Cureus
February 19, 2025
Paria Parhami, Sydney E Moriarty, Jay Parikh et al.
A 60-year-old female veteran with chronic PTSD and no prior psychiatric hospitalizations developed persistent delusions of parasitic infestation after 18 months of recreational intravenous DMT use. Her delusions that worms were coming out of her skin persisted despite haloperidol treatment but improved after 15 days of hospitalization following substance clearance and psychoeducation. The timing of hallucinogen use and symptom onset was not fully consistent, raising concern for a primary delusional disorder exacerbated by substance use. This novel case suggests a potential link between prolonged DMT use and delusional parasitosis, highlighting the need for further research.
Cureus
February 1, 2025
Eric Boccio, Jason Haidar, Michael Thiefault et al.
Chronic, high-dose ketamine use can cause a cluster of symptoms—severe abdominal pain, nausea, vomiting, and painful urination—known as K-cramps. A 25-year-old woman who used 500–1000 milligrams of ketamine weekly presented with these symptoms; lab tests were normal, and she was diagnosed with K-cramps after ruling out other causes. Treatment with intravenous fluids, antiemetics, and benzodiazepines resolved her symptoms. The condition is underrecognized by emergency physicians, leading to delayed diagnosis and unnecessary testing. Awareness and proper management, including harm reduction counseling and addiction medicine referral, are important for acute care.
Cureus
January 1, 2025
Sorcha O'Connor, Kate Godfrey, Sara Reed et al.
correction
A protocol describes a planned study testing whether a low-moderate dose of psilocybin (10 mg), combined with non-interventional therapy, can improve cognitive flexibility and neuroplasticity in people with obsessive-compulsive disorder (OCD). Twenty blinded participants will receive an active placebo (1 mg psilocybin) in a first session and 10 mg in a second session four weeks later. Cognitive flexibility will be measured with the intradimensional-extradimensional shift task two days after each session, and neuroplasticity will be assessed via electroencephalography immediately after each session. Secondary outcomes include OCD symptom severity and patient-reported measures. The results are expected to clarify neural mechanisms and guide a future randomized controlled trial.
Cureus
January 1, 2025
Mitchell B Liester
A woman with primary Raynaud's phenomenon experienced significant symptom improvement while receiving low-dose sublingual ketamine for treatment-resistant depression. Ketamine, an FDA-approved anesthetic, has vasodilatory properties that may enhance blood flow and reduce vascular constriction. This case report suggests that ketamine could be a safe and inexpensive treatment for Raynaud's phenomenon, warranting further research.
Cureus
December 1, 2024
Ahmed Z Salama, Mohammad R Dabash, Abdullah Elayan et al.
Dissociative trance disorder, a type of other specified dissociative disorder, involves abrupt loss of awareness, unresponsiveness, and involuntary actions, with individuals feeling separated from their body as if controlled by an external force. A 22-year-old patient with no prior criminal history experienced episodes of decreased consciousness, altered identity, and involuntary movements, perceived as external control, culminating in a tragic event where she killed her children. After ruling out psychotic disorders, organic factors, and substance abuse, dissociative trance disorder was diagnosed. Treatment with cognitive behavioral therapy, antidepressants, antipsychotics, and benzodiazepines improved symptoms.
Cureus
November 1, 2024
Bárbara L Mesquita, Daniela Jeremias, Ana Margarida Fraga et al.
A middle-aged man with no prior psychiatric history developed visual and persisting auditory hallucinations for months after recovering from very severe COVID-19. While hospitalized, he also reported a near-death experience and seeing his deceased father. The connection between the virus and neuropsychiatric symptoms is thought to arise from direct and indirect impacts on the brain. The case highlights the need for research into adequate interventions for severe neuropsychiatric manifestations following COVID-19.
Cureus
November 1, 2024
Catherine R La Spina, Patricia Pozo, Gisele J Wakim
Complex regional pain syndrome (CRPS) is a chronic pain disorder that often follows trauma, causing severe pain and autonomic disturbances. Managing CRPS is difficult because no FDA-approved medications exist, and off-label treatments like NSAIDs, corticosteroids, gabapentin, antidepressants, and bisphosphonates have limited or varying efficacy. Surgical options such as nerve blocks and spinal cord stimulation can help but have inconsistent success. A case study describes a patient with a treatment-resistant CRPS flare-up managed through revision neurolysis of the sciatic, tibial, and perineal nerves, release of the right tibial nerve, and intraoperative ketamine.
Cureus
November 1, 2024
Ayoyimika O Okunlola, Syahmina Sufrian, Temitope O Ajao et al.
Chronic abuse of ketamine as a recreational drug can cause damage to multiple organs. In a 24-year-old patient with no prior medical issues, the toxic metabolites of ketamine led to dysfunctions including acute kidney injury, acute systolic dysfunction, gastric dilatation, hydronephrosis, and ketamine-induced cholestasis. Stopping ketamine use is the primary treatment; other interventions offer only partial relief from the harm caused.
Cureus
October 1, 2024
Sana Rahman, Samiya Saher, Anurag Raje et al.
A 34-year-old woman who used about 5 grams of ketamine daily for two years starting at age 25 developed stage 3 chronic kidney disease and severe urinary complications, including dysuria, flank pain, burning micturition, ketamine-associated cystitis, and renal failure from hydronephrosis. Even after stopping ketamine five years ago, she still needs ureteral stents for recurrent hydronephrosis and ureteral obstruction. Early cessation of ketamine often resolves ulcerative cystitis and ureteral obstruction, but that did not happen in this patient. The case underscores the need to suspect ketamine abuse in young patients with ureteral problems and hydronephrosis, and to pursue early detection, ongoing follow-up, and a comprehensive treatment approach.
Cureus
September 1, 2024
Kaustuv Das, Jayshree Sen, Aishwarya S Borode
Ketamine, known for blocking NMDA receptors, also enhances AMPA receptor function, which may improve sensory processing in the somatosensory cortex. This review of preclinical and clinical studies suggests that ketamine's modulation of AMPA receptors, which are crucial for fast excitatory neurotransmission and synaptic plasticity, contributes to its therapeutic effects, including rapid antidepressant action. The findings indicate potential for ketamine-based therapies to treat sensory processing disorders and refine treatment strategies for mood disorders. A deeper understanding of these mechanisms could guide targeted interventions.
Cureus
August 1, 2024
Madalena Carvalho, Ana Teresa Guerra, Marta Moniz et al.
Intravenous sedation with ketamine and midazolam is a safe method for painful procedures in children, with a low rate of adverse events. In a pediatric emergency department in Portugal, 615 children (median age 6 years) received sedation, mostly for wound suturing (50.9%) or fracture reduction (36.3%). Ketamine was used in 99.2% of cases and midazolam in 95.8%, with 93.8% receiving both. Adverse events occurred in 8.1% of patients, most commonly transient oxygen desaturation (2%), vomiting (1.5%), apnea or bradypnea (1%), and hallucinations (0.8%). Respiratory complications resolved without invasive interventions. The occurrence of adverse events was not dose-dependent.
Cureus
August 1, 2024
Priyanka Saraswati, Satish Kanaujia, Bhuwan Chandra Kapri
A six-week yoga program involving pranayama and meditation improved sleep quality, reduced stress and anxiety, increased mindfulness, and decreased psychological rigidity and experience avoidance in recreational athletes aged 18 to 45. The study included 44 athletes from Banaras Hindu University, most of whom were male and had over two years of sports experience. Significant pre- to post-intervention differences were observed across all measured outcomes, including stress, sleep, anxiety, mindfulness, psychological rigidity, and experience avoidance. Stress alleviation and reduced anxiety were the strongest predictors of improved psychological flexibility.
Cureus
July 1, 2024
Indushree Manjunath, Varun Channappa, Aditya Karthikeyan
Yoga can serve as a supplementary therapy for children with attention-deficit/hyperactivity disorder (ADHD), improving symptoms and associated issues like stress, depression, and anxiety. A review of seven articles indicates that yoga interventions help create a more supportive family environment, fostering growth. This nonpharmacological approach addresses parental concerns about stimulant medication side effects in young children.
Cureus
July 1, 2024
Sabastain F Forsah, Bibi Razak, Divine Besong Arrey Agbor et al.
Ecstasy (MDMA) use can cause rhabdomyolysis, a breakdown of muscle tissue that may lead to severe acute kidney injury requiring temporary hemodialysis. A patient who used MDMA only twice experienced severe rhabdomyolysis and acute kidney injury on both occasions, indicating that some individuals are particularly susceptible to these adverse effects. Health professionals should screen adolescents and young adults for illicit drug use and counsel against it.
Cureus
June 1, 2024
David Mestre, Alexandra Paula, Francisco P Gil et al.
A patient without structural heart disease experienced multiple cardiac arrests after a single low dose of ibogaine (200 mg, 2.6 mg/kg). The case highlights that even minimal doses of ibogaine can cause lethal cardiotoxicity, specifically acquired long QT syndrome leading to polymorphic ventricular tachycardia and torsade de pointes. This warns against the use of ibogaine, which is sometimes used in alternative clinics for opioid dependence or recreationally, despite its serious cardiac risks.
Cureus
November 1, 2020
B. Pradhan, Garrett Rossi
Opioid addiction remains a national crisis in the United States despite available treatments. Repetitive transcranial magnetic stimulation (rTMS) and subanesthetic ketamine are each effective for opioid use disorders (OUD) when used alone, but their benefits can fade after treatment stops. No prior study has combined both treatments for OUD. TIMBER therapy, which alters emotionally charged memories through extinction and reconsolidation, has been successful in chronic PTSD and with ketamine. TIMBER balances memory extinction and reconsolidation approaches, avoiding over-flooding or retraumatization, and shows superior efficacy in PTSD and potential benefit in substance use disorders.
Cureus
July 1, 2026
Hoi Ki Cheung, Ngo Cheung
A 16-year-old female with moderate depression and severe anxiety, including obsessive rumination and difficulty distinguishing fantasy from reality, received a treatment regimen combining dextromethorphan, a CYP2D6-inhibiting antidepressant, piracetam, and risperidone. Over six months, depressive and anxiety symptoms improved to mild ranges, and obsessional symptoms reportedly reduced by more than 30% after dextromethorphan escalation and piracetam introduction. The patient showed better ability to interrupt rumination and improved fantasy-reality differentiation. No side effects were documented. The authors suggest NMDA-AMPA modulation may help adolescents disengage from rigid perseverative loops, but caution that polypharmacy and other factors limit interpretation.
Cureus
May 1, 2026
Ngo Cheung
A 25-year-old woman with trauma-related dissociation, including derealisation, memory gaps, and fugue-like episodes, experienced complete and sustained resolution of dissociative blank-outs and fugue-like states after treatment with a combination of dextromethorphan (30-60 mg/day), fluoxetine, piracetam, and a low-dose antipsychotic over seven months. Depressive symptoms improved from moderate to mild, while anxiety and emotional reactivity only partially improved. The case suggests that oral NMDA-AMPA modulation may help restore cognitive integration in trauma-related dissociation, though residual anxiety may need additional therapy.
Cureus
September 1, 2025
Aditya Lal Vallath, Ratan P Yadav, Michelle Bass et al.
Nitrous oxide (N2O) abuse is rising among adolescents and young adults, driven by easy access to flavored canisters sold as cooking aids and promotion on social media platforms like TikTok and YouTube. This review of 13 studies (retrospective cohorts, case series, cross-sectional surveys) found that use is highest among those aged 16–30, with males and socioeconomically disadvantaged groups disproportionately affected. The most serious physical consequence is subacute combined degeneration of the spinal cord, causing numbness, tingling, muscle weakness, and coordination problems. Biochemically, N2O abuse causes functional vitamin B12 deficiency, raising homocysteine and methylmalonic acid levels.
Cureus
August 1, 2025
Lindsay A Turmelle, Carl Chotas
Chronic recreational use of nitrous oxide can cause severe neurological and hematological toxicity, as shown in a case of a young adult who presented with abdominal pain, vomiting, confusion, radicular pain in the upper extremities, and later developed depressive symptoms, insomnia, and ataxia. Laboratory tests revealed severe neutropenia, pancytopenia, and vitamin B12 deficiency, confirming nitrous oxide-induced neurotoxicity. Treatment included stopping nitrous oxide use, vitamin B12 supplementation, psychiatric care, and supportive therapy, leading to gradual improvement. The case underscores the growing public health concern of nitrous oxide abuse, which can cause potentially irreversible neurological damage linked to vitamin B12 deficiency, and highlights the need for early recognition and preventive measures.
Cureus
August 1, 2025
Vanessa C Cornelio, Gary Lail, Kimberly Go et al.
Prolonged and frequent misuse of nitrous oxide, especially among adolescents and young adults, can cause lasting neuropsychiatric harm. The gas disrupts vitamin B12 metabolism, impairing myelin production and leading to spinal cord degeneration. Neuroimaging shows deactivation of the hippocampus and visual cortices, matching observed memory and sensory deficits. Psychiatric complications include depression, delusions, and agitation. Early intervention with cessation, vitamin B12 supplementation, and medications such as naltrexone and aripiprazole may help. Epidemiological factors like low socioeconomic status, peer influence, and concurrent alcohol or cannabis use increase the likelihood of misuse. Significant gaps remain in understanding long-term outcomes and effective treatments.
Cureus
July 1, 2025
Elizabeth Francis
A 37-year-old man with longstanding major depressive disorder, post-traumatic stress disorder, and social anxiety disorder who had not responded well to multiple medications experienced meaningful improvements in depression and anxiety after starting low-dose sublingual ketamine troches. He was also able to taper off and stop four psychotropic medications. No adverse effects occurred. This case suggests that sublingual ketamine may help reduce symptoms and simplify medication regimens in complex, treatment-resistant depression.
Cureus
May 1, 2025
Alyssa Kong, Viseth Long, Elle Wang et al.
After a counselling video was introduced, a greater proportion of emergency physicians provided counselling for buprenorphine/naloxone induction in the emergency department, especially during evening hours. Pharmacists completed a larger share of counselling overall, and there was no difference in enrollment completion whether patients were counselled by physicians or pharmacists. The findings suggest that using a video tool and distributing counselling tasks among multidisciplinary providers can improve patient access to take-home opioid agonist therapy in the emergency setting.
Cureus
September 1, 2024
N. Nguyen, Jessica Cao, Deborah Carlson et al.
A healthy patient who used nitrous oxide recreationally every day developed venous thromboembolism, including pulmonary emboli. Nitrous oxide interferes with vitamin B12, causing hyperhomocysteinemia, which can make blood more prone to clotting. Anticoagulation therapy led to significant improvement in the pulmonary emboli. As recreational nitrous oxide use rises, clinicians should recognize that hyperhomocysteinemia from the drug may create a thrombotic state.
Cureus
May 1, 2024
Shaeraine Raaj, Mian Saad Ahmed, Emma Warren et al.
A 22-year-old with no prior psychiatric history who abused 75-100 canisters of nitrous oxide (N2O) per day during the COVID-19 lockdown developed delusions, auditory hallucinations, and disorganized cognition. Laboratory and imaging results found no organic cause. Treatment with antipsychotic medications and a multidisciplinary team approach gradually improved symptoms. Chronic N2O abuse puts users at higher risk of psychosis, personality changes, affective lability, anxiety, depression, cognitive impairment, and myeloneuropathy. The case highlights the need for epidemiological studies to prevent N2O-induced psychosis.