Combined NMDA Inhibitor Use in a Patient with Multisubstance-induced Psychotic Disorder

Matteo Caloro, Giuseppa Calabrò, Eleonora De Pisa, Enrico Rosini, Georgios D. Kotzalidis, Davide Lonati, Carlo Alessandro Locatelli, Pietro Papa, Fabrizio Schifano, Paolo Girardi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Novel psychoactive substance use is a major social concern. Their use may elicit or uncover unpredictably as yet undescribed clinical pictures. We aimed to illustrate a multisubstance use case indistinguishable from paranoid schizophrenia, so to alert clinicians on possibly misdiagnosing substance-induced psychotic disorders. Case report: We describe a case of a 32-year-old man who started at 18 years with cannabinoids and ketamine, and is currently using N-methyl-d-Aspartate (NMDA) antagonists. At age 23, he developed social withdrawal after being assaulted by a stranger, but did not consult psychiatrists until age 26; during this period, he was using internet-purchased methoxetamine and ketamine, and was persecutory, irritable, suspicious, and insomniac and discontinued all received medical prescriptions. He added dextromethorphan to his list of used substances. At age 31, while using phencyclidine, and, for the first time, methoxphenidine, he developed a religious delusion, involving God calling him to reach Him, and the near-death experiences ensured by NMDA antagonists backed his purpose. He received Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of multisubstance-induced psychotic disorder and was hospitalized 8 times, 6 of which after visiting the emergency room due to the development of extreme anguish, verbal and physical aggression, and paranoia. He reportedly used methoxphenidine, methoxyphencyclidine, ethylnorketamine, norketamine, and deschlorketamine, to achieve near-death experiences, and eventually to reach God in heavens. Conclusions: This case points to the need for better control of drugs sold on the internet. It also illustrates that people using NMDA antagonists may present clinical pictures indistinguishable from those of major psychoses and are likely to be misdiagnosed.

Original languageEnglish
Pages (from-to)247-251
Number of pages5
JournalJournal of Addiction Medicine
Volume12
Issue number3
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Aspartic Acid
Psychotic Disorders
Ketamine
Diagnostic Errors
Internet
Dextromethorphan
Paranoid Schizophrenia
Paranoid Disorders
Phencyclidine
Delusions
Cannabinoids
Drug and Narcotic Control
Aggression
Psychological Stress
Diagnostic and Statistical Manual of Mental Disorders
Prescriptions
Psychiatry
Hospital Emergency Service
1-(1-(2-methoxyphenyl)-2-phenylethyl)piperidine

Keywords

  • internet drug market
  • methoxetamine
  • methoxyphencyclidine
  • methoxyphenidine
  • multisubstance-induced
  • N-methyl-d-Aspartate antagonists
  • psychosis

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Combined NMDA Inhibitor Use in a Patient with Multisubstance-induced Psychotic Disorder. / Caloro, Matteo; Calabrò, Giuseppa; De Pisa, Eleonora; Rosini, Enrico; Kotzalidis, Georgios D.; Lonati, Davide; Locatelli, Carlo Alessandro; Papa, Pietro; Schifano, Fabrizio; Girardi, Paolo.

In: Journal of Addiction Medicine, Vol. 12, No. 3, 01.01.2018, p. 247-251.

Research output: Contribution to journalArticle

Caloro, Matteo ; Calabrò, Giuseppa ; De Pisa, Eleonora ; Rosini, Enrico ; Kotzalidis, Georgios D. ; Lonati, Davide ; Locatelli, Carlo Alessandro ; Papa, Pietro ; Schifano, Fabrizio ; Girardi, Paolo. / Combined NMDA Inhibitor Use in a Patient with Multisubstance-induced Psychotic Disorder. In: Journal of Addiction Medicine. 2018 ; Vol. 12, No. 3. pp. 247-251.
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