A man in his 30s developed progressive multisystem organ dysfunction following 15 years of heavy recreational ketamine use. Complications included ketamine cystitis, cholangiopathy, obstructive uropathy, cardiomyopathy and mood disorder. This case illustrates chronic ketamine misuse as a cumulative multisystem toxicity.
Various factors limit the acceptability of methadone as an opioid agonist treatment (OAT), in which case, buprenorphine becomes the preferred alternative. The classical approach is to gradually taper methadone to a low dose and buprenorphine is initiated after some opioid-free period, which generally takes weeks. A novel approach known as 'microdosing' or the 'Bernese method' might serve as a...
BMJ Case ReportsAugust 14, 2024Morven Rosemary Baker, Christopher Iain O'Shea1 citation
Ayahuasca is a plant-based psychoactive decoction, traditionally used by indigenous Amazonian peoples, which commonly contains the hallucinogen N,N-dimethyltryptamine (DMT). There is now growing interest across the Western world in psychedelics including Ayahuasca.This case describes a previously well male with no risk factors for adverse psychiatric outcomes or forensic history. Following...
A previously healthy adolescent presented to the emergency department with an abrupt onset of altered mental status and abnormal behaviour, including shaking of the extremities, rocking back and forth, and non-sensical speech, after ingestion of chocolate that contained psilocybin. Neurological
We present a case of takotsubo cardiomyopathy following recreational ingestion of Psilocybe semilanceata (known as ‘magic mushrooms’). The patient presented with respiratory distress and pulmonary oedema responding to standard medical measures. Investigations included: echocardiogram, cardiac MRI and angiogram. Based on our search, we suggest this is only the second recognised case in the...
BMJ Case ReportsNovember 25, 2019Marissa Ginette Danielle Vive, Galia Valentinova Anguelova, Sjoerd Duim et al.
A 26-year-old man presented at the emergency department with confusion and decreased consciousness after several days of vomiting. In the preceding 6 months, he had used a 2-litre tank of nitrous oxide (N2O) weekly. His metabolic encephalopathy was caused by hyperammonaemia which probably resulted from interference of N2O-induced vitamin B12 deficiency with ammonia degradation. A catabolic...
We present the preliminary data in an ongoing open-label safety and tolerability proof of concept study exploring the potential role for 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in treating patients with alcohol use disorder. At this stage, seven participants have completed the full 8-week MDMA-assisted psychotherapy course, including two therapy sessions each with MDMA....
BMJ Case ReportsMarch 7, 2019Geoffrey Peter Ronan, Nicola Ronan, Siobhan Mcgettigan et al.4 citations
A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral history revealed acute ingestion of 3,4-methylenedioxymethamphetamine on a background of chronic drug abuse. His condition deteriorated requiring sedation and intubation with transfer to the intensive care unit. A diagnosis of...
Recreational drug use is a significant societal issue and remains a clinical challenge in emergency and critical care departments. We report on a 19-year-old woman admitted to hospital semiconscious and with severe hyponatraemia. Urinalysis was positive for methamphetamine and supported a diagnosis of hyponatraemia related to ecstasy use together with a syndrome of inappropriate antidiuretic...
Hallucinations, visual, auditory or in another sensory modality, often respond well to treatment in patients with schizophrenia. Some, however, do not and can be very chronic and debilitating. We present a patient with schizophrenia with intractable hallucinations despite state of the art care, including high-dose clozapine and transcranial magnetic stimulation. Based on the possible role of...
BMJ Case ReportsApril 7, 2018Nonyelum Evangeline Obiechina, Ahrane Jayakumar, Yusra Khan et al.
MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' is an illicit drug frequently used by young people at parties and 'raves'. It is readily available in spite of the fact that it is illegal.1 It is perceived by a lot of young people as being 'harmless', but there have been a few high-profile deaths associated with its use.2 Known side effects of MDMA include hyperthermia, rhabdomyolysis,...
Treatment-resistant depression (TRD) is a disabling disorder that can interfere with a patient's capacity to understand and participate in medical care and thus negatively impact individual morbidity and mortality. Hospitalised patients with TRD may require rapid alleviation of severe symptomatology, particularly when suicidal or if unable to participate in care decisions. Ketamine is well...
BMJ Case ReportsFebruary 2, 2016Elspeth Guthrie, Seri Abraham, Shahzada Nawaz
We present the case of a 28-year-old Afghan woman who presented perinatally with concerns of being possessed by jinns. She was noted to have third person auditory hallucinations, delusions of control and somatic passivity. She was diagnosed with schizophrenia and was treated with antipsychotic medications with a positive outcome. Her husband also believed that his wife was possessed and...
The recreational use of ketamine is increasing in popularity due to its dissociative and paralytic effects, ease of availability and low cost. However, serious and frequently irreversible damage to the urinary tract is a recently recognised side effect of recreational ketamine use. The authors present a case of a young male patient with a 2-year history of troublesome lower urinary tract...
This is a case of a 21-year-old lady who presented with history of episodes where she would display extraordinary strength while becoming aggressive towards her family members, speak in foreign language and display bizarre behaviour. The episode would last for 15-20 min and would resolve spontaneously. She would always claim amnesia for the event. This would remain irritable in the intervening...
BMJ Case ReportsFebruary 15, 2011Kazuhiro Tajima-Pozo, Diana Zambrano-Enriquez, Laura De Anta et al.
Historically, many cases of demonic possession have masked major psychiatric disorder. Our aim is to increase awareness that symptoms of schizophrenia are still being classified as demonic possession by priests today. We report the case of a 28-year-old patient who had been diagnosed 5 years previously with paranoid schizophrenia (treated with clozapine, risperidone, ziprasidone and onlanzapine...
BMJ Case ReportsJuly 7, 2009Ingo Kleiter, Ralf Luerding, Gerhard Diendorfer et al.
The case of a 23-year-old mountaineer who was hit by a lightning strike to the occiput causing a large central visual field defect and bilateral tympanic membrane ruptures is described. Owing to extreme agitation, the patient was sent into a drug-induced coma for 3 days. After extubation, she experienced simple and complex visual hallucinations for several days, but otherwise largely recovered....