A case of at-risk mental state after exposition to LSD and isotretinoin

Poster C100, Saturday, October 22, 11:30 am - 1:00 pm, Le Baron

Sylvie Berney1, Chin B. Eap2, Philippe Conus1, Alessandra Solida1; 1General psychiatry service, Lausanne University Hospital, Switzerland, 2Unit of pharmacogenetics and clinical psychopharmacology, Lausanne University Hospital, Switzerland

Purpose: To describe the case of a 18 y.o. patient who developed an at-risk mental state after using LSD while being on isotretinoin for acne. Materials and Methods: Patient described occasional audible thoughts occurring since childhood and a brief episode of delusional reference at age 10. He first took LSD once when 17 y.o. while being on 0,5 mg/kg isotretinoin, without any subsequent symptoms. He took LSD again 5 months later, while being on 1,0 mg/kg isotretinoin and developed an acute depersonalization/derealisation syndrome, lasting several hours. It remitted but appeared again three months later without any further exposition to LS D. He consulted after 1 year of symptoms. We performed a general psychiatric evaluation and investigated the presence of an at-risk mental state (ARMS) using the SPI-A (Schizophrenia Proneness Instrument - Adult version) and the SIPS (Schizophrenia Interview for Prodromal Symptoms). Results: SPI-A at baseline showed positivity to CODGIS (Cognitive Disorders) and COPER (Cognitive-Perceptive) criteria: COGDIS total score was 17/54 with more than two items score superior to 3; COPER score was 41/144 with more than 1 item score superior to 3 (items C5; C3; D4; O2;O1;D5; F2; O4; O5). SIPS Positive scale rating was also positive in the range of prodromal scores: item P4 score = 3, with worsening in the last six months. Conclusion: Exposition to toxics and/or drugs may reveal pre-existing vulnerability state to psychosis. There might be a deleterious additive or synergistic effect between LSD and isotretinoin in the development of at-risk mental state.

Topic Area: Ultra High Risk / Prodromal Research

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