Obsessive-compulsive disorder followed by psychotic episode in long-term ecstasy misuse.
OBJECTIVE
We report the case of two young subjects who developed an obsessive-compulsive disorder (OCD) during a heavy use of ecstasy. After several months of discontinuation of the drug, major depression with psychotic features developed in one subject and a psychotic disorder in the other individual. No mental disorder preceded the use of ecstasy in any subject.


RESULTS
A familial and personality vulnerability for mental disorder was revealed in one subject, but not in the other, and all physical, laboratory and cerebral NMR evaluations showed normal results in both patients. Remission of OCD and depressive episode or psychotic disorder was achieved after treatment with a serotoninergic medication associated with an antipsychotic.


CONCLUSIONS
The heavy long-term use of ecstasy may induce an alteration in the brain balance between serotonin and dopamine, which might constitute a pathophysiological mechanism underlying the onset of obsessive-compulsive, depressive and psychotic symptoms. The heavy use of ecstasy probably interacted with a vulnerability to psychiatric disorder in one subject, whereas we cannot exclude that an "ecstasy disorder" ex novo affected the other individual.
Marchesi
Carlo
C
Department of Neuroscience, Psychiatric Division, University of Parma, Italy. carlo.marchesi@unipr.it
Tonna
Matteo
M
Maggini
Carlo
C
D000293:Adolescent; D019969:Amphetamine-Related Disorders / Q000175:diagnosis* / Q000523:psychology*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology; D001921:Brain / Q000187:drug effects; D002997:Clomipramine / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics / Q000523:psychology; D004298:Dopamine / Q000378:metabolism; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006213:Hallucinogens / Q000633:toxicity*; D006801:Humans; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000633:toxicity*; D009771:Obsessive-Compulsive Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics / Q000523:psychology; D000077152:Olanzapine; D011605:Psychoses, Substance-Induced / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics / Q000523:psychology; D012307:Risk Factors; D018967:Risperidone / Q000627:therapeutic use; D012701:Serotonin / Q000378:metabolism; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D055815:Young Adult
D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D006213:Hallucinogens; D001569:Benzodiazepines; D012701:Serotonin; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D018967:Risperidone; D000077152:Olanzapine; D002997:Clomipramine; D004298:Dopamine