| Summary points: | A 34-year-old cocaine and alcohol addict with history of type 1 diabetes, diabetic retinopathy, and diabetic polyneuropathy treated with haloperidol, lormetazepam, and gabapentin presents with altered gait and mental deterioration as well as compulsive smoking of 80 to 100 cigarettes per day. This case details the patient's history, treatments, and outcome. The authors discuss the mechanism of action of topiramate and the interactions between smoking and antipsychotic medications. |