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Case Report
Ayahuasca-induced psychosis: A case report
Psicosis por consumo de ayahuasca: un reporte de caso
Harvey Ricardo Cerón Tapiaa,b,
Corresponding author
Richarc56@hotmail.com

Corresponding author.
, Mayra Alejandra González Guzmánb, Sergio Andrés Córdoba Ortizb,c
a Semillero de investigacion SEITOX, Facultad de Medicina, Universidad Surcolombiana, Neiva, Huila, Colombia
b Universidad Surcolombiana, Neiva, Huila, Colombia
c Unidad de Salud Mental, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ayahuasca is a Quechua term composed of the prefix <span class="elsevierStyleItalic">aya</span>&#44; meaning soul&#44; spirit or dead person&#44; and the root <span class="elsevierStyleItalic">waska</span>&#44; which can be interpreted as vine&#44; cord or rope&#46; Thus it can mean &#8220;vine of the spirits&#8221;&#44; &#8220;rope of the soul&#8221;&#44; &#8220;cord of the dead&#8221; or &#8220;vine of death&#8221;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> This substance has been widely used since ancient times by indigenous communities of the northwestern Amazon in countries including Colombia&#44; Ecuador&#44; Peru and Brazil&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is prepared with the Amazonian vine <span class="elsevierStyleItalic">Banisteriopsis caapi</span> and the leaves of the bush <span class="elsevierStyleItalic">Psychotria viridis</span>&#46; This concoction contains biologically active chemical compounds such as <span class="elsevierStyleItalic">N&#44;N</span>-dimethyltryptamine &#40;DMT&#41;&#44; which acts on 5-HT2A and other receptors&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Administration thereof is associated with hallucinations&#44; cognitive and perceptual changes&#44; and a heavily altered sense of self and reality&#59; this enables unconscious and subconscious thought content to be consciously exposed&#44; accompanied by emotions and perceptions that may be overlooked in a conscious state&#46; However&#44; this substance is not considered addictive&#44; as it neither stimulates compulsive consumption nor induces withdrawal symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Its use is associated with ritual purposes&#44; in a magical&#47;religious context&#44; in pursuit of contact with the supernatural spiritual world and nearness to the sacred&#44; and for medicinal purposes&#44; with the aim of curing different types of diseases&#46; It is credited with the ability to confer visions used by shamans to discover spells cast and diseases inflicted on affected persons&#46; More than 70 South American indigenous communities use ayahuasca in the form of a hallucinogenic beverage made by preparing a decoction from the bark of this plant and mixing it with &#8220;chacrona&#8221; leaves&#44; &#8220;chacrona&#8221; being a shrubby plant that Andean and Amazonian peoples have called <span class="elsevierStyleItalic">yage</span> since pre-Colombian times&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;6&#8211;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Ayahuasca is a botanical hallucinogen used in a magical&#47;religious context by indigenous groups of the Amazon in countries including Brazil&#44; Peru and Colombia&#59; an estimated 20&#44;000 people worldwide are members of Brazilian ayahuasca religions&#44; but epidemiological data on recreational use is limited&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2011&#44; Lima and T&#243;foli published 1994&#8211;2007 reporting system results and identified 29 cases with characteristics of psychosis&#46; They concluded that 19 were linked to ayahuasca use&#58; four exhibited an immediate temporal relationship in individuals with no psychiatric history &#40;first episode&#41;&#59; five featured a relapse or recurrence and 10 involved ayahuasca use as a predisposing factor associated with others&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Based on the Beneficent Spiritist Center Uni&#227;o do Vegetal&#8217;s &#40;UDV&#8217;s&#41; own censuses&#44; the incidence of new psychotic episodes would be 10&#46;8 per 100&#44;000 person-years&#46; The estimated overall risk of a psychotic break per use session would be less than two per 100&#44;000 use episodes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A 2007 review by Gable estimated the risk of a psychotic episode per use session&#46; According to the study&#44; in around 25&#44;000 ritual drinking sessions over a five-year period&#44; only 13&#8211;24 cases were documented in which ayahuasca might have been a contributing factor in a psychotic incident&#44; representing a rate of less than 0&#46;1&#37; and indicating that ayahuasca use is not a triggering event for sustained psychosis&#46; Most of these episodes were transient in nature and resolved spontaneously&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Sensation of vivid visual images&#59; altered auditory perception&#59; heightened thought processing&#59; brief but intense reactions of dysphoria&#44; disorientation and symptoms of anxiety&#59; and sensory and motor suppression interfering with a suitable relationship between the individual and their environment can be attributed to this preparation&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13&#44;14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Ayahuasca use for recreational purposes&#44; in so-called &#8220;Ayahuasca tours&#8221;&#44; offered on trips to countries such as Colombia&#44; Peru and Brazil&#44; is also being documented&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Considering that its use is becoming widespread outside the cultural context and the worldview in which it originated&#44; we consider this case report to be very important&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0050" class="elsevierStylePara elsevierViewall">The patient was a 26-year-old man from a rural area and a member of an indigenous community in Colombia &#40;P&#225;ez&#41;&#46; He was single&#44; had no children&#44; lived with three siblings and their mother&#44; and worked in agriculture and farming&#46; He had been hospitalised on the mental health unit three years earlier due to behaviour consisting of paranoid delusions&#44; visual and auditory hallucinations&#44; insomnia&#44; psychomotor restlessness&#44; and heteroaggressive behaviour&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">He was admitted to the psychiatry department due to signs and symptoms for seven months consisting of behavioural changes and delusions&#44; with subsequent exacerbation of his symptoms accompanied by aggressive behaviour towards his relatives and complex hallucinations&#46; He stated that he was &#8220;tormented by a spirit&#8221;&#46; He also reported that he decided to participate in an indigenous healing ceremony&#44; presided over by a shaman&#44; in which for the first time in his life he consumed a dark brown concoction with a bitter taste and earthy appearance called ayahuasca or <span class="elsevierStyleItalic">yage</span>&#46; In the course of this ceremony&#44; he experienced vivid visual delusions and hallucinations in which it was revealed to him that one of his neighbours had given him a potion&#44; with subsequent infiltration of his body by an evil spirit&#46; His delusional symptoms&#44; focused on the devil&#44; and aggressive behaviours then persisted over the following days &#40;&#8220;I am tormented by unclean spirits&#46; They tell me things&#46; They are in my stomach&#46; They do not let me read the Bible&#46; My neighbour sent that spirit to me&#46;&#8221;&#41;&#44; whereupon he was taken to a hospital&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In his mental examination&#44; the patient appeared well dressed&#59; participated actively in questioning&#59; was disoriented to time and place but oriented to person&#59; showed a cooperative attitude and hypoprosexia&#59; and exhibited circumstantial&#44; erratic language marked by bradylalia in a normal tone with bizarre associations&#44; delusional ideas with paranoid and mystical content&#44; and verbal and visual auditory hallucinations&#46; This was consistent with his illogical&#47;coherent thought content&#44; with misguided judgement&#44; illogical reasoning&#44; moderate impulsiveness&#44; anxiety and a lack of awareness of his disease and situation&#46; Physical examination revealed no abnormalities and the patient&#39;s vital signs were within normal limits&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The laboratory tests ordered &#40;blood glucose&#44; blood urea nitrogen&#44; creatinine&#44; complete blood count&#44; liver panel&#44; drug testing&#44; serology&#44; human immunodeficiency virus &#91;HIV&#93; and thyroid-stimulating hormone &#91;TSH&#93;&#41; were in normal ranges&#46; Neuroimaging &#40;simple computed tomography of the head&#41; did not reveal any structural abnormalities in the patient&#8217;s brain&#46; Antipsychotic treatment was indicated with biperiden in 2-mg tablets every 8<span class="elsevierStyleHsp" style=""></span>h&#44; clozapine 100<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; risperidone 2<span class="elsevierStyleHsp" style=""></span>mg&#47;8<span class="elsevierStyleHsp" style=""></span>h and sertraline 50<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#44; and haloperidol and midazolam at doses of 5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h in case of psychomotor agitation&#46; After drug treatment was started&#44; the patient&#8217;s symptoms were seen to improve&#44; with him exhibiting a modulated affect&#44; attenuated illogical&#47;coherent thinking with paranoid delusions&#44; absence of sensory&#47;perceptual alterations&#44; language with a normal tone and flow of speech&#44; normal motor behaviour&#44; still-weakened judgement and reasoning&#44; and poor introspection and prospecting&#46; Medical discharge and outpatient follow-up were considered in light of the patient&#8217;s favourable clinical course&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">We report the case of a patient with a history of episodes with paranoid delusions&#44; visual and auditory hallucinations&#44; insomnia&#44; psychomotor restlessness&#44; and heteroaggressive behaviour&#46; In a context of ayahuasca use&#44; this patient showed exacerbation of his symptoms with vivid illusions and visual hallucinations&#44; inciting us to review the literature on these two factors&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the case reported&#44; the clinical characteristics of ayahuasca-induced psychosis were seen to be similar to those in other published case reports&#58; altered sensory perception&#44; with visual hallucinations being most common&#44; as in this case&#46; It has also often been seen to be accompanied by psychomotor agitation&#44; ataxia and tremors&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> as well as somaesthetic alterations&#44; other sensory alterations&#44; altered thought content&#44; dysphoria and emotional and affective lability&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Likewise&#44; some case reports have featured plasma abnormalities such as increased prolactin&#44; cortisol and growth hormone following ayahuasca use and moderate abnormalities in measurements of autonomic system functions such as temperature&#44; respiration and pupil measurements&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; this case report featured only abnormalities related to exacerbation of psychosis&#44; with no other associated clinical abnormalities&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">However&#44; the incidence of psychosis after ayahuasca use has not been thoroughly elucidated&#46; As seen&#44; this type of presentation is rare&#44; accounting for less than 1&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Several studies have been conducted that included ayahuasca use as part of treatment for psychiatric disorders and psychoactive substance use&#44; yielding positive results with a significant reduction in intensity of psychiatric symptoms after one week of use and reduction of problematic use of substances such as cocaine&#44; alcohol and tobacco&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6&#44;9</span></a> unlike our patient&#44; who after using the substance experienced heightening of his existing psychosis-related symptoms&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Systematic reviews on ayahuasca use and its relationship to psychotic episodes have indicated that this is a rare phenomenon&#44; with these isolated cases usually marked by premorbid characteristics&#44; especially a personal or family history of schizophrenia or schizophreniform disorders&#44; psychotic depression or mania&#44; or ongoing manic or psychotic symptoms&#59; such people should avoid drinking this type of beverage&#46; Thus this case report represents an instance of an isolated presentation of psychosis that also had important antecedents that heightened the condition following the use of this substance&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In this vein&#44; the differential diagnosis could include diagnosis of substance-induced mental disorders&#44; based on DSM-V criteria when the characteristic symptoms of the disorder appear during use or up to one month later&#44; as long as there is no evidence of a primary disorder<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#59; however&#44; as the patient had already suffered from psychiatric symptoms&#44; a diagnosis of ayahuasca-induced schizophrenia was not seen to be founded&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">This study was not without limitations&#46; First&#44; a blood test to detect DMT was not performed&#59; however&#44; the patient had consumed the concoction seven months earlier&#44; so DMT could not have been measured as it is rapidly eliminated in urine&#46; The composition of the product and the amount ingested were not known for certain&#46; Similarly&#44; it was not very clear how much time had elapsed between the use of the substance and the onset of symptoms&#46; The patient&#39;s history of psychosis also might have played an essential role in this episode&#46; Finally&#44; given that few case reports exist&#44; the extent to which this beverage exacerbated his underlying medical condition was unknown&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Psychosis induced by ayahuasca is a rare occurrence&#46; However&#44; due to an increase in the access and distribution of this substance&#44; it is necessary to highlight the cases in which it occurs&#46; We describe the case of a 26-year-old man who was admitted to the psychiatric service after seven months of changes in behaviour&#44; delusions and the subsequent exacerbation of symptoms&#44; after participating in a ritual ceremony during which he consumed an ayahuasca concoction for the first time&#46; Initially&#44; he required hospital treatment to control the acute psychotic episode&#44; but after tolerating and responding well to the antipsychotic treatment&#44; he was discharged with an outpatient follow-up&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La inducci&#243;n de psicosis por ayahuasca es un evento poco frecuente&#46; Sin embargo&#44; debido a un aumento en el acceso y la distribuci&#243;n de esta sustancia&#44; resulta menester destacar los casos en que se presenta&#46; Se describe el caso de un paciente var&#243;n de 26 a&#241;os que ingres&#243; al servicio de psiquiatr&#237;a por un cuadro cl&#237;nico de 7 meses de evoluci&#243;n dado por cambios en el comportamiento&#44; ideas delirantes y posterior exacerbaci&#243;n de los s&#237;ntomas&#44; tras participar en una ceremonia ritual en la que consumi&#243; por vez primera un brebaje de ayahuasca&#46; Requiri&#243; inicialmente tratamiento hospitalario para controlar el episodio psic&#243;tico agudo&#44; con buena respuesta y tolerancia al tratamiento farmacol&#243;gico&#44; lo que permiti&#243; continuar su seguimiento cl&#237;nico ambulatorio&#46;</p></span>"
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                  "referenciaCompleta" => "Abate BECAL&#44; Ena WLS&#44; Comps AR&#46; B c l&#44; w s a &#40;&#46;&#41;&#46; 2003&#59;381&#8211;6&#46;"
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                  "referenciaCompleta" => "Overview focusing on developmental toxicology safety and side effects of ayahuasca in humans &#8212; an overview focusing&#46; 2013&#59;&#40;April&#41;&#58;37&#8211;41&#46;"
                ]
              ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The current state of research on ayahuasca&#58; a systematic review of human studies assessing psychiatric symptoms&#44; neuropsychological functioning&#44; and neuroimaging"
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                          "etal" => false
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                            3 => "J&#46;E&#46;C&#46; Hallak"
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                      "titulo" => "LAS PROPIEDADES FARMACOCIN&#201;TICAS DEL AYAHUASCA"
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                  "referenciaCompleta" => "S CT&#46; Neurociencias y aplicaciones psicoterap&#233;uticas en el renacimiento de la investigaci&#243;n con psicod&#233;licos Neurosciences and psycotherapeutic applications in the psychedelic research renaissaince&#46; 2014&#59;52&#40;2&#41;&#58;93&#8211;102&#46;"
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                0 => array:1 [
                  "referenciaCompleta" => "Halpern JH&#46; Hallucinogens and dissociative agents naturally growing in the United States&#46; 2004&#59;102&#58;131&#8211;138&#46;"
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                  "referenciaCompleta" => "Xarau SN&#44; Pinillos MA&#44; Hoffman RS&#46; Emergent drugs &#40;III&#41;&#58; hallucinogenic plants and mushrooms&#46; 2013&#59;&#40;III&#41;&#58;505&#8211;18&#46;"
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                  "referenciaCompleta" => "Tortajada RE&#46; Bloque de inter&#233;s&#46; 2015&#59;2&#58;75&#8211;91&#46;"
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                  "referenciaCompleta" => "Gambelunghe C&#44; Aroni K&#44; Rossi R&#44; Moretti L&#44; Bacci M&#46; Identification of N&#44;N-dimethyltryptamine and &#946;-carbolines in psychotropic ayahuasca beverage&#46; 2008&#59;1059&#40;May&#41;&#58;1056&#8211;9&#46;"
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                  "referenciaCompleta" => "Bilhimer MH&#44; Schult RF&#44; Higgs KV&#44; Wiegand TJ&#44; Gorodetsky RM&#44; Acquisto NM&#46; Case report acute intoxication following dimethyltryptamine ingestion&#46; 2018&#59;2018&#58;3&#8211;6&#46;"
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                  "referenciaCompleta" => "Scroll P&#44; For D&#46; The effects of ayahuasca ritual participation on gay&#46; 2014&#59;&#40;November&#41;&#58;37&#8211;41&#46;"
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ISSN: 25303120
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