Observations placeholder
Psychosis from whippit abuse
Identifier
002172
Type of Spiritual Experience
Background
A description of the experience
Nitrous oxide "whippit" abuse presenting with cobalamin responsive psychosis. Sethi NK Mullin P, Torgovnick J, Capasso G. Department of Neurology, Saint Vincent's Hospital and Medical Centers, New York, NY 10011, USA. sethinitinmd@hotmail.com
INTRODUCTION: Nitrous oxide is a commonly abused inhalant drug. It is known to precipitate vitamin B12 deficiency when used chronically and acutely, especially in people having marginal vitamin B12 reserve.
CASE REPORT: We are presenting a case of nitrous oxide "whippit" abuse in a thirty-three-year-old male with bizarre behavior and delusions. The patient had low normal levels of vitamin B12 (202 pg/ml), but he had markedly high methylmalonyl CoA (1078 nmol/L) and homocysteine (48.4 mcmol/L). Treatment with intramuscular cobalamin led to a resolution of his psychosis.
DISCUSSION: This case report highlights the need to consider vitamin B12 deficiency in patients who arrive at a hospital with psychiatric manifestations and who report having a history of nitrous oxide exposure or abuse in the recent or remote past. A review of the literature on the neuropsychological manifestations of vitamin B12 deficiency is provided.