An Episode of Psychosis After Nitrous Oxide Abuse During a Pandemic: A Case Report.

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.

Study at a glance

Abstract

The abuse of inhalants like nitrous oxide (N2O), readily available worldwide, has remained a prominent public health problem during the last few decades. Literature reveals increased use during the previous pandemic, particularly regarding recreational use. There is limited evidence-based data available to relate the abuse of N2O with psychosis. Therefore, this case report of a 22-year-old adult with no previous psychiatry history, reportedly abusing 75-100 canisters of N2O per day during the last pandemic COVID-19 lockdown, highlights the relationship between (N2O) abuse and the symptoms evolved including delusions, auditory hallucinations, and disorganized cognition. All the laboratory findings and results from imaging modalities were inconsistent for any organic cause of the symptoms. The case then underwent treatment with antipsychotic medications and a multidisciplinary model, which improved the symptoms gradually. The case, in particular, discusses N2O abuse, which is widespread in European Union countries, including the UK and the Republic of Ireland, and its chronic use puts one at a higher risk of developing psychosis, personality changes, affective lability, anxiety, depression, cognitive impairment, and myeloneuropathy. The sale of N2O for its psychoactive properties is prohibited in many countries, including the Republic of Ireland, as per legislation. However, N2O is not a controlled drug, meaning it is not a crime to possess N2O. This case report manifests the psychopathy caused by abuse of N2O, which would further attract specialists in the field to conduct epidemiological studies for prevention at the primary level.