Reporting a Case of Injecting Methylphenidate (Ritalin) Tablets, Intensified Symptoms of Schizoph-renia or Induce Separate Mental Disorder?
The patient was a 38-year-old single man from Kerman city who was admitted in Shahid Beheshti Hospital of Kerman four years ago because of aggression and behavioral change for the first time. According to the patient, he has been using oral Ritalin for the past 6 months and in the recent months, he has diluted tablets in water and injected intravenously and after injection, the shape and meaning of objects have changed for him. He had sometimes injected even up to 4 Ritalin tablets. According to the patient, he feels that he has parasitic infection and he sees cockroaches with blue color crewel on his body and because of that he has burned different parts of his body by cigarettes to destroy them. Also, he sees these bugs on the floor and around objects and because of that he fired house items many times and even fired his bed, TV and personal computer (PC). Even once, his entire house was burned in fire. Sometimes he washed objects with water to destroy bugs. He would stand under the shower for hours to send away these bugs. People around him have always seen him playing with water or fire. Along with these symptoms, he was suspicious to others and believed that they have prepared amulet for him and followed him sometimes. He complained of sleeplessness and restlessness. In physical examination, multiple skin abscesses and acute cellulitis caused by injections were visible on different areas of his body and there was bilateral pitting edema on his legs. He had also tachycardia and there was no problem in the brain CT scan and heart echocardiography.\nIn psychological condition examination, he was restless and to some extent irritable. He also had flight of ideas and noted vision and touch fantasies as well as delirium of harm and damage and being under control. Attention was reduced but immediate, near and far memories were natural. Also, knowledge of time, place and person was normal. Impairment in judgment and vision was evident. The patient was hospitalized for the diagnosis of psychotic disorder due to Ritalin injection and after preventing Ritalin consumption and recovery from infection symptoms, fornication signs were resolved. In later interviews with the patient, schizophrenic symptoms such as deliriums of pessimism and being under control were detected and the patient was treated for schizophrenia diagnosis. After discharge, in spite of regular medication, he was hospitalized for two times and both times it was after Ritalin tablet injections and he was discharged after disease symptoms were controlled and there was no obstacle for medication. By preventing Ritalin consumption after discharge, he has not experienced psychotic symptoms yet and his background disease is under control with anti-psychotic drugs.