.png)
This case is about psychiatric condition after usage of common cold medicine containing pseudo-ephedrine. Pseudoephedrine is an active stereoisomer of the medicine called ephedrine. It has a similar pharmacological mechanism. 5000 years ago, in ancient China, a plant called Ma-Huang, had been administered to cure various illnesses. In 1885, the active substance was purified by Yamanashi. In 1915 Hiroso and To, discovered the sympathomimetic effects of the purified substance. In modern medicine, pseudoephedrine is used for systemic decongestion via direct and indirect sympathomimetic effects. Directly, it is alpha and beta agonists, monoamine oxidase enzyme inhibitor. Indirectly, it increases Dopamine and Noradrenaline levels in central system. Common adverse effects are nervousness, tremor, tachycardia, hypertension, and insomnia. A 42-year-old single female, third of four siblings, dropped out of college in the second year. She has been living with her mother and elder brother. She was diagnosed as having schizophrenia 20 years ago. Her first complaints became apparent at age 21, when she was studying second year in college. In that period, she used to talk to herself and had persecutory delusions. She was diagnosed with schizoaffective in second admission. She has been having a symptomatical remission with clozapine 600 mg/day and valproic acid 1000mg/day for the last ten years. This winter she had şu, then used a medicine prescribed by her general practitioner, which contains 30 mg pseudoephedrine for three times a day for five days. A few days after pseudoephedrine treatment, symptoms such as insomnia, accelerated speech, logorrhea, aggressive behavior arisen. As her symptoms were progressively increased in two-three weeks, she was taken to our psychiatric emergency department by her parents. Her mood was elevated and affect was blunted. Her speech was accelerated; interactions were missed with şight of idea. There was psychomotor activity increasing, she was having erotomanic and grandiose delusions, and audio hallucinations. She was having no insight. Valproic acid blood level was 55 in her admission. According to DSM-5 diagnose criteria schizoaffective disorder, with two sided diagnose, haloperidol 20 mg/day, biperidene 10mg/day, via parenteral route, was started because her state of excitation. Then clozapine 600 mg/day, valproic acid 1250 mg/day, were started orally. After clinical observation, parenteral treatment stopped and then added amisulpride 400 mg/day, instead. Valproic acid was increased to 1500 mg/day to reach effective blood level for mania (68). After there was no clinical improvement in her statement, she was considered as medically resistant to treatment, so electro-convulsive treatment was started. After seven sessions, her clinical statement resolves. She discharged with clozapine 600mg/day, amisulpride 400 mg/day and valproic acid 1500 mg/day orally. Many drugs especially for cold and for şu symptoms are containing ephedrine and pseudoephedrine. In our case, pseudoephedrine-induced manic and psychotic symptoms in schizoaffective patient, who have had remission for ten years. Despite many cases showing that pseudoephedrine and ephedrine-induced psychotic and mood disorders use of pseudo-ephedrine in these patients is still an unheeded issue. Therefore, we need more research about this subject.