Mr. A, a 27-year-old Japanese businessman, had no previous psychiatric or medical illness. He also had no known family history of mental disorders. He had never used recreational drugs including methamphetamine, MDMA, or organic solvents. However, from his teens, he had felt sleep irregularities, and primary insomnia became worse in his mid-20s. Then, he started taking a traditional anti-histamine sleeping OTC (over-the-counter) drug, diphenhydramine hydrochloride 50 mg/day at night for approximately 1 year without professional consultation. Recently, he thought of taking a drug for his sleep disturbance. Though he did not know methylone in detail, he believed it could help feel him free from insomnia. Then, he bought the drug 1 g as pure methylone powder via an internet-order.
He took approximately 200 mg of the drug powder p.o. Thirty minutes later, he started to feel nausea and sick in the stomach, and visited one of his friends for help. In his friend's room, he shouted with agitation. He fell down on the floor, and he kicked around in a prone position aimlessly. He kept crying out that he felt very lonely, all is vanity, and added that he took a recreational drug “methylone” bought via internet. Soon an ambulance arrived, and medical technicians could not carry him because of his psychomotor excitement. The policemen were contacted and they helped him to move to our hospital.
At the emergency room of our hospital, he opened his eyes and stared around incoherently and silent in confusion, but exhibited sudden and brief psychomotor excitement and shouted for no reason. His temperature was 37.8 °C, pulse 150 bpm, and blood pressure 144/81 mm Hg. He showed dilated pupils and sweating. After a gastrolavage and urine sample through a balloon catheter, Triage® Drug of Abuse Panel plus TCA (Biosite Diagnostics, San Diego, CA) rapid drug screening device was used to examine the contents of his stomach and urine. The assay systems showed no immunoreactivity to phencyclidine, benzodiazepines, cocaine metabolite, amphetamine and methamphetamine, marijuana metabolite, opiates, barbiturates, and tricyclic antidepressants in his urinary and gastric fluid sample. Following his confession to his friend, he was temporarily diagnosed as having substance intoxication with an unknown powder. He still exhibited symptoms of substance-induced psychomotor excitement, although more than 3.5 h from drug inducement. We had him take 4 mg of a risperidone oral solution. His psychomotor excitement became gradually sedative. One and half hours after risperidone treatment, his symptoms disappeared and he could communicate coherently. He wanted to know what he did after he took the drug. He was observed and given supportive care until noon the following day, then discharged without any known sequel. Two weeks after recovery from acute intoxication, he did not exhibit any residual symptoms including a depressive mood or euphoria. He, however, had no recollection of his experience during acute intoxication.
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Therefore, it is unclear whether or not it was either methylone (120 mg) or 5-MeO-MIPT (76 mg) or the combination of the two agents that caused the adverse symptoms experienced by the patient.