Title : Polydrug use and atypical psychosis: Navigating complex presentations and treatment paths
Abstract:
The escalating global prevalence of polydrug use presents a complex challenge for healthcare professionals, with relatively unexplored implications for chronic users. Recent studies have established a link between drug abuse and psychosis, highlighting diverse pathogenetic mechanisms associated with different drug classes. However, there remains a scarcity of research on the combined effects of polydrug use on neuropathogenesis and psychosis development. This case report focuses on a polydrug user, specifically utilizing "tusi," a combination of substances including ketamine, MDMA, methamphetamine, cocaine, and opioids. The case underscores distinctive presenting symptoms, prolonged hospitalization, and resistance to conventional treatment, emphasizing the necessity for a comprehensive understanding of polydrug use.
The patient, an adult female in her mid-twenties with an unknown medical history, exhibited a range of behaviors upon admission, including disorientation, inappropriate laughter, agitation, and mood incongruence. Psychiatric care began with the initiation of conventional antipsychotic treatment. Subsequently, a variety of medications from different classes were introduced and trialed to address the patient's symptoms. Throughout her hospitalization, the patient demonstrated a unique combination of symptoms, diverging from typical patterns of drug-induced psychosis, including selective mutism, episodic agitation, and drug-induced catatonia. Treatment involved a multidisciplinary approach, with medication dosages and combinations adjusted systematically. Despite extensive efforts, the patient remained in a grossly psychotic state, ultimately requiring 12 bilateral electroconvulsive therapy trials for improvement and discharge after 81 days.
This case highlights the profound implications of polydrug use on neuroanatomical changes, resulting in an atypical clinical presentation and challenging treatment course. Polydrug abuse can lead to complex alterations in neurotransmitter systems, contributing to a diverse array of symptoms. The observed clinical presentation suggests the intricate interplay of neurobiological effects from multiple substances, underscoring the challenges in diagnosing and treating individuals with such complex substance abuse histories. Understanding these complexities is essential for healthcare professionals to effectively assess and address the intricacies of polydrug abuse. Tailored treatment strategies are crucial for improving outcomes in patients with multifaceted drug abuse profiles. This insight underscores the importance of comprehensive approaches in managing polydrug use and its associated psychiatric manifestations.
Audience Take Away Notes:
- Understanding the complex implications of polydrug use on psychiatric presentations, including the diverse array of symptoms and challenges in treatment.
- Gaining insights into the importance of a comprehensive approach to psychiatric care, including tailored medication regimens and multidisciplinary interventions.
- Recognizing the need for further research and exploration into the combined effects of polydrug use on neuroanatomy and psychosis development.
- Appreciating the significance of individualized treatment strategies in addressing the complexities of polydrug abuse and associated psychiatric manifestations.
- Contribution to ongoing efforts to address the global public health challenge of substance abuse and addiction.
