Persistent Psychosis Associated With Salvia Divinorum Use

“Mr. J” was a 21-year-old man with no family or personal psychiatric history or laboratory abnormalities. He was reported to have normal social interactions, behavior, and cognitive skills. He was transferred to our psychiatric unit for acute psychosis and paranoia, which occurred shortly after smoking salvia. In transport, the patient became suspicious and attempted to jump from the vehicle. Upon presentation, he demonstrated echolalia, paranoia, flight of ideas, and psychomotor agitation. The patient remained agitated for the first 2 days of hospitalization. He attempted to barricade himself in his room. Risperidone (3 mg by mouth/three times per day) was administered, and the patient was eventually stabilized. The dosage, however, resulted in the parkisonian features of rigidity, bradykinesia, and masked facies.

Mr. J was transferred to the chemical dependency unit for further treatment. He was stabilized, and treatment with risperidone was slowly tapered. During the taper from risperidone, the patient continued to improve and manifested better insight and logical thought processes. He participated in group therapy and interacted with peers, and the parkinsonian features subsided. One day after risperidone was withdrawn, the patient’s symptoms abruptly returned. He became agitated, paranoid, and aggressive and believed he was able to project and receive thoughts. He returned to the inpatient psychiatry unit where risperidone (3 mg by mouth/twice daily) was reinstated. He was once again stabilized and transferred to the referring psychiatric facility for further treatment. At the 4-month follow-up, the patient exhibited no perceptible improvement.