Refractory Psychosis After Carbon Monoxide Poisoning: a Case Report.

Area of Science:

• Neuroscience
• Psychiatry
• Toxicology

Background:

• Carbon monoxide (CO) poisoning can lead to severe neurological and psychiatric sequelae.
• Refractory psychosis presents a significant challenge in clinical management, often requiring extensive treatment trials.

Observation:

• A 65-year-old woman developed refractory psychosis, including paranoia and auditory hallucinations, after attempted suicide via charcoal burning (CO poisoning).
• Initial treatment with quetiapine, followed by olanzapine augmentation with amisulpride and valproate sodium, yielded poor clinical response.
• The patient remained significantly distressed and psychotic despite multiple antipsychotic trials.

Findings:

• Switching to clozapine (300 mg nightly) resulted in marked improvement of psychotic symptoms.
• While residual auditory hallucinations persisted, the patient experienced reduced distress associated with them.

Implications:

• Clozapine may be an effective treatment option for refractory psychosis secondary to carbon monoxide poisoning.
• This case highlights the complex neuropsychiatric manifestations of CO poisoning and the need for persistent therapeutic strategies.
• Further research into the neurobiological mechanisms underlying CO-induced psychosis and clozapine's efficacy is warranted.