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Reversible worsening of psychosis due to benzydamine in a schizoaffective young girl who is already under treatment with antipsychotics

Mehmet Kerem Doksat.

Benzydamine, available as the hydrochloride form, is an anti-inşammatory drug providing both rapid and extended pain relief in many painful inşammatory conditions. In oral dosages of 500 mg to 3000 mg it is a ?deliriant? and CNS stimulant, popular in Poland and Brazil. In Brazil it is so popular that many people use it for recreational purposes. A person in a ?benzydamine trip? may experience a feeling of well-being, euphoria and in higher doses hallucinations, paranoia, dry mouth and convulsions may also be experienced. In dosages of 750 mg to 2000-3000 mg benzydamine is a hallucinogen and CNS stimulant. These ?triply? effects may be observed in poisoning or accidental or ?on purpose? overdose cases also, hallucinosis (i.e. ego-dystonic hallucinations) is typical in such cases and generally remits spontaneously in 2 to 3 days after cessation of the drug even in children.
I report a 22 years-old schizoaffective patient under almost complete remission with citalopram 40 mg, ziprasidone 80 mg and biperiden 2 mg tid for mild akathisia. She was almost symptom-free for three years. She had a leg injury and an orthopedist prescribed Tantum pills 50 mg tid after meals. On the second day she was hallucinated with complete insight (i.e., hallucinosis), dysphoric and slightly paranoid; like her initial complaints. She used the drug for totally 5 days. When I examined her on the 6th day, she was vigil; her orientation and judgment were intact, excluding the diagnosis of delirium. There was nothing abnormal in her neurological examination and laboratory testing including CBC, liver, kidney and thyroid functions. We quitted benzydamine and did nothing else except waiting for the course. It took her 5 days to become symptom-free again. She had no recurrent complaint or persisting hallucinosis. Although there is no previously published information about this hallucinogenic and deteriorating effect of benzydamine in a psychotic young person, physicians including orthopedist, dermatologists etc planning to prescribe benzydamine to their patients should concern and must take at least a brief anamnesis for previous or ongoing psychotic disorder.

Key words: Benzydamine, hallucinosis, drug induced psychosis, substance abuse

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