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    Mephentermine Abuse For Stamina, Resulting in Mania - A Case Report

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    gaurav sharma
    This case report describes a 38-year-old man who presented with manic symptoms after abusing mephentermine intravenously for three years to enhance his athletic performance and stamina. The man reported increased energy, irritability, distractibility, and impaired sleep and memory. He was diagnosed with severe mephentermine use disorder and mephentermine-induced bipolar disorder. He was treated as an outpatient with antipsychotics and mood stabilizers, and his mania symptoms remitted within three weeks, though his substance dependence continued. The report aims to increase awareness of growing mephentermine abuse and related psychiatric issues among clinicians and the public.

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    Mephentermine Abuse For Stamina, Resulting in Mania - A Case Report

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    gaurav sharma
    63 views4 pages
    This case report describes a 38-year-old man who presented with manic symptoms after abusing mephentermine intravenously for three years to enhance his athletic performance and stamina. The man reported increased energy, irritability, distractibility, and impaired sleep and memory. He was diagnosed with severe mephentermine use disorder and mephentermine-induced bipolar disorder. He was treated as an outpatient with antipsychotics and mood stabilizers, and his mania symptoms remitted within three weeks, though his substance dependence continued. The report aims to increase awareness of growing mephentermine abuse and related psychiatric issues among clinicians and the public.

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    This case report describes a 38-year-old man who presented with manic symptoms after abusing mephentermine intravenously for three years to enhance his athletic performance and stamina. The man reported increased energy, irritability, distractibility, and impaired sleep and memory. He was diagnosed with severe mephentermine use disorder and mephentermine-induced bipolar disorder. He was treated as an outpatient with antipsychotics and mood stabilizers, and his mania symptoms remitted within three weeks, though his substance dependence continued. The report aims to increase awareness of growing mephentermine abuse and related psychiatric issues among clinicians and the public.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    63 views4 pages

    Mephentermine Abuse For Stamina, Resulting in Mania - A Case Report

    Uploaded by

    gaurav sharma
    This case report describes a 38-year-old man who presented with manic symptoms after abusing mephentermine intravenously for three years to enhance his athletic performance and stamina. The man reported increased energy, irritability, distractibility, and impaired sleep and memory. He was diagnosed with severe mephentermine use disorder and mephentermine-induced bipolar disorder. He was treated as an outpatient with antipsychotics and mood stabilizers, and his mania symptoms remitted within three weeks, though his substance dependence continued. The report aims to increase awareness of growing mephentermine abuse and related psychiatric issues among clinicians and the public.

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    148

    Case Report
    MEPHENTERMINE ABUSE FOR STAMINA, RESULTING IN MANIA -
    A CASE REPORT
    Pranav V Nair1*, Bindhya Babu1, Zoheb Raj2, Sushil Kakkan3
    1JuniorResident, Department of Psychiatry, KMCT Medical College, Kozhikode
    2Associate Professor, Department of Psychiatry, KMCT Medical College, Kozhikode
    3Professor and HOD, Department of Psychiatry, KMCT Medical College, Kozhikode

    *Corresponding address: Department of Psychiatry, KMCT Medical College, Mukkam, Kozhikode, PIN –
    673602. Email: [email protected]

    ABSTRACT
    Mephentermine is an amphetamine-like drug used to treat hypotension. There have been case
    reports of mephentermine abuse in India, some associated with psychosis. This is the first to be
    associated with mania and the first reported from Kerala. We report the case of an adult male with
    a three-month history of irritable mood, increased energy and various other manic symptoms.
    Interview revealed three years history of intravenous mephentermine use for athletic
    enhancement that evolved to a dependence pattern. Higher mental function evaluation revealed
    deficits in concentration and recent memory. He was started on a combination of antipsychotic
    and mood stabilizer; psychoeducation was also initiated. Mania went into remission over three
    weeks but dependence continued, and the patient was then lost to follow-up. We expect this case
    report to increase awareness among both clinicians and the public and to start an investigation
    into the prevalence of this problem in at-risk populations.
    Keywords: mephentermine, mania, athletics, stimulant, dependence

    INTRODUCTION amphetamines.1 Published reports talking


    Mephentermine is a cardiac stimulant related to about this, including in India, recognize that at
    the class of amphetamines. It appears to work as least in some of these cases, mephentermine
    a sympathomimetic agent, causing increased abuse results in psychiatric morbidity beyond
    norepinephrine release and acting as an agonist dependence alone. While cases have been
    at the alpha-adrenergic receptor. It is primarily reported across India, this is the first case
    used in clinical medicine as a vasoconstrictor, to report, to our knowledge, that documents an
    combat hypotension in spinal anesthesia, as an episode of mood disorder, most probably
    interim drug in hypotensive shock, and as a induced by mephentermine abuse. To our
    nasal decongestant. However, there are many understanding, this is also the first case report
    case reports that it is being misused for its of mephentermine abuse of any kind from
    stimulant-like properties despite theoretically Kerala. With this case, we wish to bring to
    not having quite the same effect on CNS as attention a growing problem in some
    Access the article online:
    https://kjponline.com/index.php/kjp/article/view/361
    QR code: Please cite this article as: Nair PV, Babu B, Raj Z,
    DOI: https://doi.org/10.30834/KJP.35.2.2023.361 Kakkan S. Mephentermine abuse for stamina,
    Received: 07/09/2022. Accepted: 04/12/2022. resulting in mania - a case report. Kerala Journal
    Web publication: 03/01/2023.
    of Psychiatry 2022;35(2):148-151.

    Kerala Journal of Psychiatry //35(2) Jul-Dec 2022


    149

    populations that may be going under-reported course of three years to a usage pattern of
    and unnoticed. around 20 ml per day of the same solution, as he
    could no longer achieve the same effect with the
    CASE REPORT
    smaller dose. He had an intense craving for the
    Mr. Z is a 38-year-old married Muslim male, substance and would self-medicate with it
    formerly a manual labourer, currently not when stressed, claiming it helped relieve his
    gainfully unemployed and educated till 10th stress. He occasionally thought about cutting
    standard. He presented to the Outpatient down on the substance but was ultimately
    Department, brought by a close friend. He was unsuccessful in doing so and never seriously
    actively involved in bodybuilding and athletics, attempted abstinence. He complained of feeling
    primarily the sport of tug-of-war. He weak, restless, and anxious whenever the dose
    complained of racing thoughts, distractibility, was reduced. Past history was not significant
    being increasingly irritable all the time, and family history was positive for substance
    forgetfulness and “getting carried away with use disorders.
    whatever he was doing” for the past three
    Clinical findings
    months. The friend confirmed this and reported
    that he was excessively talkative, always Mental status examination revealed a restless
    irritable, getting angry, and picking fights at the individual with increased psychomotor activity,
    slightest provocation. He was overfamiliar with pressured speech and prolixity of thought with
    individuals, starting arguments with persons elevated and irritable mood with no perceptual
    with whom he was not personally acquainted, disturbances. Assessment of higher mental
    even those in positions of authority. As a result function showed a conscious and oriented
    of these behaviors, he was dismissed from his individual with impaired attention and
    job a month back. concentration on digit span test and serial
    subtraction, as well as some deficits in recent
    The patient denied that the problems had been
    memory. The patient had Grade 3 insight into
    that severe, although he admitted that his
    his manic symptoms but was in the
    behavior now was different and that he would
    contemplation phase regarding his usage of
    not have done this before. He also reported a
    mephentermine and ambivalent about the
    decreased need for sleep, with a constant need
    possibility of it contributing to his current
    to be engaged in activities, and significantly
    problems. General physical examination
    increased libido and sexual activity with his
    showed multiple puncture marks over the left
    wife, which he acknowledged was causing
    arm with an elevated blood pressure of 160/90
    difficulties for his wife and impairment in their
    mm Hg. Systems were within normal limits.
    marital relationship. Further, on a detailed
    assessment of history, the patient revealed that Diagnostic assessment
    he had been regularly using intravenous A provisional diagnosis was made as per DSM-5
    mephentermine for the past three years. He was of F15.24 Severe Mephentermine [Stimulant]
    initially introduced to the substance by his Use Disorder with Mephentermine-induced
    sports teammate, who claimed that it would Bipolar and Related disorder. Baseline Young
    boost his performance. He reported that he had Mania Rating Scale [YMRS] scoring showed a
    increased strength and vigor after using it, felt score of 26, indicating moderate mania. All
    less exhausted than before from doing the same relevant baseline investigations were done,
    activities and performed better in sports. He which were within normal limits. He was
    quickly began using it for the perceived benefits counseled about the need for neuroimaging,
    on a daily basis, starting at 5ml per day of considering his cognitive deficits and potential
    30mg/ml solution. This progressed over the unknown hazards and risks of using the

    //www.kjponline.com
    150

    substance. However, he deferred due to performance, stamina and endurance.5,6,7,8,9,10.


    financial constraints. Our patient falls into this patient profile. Cases
    of psychosis resulting from mephentermine
    Therapeutic intervention
    abuse are not uncommon among these; often,
    The patient was advised inpatient management psychotic symptoms may be the only reason the
    for de-addiction but refused, and hence, patient is brought to medical attention.5,6,7 It is
    managed on an outpatient basis. He was started to be noted that the usage of mephentermine is
    on a combination of Risperidone 2 mg and a prohibited by the World Doping Agency
    divided dose of Sodium Valproate 1000 mg. He because of its performance-enhancing abilities.
    was psychoeducated on the nature of the illness To the best of our knowledge, this is the first
    and the further consequences and health report of a case of mephentermine dependence
    hazards of continued substance use and with an induced mania and the first case report
    dependence and advised to follow up after one of mephentermine from Kerala.
    week and three weeks.
    CONCLUSION AND FUTURE DIRECTIONS
    Follow-up and outcomes
    It appears that mephentermine abuse is
    His target manic symptoms had subsided in becoming more widespread across India. It is
    three weeks, with a YMRS score of 9, and the worrying that this seems to have spread to
    bystander corroborated that his social Kerala as well. News media have also picked up
    functioning had improved in that period. He on this trend and started reporting on it.
    was tolerating medications well. However, he However, general awareness appears to be
    admitted that he was continuing relatively low among the public and medical
    mephentermine use and was rationalizing that practitioners. It seems not only quite capable of
    he needed it to function effectively in athletics inducing mood and psychotic disorders, which
    and his daily life. He subsequently became lost cause much morbidity but also poses major
    to follow-up. physical health hazards, including
    DISCUSSION hypertension, hepatic failure and even
    cognitive issues, among others. Much further
    A thorough screening for substances beyond research is needed in this area. A community
    those routinely seen in practice enabled us to survey with assured anonymity regarding the
    pick up on a newer and rarer kind of substance prevalence and practices of use of
    abuse, and one which explained the current mephentermine and other similar substances,
    clinical presentation, which would otherwise performance enhancers and anabolic steroids
    have been missed, and probably misdiagnosed among at-risk populations such as
    as a primary mood disorder. On examining the sportspersons, athletes, bodybuilders, fitness
    available literature, it is striking that most case enthusiasts, gymnasium workers, physical
    reports regarding mephentermine misuse have trainers may be warranted to understand the
    been reported in India, particularly concerning scale of the problem.
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    Kerala Journal of Psychiatry //35(2) Jul-Dec 2022


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    //www.kjponline.com

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