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A Case Study of LSD Induced Late Psychosis in a 19-Year-Old Woman

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A Case Study of LSD Induced Late Psychosis in a 19-Year-Old Woman RESEARCH A case study of LSD induced late psychosis in a 19-year-old woman Garima Singh, Nicholas C Laucis, Emaya Anbalagan, Kunal Malhotra, Ganesh Gopalkrishna University of Missouri-Columbia Corresponding author’s e-mail: [email protected] ABSTRACT This manuscript reports a case study about a young woman who developed psychotic and manic symptoms after first time lysergic acid diethylamide use. KEYWORDS: Lysergic acid diethylamide, LSD, Psychosis Citation: Singh G, Laucis NC, Anbalagan E, Malhotra K, Gopalkrishna G (2018). A case study of LSD induced late psychosis in a 19-year-old woman. Research Reports; 1:e1-e3. doi:10.9777/rr.2018.10334 . www.companyofscientists.com/index.php/rr e1 Research Reports RESEARCH INTRODUCTION hospital. She developed a dystonic reaction that resolved with diphenhydramine, but her psychosis Lysergic acid diethylamide (LSD) is a psychedelic did not improve. Risperidone was discontinued drug abused for its mind-altering properties. It can and olanzapine was added, which she tolerated induce changes in mood, thought process, and showed improvement. content, insight, judgment, and sensory perceptions, which vary depending on the The patient had history of mature cystic teratoma individual, environment, dosage and other factors. removal 3 years ago. Due to the atypical LSD affects a large number of receptors, including presentation and the risk of anti-NMDA receptor all dopamine and adrenoreceptor subtypes. The encephalitis, even years after the removal of the psychedelic effects of LSD are attributed to its teratoma, a workup was done. This was negative strong partial agonist effects at 5-HT2A receptors1. for Anti-NMDA receptor autoantibodies, ANA, Its exact mechanism of action is unknown; it is RNP, SM, PM-1, SSA/SSB, SCL-70, and ds DNA hypothesized to work by reducing the inhibitory antibodies. She was discharged after 10 days of influence of the striatum on the thalamus, and thus hospitalization with complete resolution of allows overstimulation of the cortex2. There have presenting symptoms. been several reports on LSD inducing psychosis and mood instability3,4,5. DISCUSSION We report a case of a young woman who There are limited studies on the causes, risk developed psychotic and manic symptoms after factors, pharmacokinetics and dynamics of LSD first time LSD use. and related illnesses. There is some literature, primarily reported in the 1960s and 1970s, about CASE REPORT LSD induced schizophrenia and similar psychotic disorders on the schizophrenia spectrum6. A 19-year-old female with no past psychiatric Although there are reports of suicide and murder diagnosis was brought to the hospital by her under LSD intoxication7, the atypical onset and father with concerns of bizarre behavior after LSD differential diagnosis makes our case unique. use. She reportedly consumed an unknown Vardy et al. reported a higher incidence of LSD quantity of LSD for the first time at a party 4 days psychosis with parental alcoholism, which is prior to admission. She was fixated on “Girls, boys, consistent with our patient. Furthermore, our sex and molestation” and stated that she was in experience adds support for the use of olanzapine the hospital to “see her family”. Her odd behavior as treatment for LSD psychosis, which has been began a day after LSD ingestion. discussed in reports of psychosis in chronic LSD users8. On examination, she maintained an intense stare, had an animated, labile affect, and disorganized Data from National Survey on Drug Use and thought process along with delusions of Health9 and Monitoring The Future10 showed persecution and auditory hallucinations. Labs were declining trends in LSD use with the reduction in normal except for a urine drug screen positive for its availability and the emergence of psychoactive cannabinoids. At her baseline, she was a high drugs like MDMA. The survey also showed a functioning student currently in college. decrease in the perceived risk of using LSD among youth, which predisposes a risk for reemergence. It She was hospitalized and started on risperidone 1 continues to be a “club drug” as in our patient mg twice daily that was later increased to 3mg per who ingested it at a party. day. She had some disinhibited behaviors in the www.companyofscientists.com/index.php/rr e2 Research Reports RESEARCH LSD-induced late psychosis is a serious combination of fluoxetine and olanzapine: case report. J complication of LSD use and literature on the topic Clin Psychopharmacol. 2001 Jun;21(3):343-4. 9. Substance Abuse and Mental Health Services is outdated, so further investigation and education Administration. (2009). Results from the 2008 National in the cause and the course of the disease is Survey on Drug Use and Health: National Findings (Office warranted to prevent a resurgence of use among of Applied Studies, NSDUH Series H-36, HHS Publication naïve youth in the future. No. SMA 09-4434). Rockville, MD. http://www.samhsa.gov/data/nsduh/2k8nsduh/2k8Result s.pdf. Accessed August 22, 2013. Acknowledgements 10. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & The authors is thankful to the patient for Schulenberg, J. E. (2012). Monitoring the Future national participation in the study. survey results on drug use, 1975–2011: Volume II, College students and adults ages 19–50. Ann Arbor: Institute for Social Research, The University of Michigan. Conflict of interest statement http://www.monitoringthefuture.org/pubs/monographs/ The author has declared that no competing or mtf-vol2_2011.pdf. Accessed August 22, 2013. conflict of interests exist. The funders had no role in study design, writing of the manuscript and decision to publish. Authors’ contributions GS conceived, designed, conducted the study and wrote the manuscript. NC, EA, KM, GG assisted in reviewing and editing the manuscript. REFERENCES 1. Passie T, Halpern JH, Stichtenoth DO, Emrich HM, Hintzen A. The pharmacology of lysergic acid diethylamide: a review. CNS Neuroscience & Therapeutics. 2008;14(4):295-314. 2. Vollenweider FX, Geyer MA. A systems model of altered consciousness: integrating natural and drug-induced psychoses. Brain Research Bulletin. 2001;56(5):495-507. 3. Lake CR, Stirba AL, Kinneman RE, Jr., Carlson B, Holloway HC. Mania associated with LSD ingestion. The American Journal of Psychiatry. 1981;138(11):1508-9. 4. Cohen S, Ditman KS. Prolonged adverse reactions to lysergic acid diethylamide. Archives of General Psychiatry. 1963;8:475-80. 5. Abraham HD, Aldridge AM. Adverse consequences of lysergic acid diethylamide. Addiction. 1993;88(10):1327- 34. 6. Vardy MM, Kay SR. LSD psychosis or LSD-induced schizophrenia? A multimethod inquiry. Archives of General Psychiatry. 1983;40(8):877-83. 7. Schwarz CJ. The complications of LSD: a review of the literature. The Journal of Nervous and Mental Disease. 1968;146(2):174-86. 8. Aldurra G, Crayton JW. Improvement of hallucinogen persisting perception disorder by treatment with a www.companyofscientists.com/index.php/rr e3 Research Reports .
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