[Psychotic disorders related with chronic use of mephedrone. Case report]

Area of Science:

• Psychiatry
• Toxicology
• Pharmacology

Background:

• Legal highs, often containing synthetic or botanical substances, are increasingly popular among young adults.
• Limited information exists regarding the precise contents and effects of many legal highs.
• Physicians face challenges in diagnosing and managing potential somatic and psychiatric complications associated with their use.

Observation:

• A patient with a history of regular mephedrone use (several times weekly for four months) presented with psychotic symptoms including delusions and agitation.
• Initial psychiatric hospitalization led to a schizophrenia diagnosis and olanzapine treatment, but symptoms recurred upon continued legal high use.
• A second hospitalization saw symptom resolution without antipsychotic intervention, though somnolence, apathy, and social isolation persisted.

Findings:

• Recurrent psychotic symptoms in the patient were strongly associated with persistent mephedrone intoxication.
• The resolution of psychosis without antipsychotic medication in the second hospitalization suggests a direct effect of mephedrone withdrawal or a specific drug-induced phenomenon.
• The patient's potential predisposition to psychosis remains unclear due to a lack of information on prior ultra-high risk state features.

Implications:

• This case underscores the significant psychiatric risks, including psychosis, associated with synthetic stimulant use like mephedrone.
• It highlights the diagnostic challenges in differentiating drug-induced psychosis from primary psychotic disorders.
• Further research is needed to understand the neurobiological mechanisms and long-term consequences of legal high-induced psychiatric complications.