First episode of catatonia followed by a psychotic episode related to chronic nitrous oxide use: A case report
Tanguy Taillefer de Laportalière, Maximilien Redon, A. Roussin, Estelle Willemet, Etienne Very, Jean Olivier, Maryse Lapeyre-Mestre
Drug and Alcohol Review February 3, 2025 DOI: 10.1111/dar.14012 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 20-year-old woman with a history of frequent nitrous oxide use |
| Intervention | Nitrous oxide |
| Duration | Nine months after the catatonic episode, she experienced a psychotic episode; one year after the initial neuropathy, she presented with catatonia |
| Key findings | The authors report a 20-year-old woman with chronic nitrous oxide use who developed peripheral neuropathy, then catatonia with vitamin B12 deficiency and hyperhomocysteinemia, and later a psychotic episode. They propose that nitrous oxide-induced hyperhomocysteinemia may explain these psychiatric complications and suggest homocysteine, methylmalonic acid, and active vitamin B12 as key biomarkers. |
Abstract
Abstract Introduction Nitrous oxide is widely used for recreational purposes, leading to constantly increasing cases of severe use disorder. Although the scope of the deleterious consequences of nitrous oxide use is relatively well described for neurological and thromboembolic‐related complications, this is not the case in the psychiatric field. Case Presentation We report the case of a 20‐year‐old woman who developed nitrous oxide‐induced peripheral neuropathy. The patient had a history of frequent nitrous oxide use. One year later, she presented with catatonia linked to nitrous oxide use, associated with vitamin B12 deficiency and hyperhomocysteinemia, with no apparent psychiatric causes. Nine months after the catatonic episode, she experienced a psychotic episode linked to long‐term nitrous oxide use. Discussion and Conclusion To the best of our knowledge, this is the first report describing a cascade of neurologic and psychiatric complications of chronic use of nitrous oxide. Hyperhomocysteinemia caused by nitrous oxide consumption could explain the occurrence of such events. Homocysteine, methylmalonic acid, and active vitamin B12 are key biomarkers to determine the involvement of nitrous oxide in psychiatric symptoms.