Deciphering a psychosis: A case of dextromethorphan-induced symptoms

This article presents a case of a 35-year-old woman presenting for the first time in a severely agitated, tearful, and psychotic state. She was experiencing frightening auditory hallucinations and was reading her Bible constantly throughout the night. She had been dancing around her house, going into the basement, and praying on her knees. She described how she "anointed her house with oil" by taking oil and painting a large cross on her bedroom wall. She had previously been a high functioning person, having some college education and having been employed in a bank for 7 years. She had no previous history of any psychiatric treatment or hospitalization. Upon physical examination, she presented with a severe cough and explained to the examiner that she had been using large quantities of Nyquil as a cough suppressant for days prior to admission. A diagnosis of dextromethorphan-induced psychosis was made. The patient responded well to risperidone 1 mg BID, sertraline 100 mg/day, and lorazepam 1 mg BID. Her psychosis resolved and she was discharged 1 week later. She returned to her job and there have been no further episodes of psychosis.