A Case of Manic-Like Symptoms and Confusion After Supplement Ingestion

A variety of etiologies can lead a patient to present with symptoms that appear manic. A wide differential should be considered, including delirium, which may in turn be caused by multiple etiologies. Substance ingestion, specifically of dietary supplements, is one potential trigger that is not always considered. A 40-year-old male patient with a history of long-standing attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression presented with anxiety, restlessness, memory gaps, nausea, low appetite, and insomnia. Prior to admission, the patient started taking an herbal supplement for 15 days and stopped taking lisdexamfetamine for 1.5 weeks. Upon initial presentation, the patient was hypertensive and tachycardic. The physical exam was significant for bilateral conjunctival injection and hand tremors. He was disoriented to time and had tangential, pressured speech. A comprehensive medical work-up was largely unremarkable. The urine drug screen was positive for amphetamines and marijuana. The Psychiatry Consultation and Liaison Service evaluated this patient and diagnosed him with delirium, possibly secondary to the supplement side effects. The supplement was discontinued, and the patient's symptoms resolved within 24 hours. While many diagnoses were considered for this patient, delirium, possibly triggered by starting a new herbal supplement, was determined to be the most likely etiology. Many supplements have not been well-studied and are inadequately regulated. This case highlights the potential for clinically significant adverse effects associated with supplement use and emphasizes the need for further research into their safety profiles, pharmacokinetics, and neuropsychiatric consequences to improve patient care and education.