Letter to the Editor
Ayahuasca intoxication
Intoxicación por ayahuasca
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As history of interest, the patient had been monitored by psychiatry since the age of 15 due to manic and psychotic symptoms in the context of cannabis use. The patient also reported experimental use of cocaine, LSD and Ayahuasca.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient displayed awareness and was cooperative during the interview. Extra-familiarity, inadequate at times, unable to concentrate, increased perceptions of his own capacities and mystical content conversation were observed. He reported euphoria, feeling of well-being, hyperactivity and decreased sleep, with partial awareness of his condition.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As we were dealing with behavioural alterations related to intoxication, the patient was referred to hospital emergencies, where a urine drug test was performed, being negative for cocaine, cannabis, amphetamines and heroin. With drug-induced organic psychosis being suspected, antipsychotics were administered and the patient was admitted for progression control.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ayahuasca, also known as <span class="elsevierStyleItalic">yage</span>, <span class="elsevierStyleItalic">iowaska</span> or <span class="elsevierStyleItalic">daime</span>, has a long history of use in various countries of South America (Peru, Colombia, Brazil and Ecuador) in the field of medical and/or religious practices. The name comes from the Quechua language, with <span class="elsevierStyleItalic">aya</span> meaning soul and <span class="elsevierStyleItalic">wasca</span> (huasca) meaning vine or root. It comes from the cooking of <span class="elsevierStyleItalic">Banisteriopsis caapi</span> vines and <span class="elsevierStyleItalic">Psychotria viridis</span> leaves, and is usually mixed with other psychoactive drugs (cocaine, atropine, or other combinations of alkaloids). Pharmacologically, the main ingredients of Ayahuasca are N,N-dimethyltryptamine (DMT), which comes from <span class="elsevierStyleItalic">P. viridis</span>, which is the substance primarily related to its hallucinogenic effects, and a combination of alkaloids that act as reversible inhibitors of monoamine oxidase (harmine and harmaline) and selective serotonin reuptake inhibitors (tetrahydroharmine).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The extract is classically prepared as an infusion, which is ingested during rituals. People from all over the world travel to the Amazon area to participate in these rituals, which have gained a lot of popularity. Likewise, the use of Ayahuasca for recreational purposes is becoming a global phenomenon in recent years, and can be ingested in different ways: as a drink, smoked or inhaled.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The possibility of overdose in relation to oral consumption (infusion) is low due to the serotonergic stimulation of the vagal routes, which cause vomiting and diarrhoea. The bioavailability increases if smoked or inhaled, increasing the potential for intoxication. A recent review carried out in the USA<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> analysed all the episodes of exposure to Ayahuasca registered with the American Association of Toxic Substances Control Centres and the National Toxic Substances Database between 2005 and 2015. The results showed that 17% of patients required admission to the ICU and 11% required treatment in a semi-intensive care unit. Rates of 5% were recorded for mechanical ventilation and 1% for respiratory and cardiac arrest. In 2005, the case of a 25-year-old patient who died of Ayahuasca intoxication was diagnosed post-mortem after identifying DMT in blood and urine samples by mass spectrometry.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The risk of developing psychiatric disorders in relation to consumption increases in patients with a personal and family history of mental illness or psychosis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition to its recreational use, several studies have been conducted in recent years on its therapeutic use, mainly based on its serotonergic effects. A systematic review was carried out in 2016<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> on the therapeutic properties of Ayahuasca, psilocybin and LSD. It concluded that these substances could be a tool in the treatment of drug dependence, anxiety and mood disorders, especially in patients with resistance to conventional treatments. However, these clinical trials were not adequately designed, which limited the extrapolation of results. Nevertheless, they do encourage further research into these potential uses.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Pablo Márquez B, Dietl Gómez-Luengo B. Intoxicación por ayahuasca. Med Clin (Barc). 2017;149:136–137.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The therapeutic potentials of ayahuasca: possible effects against various diseases of civilization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Frecska" 1 => "P. Bokor" 2 => "M. 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Hallak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ther Adv Psycopharmacol" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "193" "paginaFinal" => "213" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014900000003/v1_201708260033/S2387020617304473/v1_201708260033/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014900000003/v1_201708260033/S2387020617304473/v1_201708260033/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617304473?idApp=UINPBA00004N" ]
