Martinak Bridgette, Bolis Ramy A, Black Jeffrey Ryne, Fargason Rachel E, Birur Badari
Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham.
Psychopharmacol Bull. 2017 Sep 15;47(4):59-63.
Dextromethorphan (3-methoxy-N-methylmorphinan), also known as "DXM" and "the poor man's PCP," is a synthetically produced drug that is available in more than 140 over-the-counter cough and cold preparations. Dextromethorphan (DXM) has overtaken codeine as the most widely used cough suppressant due to its availability, efficacy, and safety profile at directed doses. However, DXM is subject to abuse. When consumed at inappropriately high doses (over 1500 mg/day), DXM can induce a state of psychosis characterized by Phencyclidine (PCP)-like psychological symptoms, including delusions, hallucinations, and paranoia. We report a noteworthy case of severe dextromethorphan use disorder with dextromethorphan-induced psychotic disorder in a 40-year-old Caucasian female, whose symptoms remitted only following treatment with a combination of an antipsychotic and mood stabilizer. While some states have begun to limit the quantity of DXM sold or restrict sales to individuals over 18-years of age, there is currently no federal ban or restriction on DXM. Abuse of DXM, a readily available and typically inexpensive agent that is not detected on a standard urine drug screen, may be an under-recognized cause of substance-induced psychosis. It is imperative that clinicians are aware of the potential psychiatric sequelae of recreational DXM use.
右美沙芬（3-甲氧基-N-甲基吗啡喃），也被称为“DXM”和“穷人的苯环己哌啶”，是一种合成药物，在140多种非处方止咳和感冒药中都有。由于其可得性、有效性以及在规定剂量下的安全性，右美沙芬（DXM）已超过可待因，成为使用最广泛的止咳药。然而，DXM容易被滥用。当以不适当的高剂量（超过1500毫克/天）服用时，DXM会诱发一种精神病状态，其特征为出现类似苯环己哌啶（PCP）的心理症状，包括妄想、幻觉和偏执狂。我们报告了一例值得注意的严重右美沙芬使用障碍伴右美沙芬诱发的精神病性障碍病例，患者为一名40岁的白人女性，其症状仅在使用抗精神病药和心境稳定剂联合治疗后才缓解。虽然一些州已开始限制DXM的销售量或限制向18岁以上的个人销售，但目前联邦层面没有对DXM的禁令或限制。滥用DXM这种容易获得且通常价格低廉、在标准尿液药物筛查中无法检测到的药物，可能是物质所致精神病的一个未被充分认识的原因。临床医生必须意识到娱乐性使用DXM可能产生的精神后遗症。
