Citation

McCarthy S. J. Parasitol. Res. 2015; 2015.

Copyright

(Copyright © 2015, Hindawi Publishing)

DOI

10.1155/2015/287651

PMID

unavailable

Abstract

The Australian Defence Force (ADF) has used mefloquine for malaria chemoprophylaxis since 1990. Mefloquine has been found to be a plausible cause of a chronic central nervous system toxicity syndrome and a confounding factor in the diagnosis of existing neuropsychiatric illnesses prevalent in the ADF such as posttraumatic stress disorder and traumatic brain injury. Overall health risks appear to have been mitigated by restricting the drug's use; however serious risks were realised when significant numbers of ADF personnel were subjected to clinical trials involving the drug. The full extent of the exposure, health impacts for affected individuals, and consequences for ADF health management including mental health are not yet known, but mefloquine may have caused or aggravated neuropsychiatric illness in large numbers of patients who were subsequently misdiagnosed and mistreated or otherwise failed to receive proper care.

FINDINGS in relation to chronic mefloquine neurotoxicity were foreseeable, but this eventuality appears not to have been considered during risk-benefit analyses. Thorough analysis by the ADF would have identified this long-term risk as well as other qualitative risk factors. Historical exposure of ADF personnel to mefloquine neurotoxicity now also necessitates ongoing risk monitoring and management in the overall context of broader health policies. © 2015 Stuart McCarthy.

Language: en

Keywords

human; mental health; suicide; systematic review; traumatic brain injury; bipolar disorder; insomnia; psychotherapy; suicidal ideation; depression; prevalence; aggression; schizophrenia; social support; psychosis; suicidal behavior; military medicine; risk assessment; social isolation; environmental exposure; wellbeing; longitudinal study; drug overdose; monitoring; posttraumatic stress disorder; mood disorder; neuroimaging; unemployment; risk factor; fatigue; anorexia; mental disease; questionnaire; retrospective study; socioeconomics; health care policy; clinical feature; tachycardia; priority journal; hallucination; headache; somnolence; vertigo; cognitive therapy; paranoia; impulsiveness; anxiety disorder; panic; coma; myoclonus; neurotoxicity; pesticide; malaria; nonhuman; doxycycline; confusion; convulsion; drug safety; placebo; family history; psychometry; medical research; seizure; risk benefit analysis; drug tolerability; tremor; health care management; restlessness; risk management; prophylaxis; mania; neurologic disease; side effect; amnesia; agitation; tinnitus; brain disease; qualitative analysis; exposure; drug synthesis; emotional stability; low drug dose; drug contraindication; ataxia; concentration loss; solvent; histopathology; paresthesia; psychopathy; nervousness; depersonalization; disease duration; dizziness; vestibular disorder; central nervous system disease; mepacrine; nerve cell degeneration; neuropathy; memory disorder; quantitative analysis; delusional disorder; Article; coordination disorder; chloroquine; Symptom Checklist 90; mefloquine; visual disorder; blood brain barrier; heavy metal; vivid dream; lassitude; abnormal dreaming; brain toxicity; balance disorder; hearing impairment; nerve degeneration; faintness; neurotoxicology; malaria falciparum; clioquinol; phase 3 clinical trial (topic); aptitude test; Australian; antimalarial drug resistance; disease eradication; mood swing; organisational context; pamaquine; peripheral motor neuropathy; peripheral sensory neuropathy; Plasmodium vivax malaria; postconcussive syndrome; Present State Examination; quinoline; repetition exposure