First episode of psychosis induced by high-proof alcohol and an energy drink in an adolescent girl

Abstract

Introduction: Recent studies have shown that the consumption of alcohol mixed with energy drinks (AmED) is increasing among European adolescents. This pattern of consumption has been linked to risk-taking behaviours and psychiatric decompensation in vulnerable individuals. Clinical Case Description: We present the case of a 16-year-old adolescent with no significant prior psychiatric history who experienced an acute psychotic episode following the consumption of high-strength alcohol mixed with an energy drink in less than an hour. Initially, the patient presented insomnia and aggressive behaviour, followed by persecutory and self-referential delusions, as well as auditory hallucinations. The patient had engaged in risky behaviours since the age of 13 and had a family history of psychiatric disorders. She was admitted to the Child and Adolescent Psychiatry Unit, where he was initially treated with olanzapine, later switching to aripiprazole, which resulted in gradual improvement. Discussion: In this case, the temporal relationship, clinical features and improvement following abstinence all support a diagnosis of substance-induced psychosis. Alcohol and caffeine can both independently trigger psychosis; therefore, it is likely that the two substances had an additive effect in this instance. The ease of access to AmED, its low cost, pleasant taste and social acceptance contribute to its widespread use among adolescents. Proactive identification, follow-up and preventive education are essential to mitigate psychiatric complications. Conclusion: Healthcare professionals should consider AmED consumption as a potential trigger for acute psychotic episodes in adolescents and young adults.