psychiatric events
during use of mefloquine in cases without a history of
psychiatric diseases was 3.8 (95% CI = 1.4 to 10.1), whereas the
risk in cases with a history of psychiatric diseases was 8.0 (95%
CI = 1.8 to 35.8).