Five herbal products sold as Salvia divinorum all contained salvinorin A, but at concentrations far below what their labels claimed. Two products were adulterated with vitamin E and one with caffeine. The discrepancy between advertised and actual potency may increase risks of misuse and overdose. The findings highlight the need for clinicians to recognize signs of salvia use, especially after a reported teenage suicide possibly linked to the plant.
A 77-year-old woman with schizophrenia and severe catatonia—immobility, stupor, mutism—did not improve with benzodiazepines or haloperidol, and electroconvulsive therapy was unavailable during the COVID-19 pandemic. A single intravenous infusion of ketamine at 0.5 mg/kg over 40 minutes led to complete rapid recovery, and she remained stable as an outpatient. The authors suggest that a single ketamine infusion may be a safe and feasible option for drug-resistant catatonia in schizophrenia patients when standard therapies fail, though caution is needed due to possible psychosis exacerbation. Further research is warranted.
Phencyclidine-induced psychosis more completely reflects the pathophysiology of schizophrenia than current models of drug-induced psychosis. Phencyclidine decreases glutamatergic neurotransmission, which reduces GABA release from the nucleus accumbens, striatum, and hippocampus; may inhibit tonic dopamine release from those regions, increasing phasic dopamine reactivity; and decreases long-term potentiation. Glutamatergic system dysfunction may be involved, but pharmacologic manipulation has not revealed a clear mechanism.