Other Hallucinogens

Seeds of the morning glory plant (Ipomoea violacea, Ipomoea tricolor, and others) contain lysergic acid amide (ergine), a compound closely related to LSD. They are sometimes intentionally ingested for the hallucinogenic effects. Several hundred seeds may be taken as a "dose." Physical and psychological manifestations closely resemble effects of LSD, and patients can be managed similarly.

Accidental or intentional ingestion of large amounts of nutmeg can cause delirium with hallucinations. Nutmeg is the dried seed from the tropical Myristica fragrans tree. The hallucinogenic properties of nutmeg may be due to a component, myristicin, but the mechanism is not well understood. Ingestion of 1 to 3 nutmegs or 5 to 15 g of the ground spice produces psychological effects, which begin 3 to 6 h later and last for 6 to 24 h. Uncomfortable physical symptoms are prominent, and may include tachycardia, flushing, dry mouth, nausea, and abdominal pain. Signs and symptoms may resemble anticholinergic poisoning, but pupils are usually small or midsize. Management is generally supportive.

Jimson weed (Datura stramonium) and angel's trumpet (Datura Candida) plants grow naturally in the United States, and contain the anticholinergic alkaloids atropine, scopolamine, and hyoscyamine. Seeds or other parts of the plant can be ingested or smoked, and cause the anticholinergic toxic syndrome. Delirium, hallucinations, and seizures can occur, along with other classic anticholinergic effects, such as mydriasis, tachycardia, dry mouth and skin, blurred vision, urinary retention, and hyperthermia. Gastric emptying can be delayed, so gastric decontamination is an important part of the management of such patients. Medications with anticholinergic properties, such as phenothiazine, should be avoided. Use of physostigmine should be reserved for patients with severe anticholinergic toxicity who do not respond to supportive measures.

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