The many faces of psilocybin-related psychosis: A case series
Yumin Kim, Rachel Bigley, Aubrey DeVinney, Paul S. Nestadt
Psychiatry Research Case Reports December 7, 2024 DOI: 10.1016/j.psycr.2024.100243 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Patients in a dual diagnosis inpatient psychiatry unit |
| Intervention | neuroleptic medication |
| Topics | Psilocybin |
| Citations | 4 |
| Key findings | Psilocybin use was associated with prolonged psychosis, paranoia leading to suicide attempt, and mania-like symptoms, with varying treatment responses. |
Abstract
Psilocybin use has been increasingly popular in the United States, and its use as a novel therapeutic treatment for psychiatric conditions has led to greater public acceptance as a recreational substance. Consequently, clinicians are faced with managing complications and adverse effects associated with psilocybin use. We present three cases seen in a dual diagnosis inpatient psychiatry unit during a four-week period in 2023: Case 1: the case of intermittent psilocybin use associated with a particularly prolonged psychosis requiring treatment with higher doses and a longer course of neuroleptic medication; Case 2: the case of a short period of frequent psilocybin use culminating into increasing paranoia and a medically serious suicide attempt treated with neuroleptics; and Case 3: the case of long-term “microdosing” followed by mania-like symptoms including grandiosity, irritability, and physical aggression towards others, but with resolution of symptoms after discontinuing psilocybin use. Amidst psilocybin's increasing prevalence and acceptance, clinicians are faced with managing the complications and adverse effects of psilocybin use with minimal guidelines or evidence. This case series aims to highlight varied presentations, management strategies, and treatment responses to contribute some insight into this unknown territory.
Comparable studies
Other case reports and case series on psilocybin, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psilocybin Mushroom (Psilocybe semilanceata) Intoxication with Myocardial Infarction 18-year-old man | 1998 | Case study | n = 1 |
| Relief from intractable phantom pain by combining psilocybin and mirror visual-feedback (MVF) Person with leg amputation and phantom-limb pain | 2018 | Case study | n = 1 |
| Hallucinogen persisting perception disorder after psilocybin consumption: a case study 18-year-old man with HPPD after mixed psilocybin and cannabis intoxication | 2005 | Case study | n = 1 |
| Microdosing psilocybin for chronic pain: a case series Individuals with chronic neuropathic pain | 2022 | Case series | n = 3 |
| Psilocybin and Obsessive Compulsive Disorder Individual with Obsessive Compulsive Disorder | 2014 | Case study | n = 1 |
Citations in the library
Cited by 3
- Chronic psilocybin administration increases sociability and alters the gut microbiome in male wild-type mice but not in a preclinical model of obsessive-compulsive disorder Neuropharmacology August 21, 2025
- Freedom of Recreation: A Critique of the Prohibition, Decriminalization, and Legal Regulation of Psychedelics for Recreational Use Contemporary Drug Problems August 28, 2025
- Psilocybin and ayahuasca in treatment-resistant depression: clinical evidence, methodological constraints and ethical challenges: a narrative review Frontiers in Psychiatry September 15, 2026
Cites 19
- Psilocybin induces schizophrenia-like psychosis in humans via a serotonin-2 agonist action Neuroreport December 1, 1998
- Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences Journal of Psychopharmacology August 31, 2016
- Acute, subacute and long-term subjective effects of psilocybin in healthy humans: a pooled analysis of experimental studies Journal of Psychopharmacology September 20, 2010
- Psychedelics and Mental Health: A Population Study PLoS One August 19, 2013
- Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study BMJ March 1, 2011
and 14 more in the library