N,N-dimethyltryptamine (DMT) is a psychoactive substance that has been gaining popularity in therapeutic and recreational use. This is a case of a physician who chronically took DMT augmented with phenelzine in an attempt to self-medicate refractory bipolar depression. His presentation of altered mental status, mania, and psychosis is examined in regards to his DMT use. This case discusses DMT, the possible uses of DMT, and the theorized mechanism of DMT in psychosis and treatment of depression, particularly involving its agonist activity at 5-HT1A, 5-HT2A, and 5-HT2C. It is also important to recognize the dangers of self-medication, particularly amongst physicians.

Objective The aim of our study was to assess the impact of psychiatric medications and concomitant risk factors on the prevalence of QTc prolongation and torsades de pointes (TdP) in hospitalized subjects. We examined the association between individual risk scores and QTc prolongation and proposed an evidence-based protocol for electrocardiogram monitoring on psychotropic medications. Method Electrocardiograms (ECGs) of subjects hospitalized over a 1-year period were analyzed for QTc prolongation, associated risk factors, and use of medications. Analysis was performed using logistic regression to identify independent predictors of QTc prolongation, and the Pearson χ2 test was used for risk score assessment. Results A total of 1249 ECGs of 517 subjects were included in this study. Eighty-seven subjects had QTcB intervals greater than 470 milliseconds for females and greater than 450 milliseconds for males. Twelve (2.3%) subjects had QTcB of 500 milliseconds or greater, or greater than 60 milliseconds of change from baseline. Of these subjects, only 1 case of QTc interval change was related to routine use of psychiatric medications. There were no incidents of TdP. Age, diabetes, hypokalemia, overdose, diphenhydramine, and haloperidol were significant independent predictors of QTc prolongation. Risk scores were significantly correlated with QTc prolongation (P = 0.001). Conclusion Our retrospective review study found that the occurrence of TdP and QTc prolongation was low in this subject population. QT abnormalities were associated with known risk factors, and risk scores correlated well with QTc prolongation. Providers can use the protocol proposed in this study, which incorporates risk scores and the CredibleMeds classification system to determine the need for ECG monitoring and to guide treatment.

To the Editor: According to the Centers for Disease Control and Prevention, 5%220% of the US population is infected by the influenza virus annually. The influenza virus commonly affects the respiratory system, but the neuropsychiatric symptoms are often underappreciated. Karl Menninger was one of the first to link neuropsychiatric symptoms in 100 patients with influenza who were admitted with behavioral changes in 1918. 1 The famous 1918 strain of influenza was associated with von Economo's encephalitis lethargica and postencephalitic parkinsonism. 2 In the 1960s, pediatric cases of influenza infections were associated with Reye's syndrome. 2 The influenza A 2009 strain was coupled with an increase in the number of serious cases of acute necrotizing encephalopathy. 2 Primary neurological manifestations appear more commonly in children but can emerge in adults with symptoms of headaches, numbness, paresthesia, weakness, vertigo, decreased alertness, seizures, encephalopathy, and meningismus. Other less common neurologic complications include Guillain-Barré syndrome, aseptic meningitis, and transverse myelitis. 2,3 The influenza virus has also been associated with acute psychosis and the onset of a manic episode. [4][5][6] The following report illustrates a case of a patient with suspected influenza-induced mania.

No abstract