BMJ case reports
March 7, 2019
Geoffrey Peter Ronan, Nicola Ronan, Siobhan Mcgettigan et al.
4 citations
A 26-year-old cachectic man with chronic drug abuse presented with altered mental status, agitation, tremors, hyperthermia, diaphoresis, and dilated pupils after acute ingestion of MDMA. His condition deteriorated, requiring sedation and intensive care. Serotonin syndrome was diagnosed using Hunter criteria, and supportive care managed a brief delirium. After recovery, blood work revealed concurrent thyrotoxicosis, which may have contributed. He was treated for thyroid disease and referred for specialist follow-up.
BMJ case reports
August 14, 2024
Morven Rosemary Baker, Christopher Iain O'Shea
1 citation
A man with no prior psychiatric risk factors or criminal history developed a lasting psychotic episode after using ayahuasca, a plant-based psychedelic containing DMT. During the episode he seriously assaulted a relative and was admitted to a forensic psychiatric unit. Treatment with the antipsychotic aripiprazole resolved his psychotic symptoms, and recovery was sustained 18 months after admission. Previous case reports described psychosis after ayahuasca use but typically brief and in people with personal or family psychiatric history or other substance use. This case highlights that ayahuasca can trigger prolonged psychosis and risk of violence even in low-risk individuals.
BMJ case reports
July 8, 2026
Cocoa Mudgal, H J Bodansky
Chronic heavy ketamine use over 15 years in a man in his 30s led to progressive failure of multiple organ systems, including bladder inflammation (ketamine cystitis), bile duct damage (cholangiopathy), urinary tract obstruction, heart muscle disease (cardiomyopathy), and mood disorder. The case demonstrates that long-term ketamine misuse can cause cumulative, widespread toxicity affecting many parts of the body.
BMJ case reports
November 7, 2024
Yesh Chandra Singh, Shalini Singh, Roshan Bhad et al.
Transitioning from methadone to buprenorphine for opioid agonist treatment can be limited by factors like withdrawal symptoms and lengthy tapering. A novel approach called microdosing, or the Bernese method, offers a faster alternative. Two cases are described in which patients successfully switched from methadone to buprenorphine using this method, suggesting it may be a valuable option for those who cannot tolerate the classical gradual taper.
BMJ case reports
November 25, 2019
Marissa Ginette Danielle Vive, Galia Valentinova Anguelova, Sjoerd Duim et al.
A 26-year-old man arrived at the emergency department confused and with decreased consciousness after several days of vomiting. For the preceding six months, he had used a 2-liter tank of nitrous oxide weekly. His metabolic encephalopathy was caused by hyperammonaemia, probably resulting from nitrous-oxide-induced vitamin B12 deficiency interfering with ammonia degradation. A catabolic state may have contributed. After treatment with vitamin B12 and lactulose, both his consciousness and hyperammonaemia improved. He reported no residual complaints after three months of follow-up. The authors recommend considering hyperammonaemia as a cause of metabolic encephalopathy in cases of nitrous oxide use and altered mental status.