Benzodiazepine-Induced Acute Psychosis Leading to Self-Enucleation and Auto-Cannibalism

Lorazepam is a benzodiazepine that has been FDA-approved as a fast-acting anxiolytic and sedative. It is one of the most commonly used medications for these indications and is considered highly effective and safe. We present a case of a patient without prior mental illness who received intravenous lorazepam to treat anxiety and claustrophobia in order to facilitate an MRI, and who subsequently developed acute psychosis, performed self-inflicted digital enucleation of his left eye, and then ingested it. Despite an extensive evaluation by ophthalmology, neurology, neurosurgery, infectious disease, and psychiatry, the ultimate etiology of the patient's psychosis was thought to be acute delirium due to benzodiazepine use. This case report demonstrates a very rare but life-threatening paradoxical side effect of benzodiazepines, as well as the extensive evaluation patients should undergo for acute psychosis in the hospital. Recognition and awareness of this paradoxical drug side effect are essential for providers administering benzodiazepines to ensure patient safety.