Nutmeg-induced acute psychosis in an adolescent: a case report

<title>Abstract</title> <p> <bold>Background</bold> Nutmeg ( <italic>Myristica fragrans</italic> ) active compounds partially metabolize into amphetamine derivatives with hallucinogenic properties. Acute nutmeg intoxication can induce psychotic states, yet this psychotomimetic potential remains largely unrecognized in clinical practice. We report the first case of nutmeg-induced acute psychosis in an adolescent, highlighting the diagnostic challenges and the role of individual vulnerability as a modulating factor. <bold>Case presentation</bold> A 15-year-old male with longstanding anxiety, depressive symptoms, early suicidal episodes, and dissociative phenomena ingested approximately 30 grams of ground nutmeg in a single dose after exposure to online content promoting it as a natural weight loss aid. Over the following days, he developed derealization, visual hallucinations, thought disorganization, and persecutory ideation. At emergency presentation fifteen days later, physical examination showed moderate sinus tachycardia; ECG, blood tests, and a full toxicological screen were unremarkable, as no specific assay for nutmeg metabolites is available in routine practice. He was diagnosed with an acute delusional episode (DSM-5) precipitated by nutmeg intoxication on a vulnerable psychiatric background, treated with cyamemazine then risperidone, and hospitalized in a child and adolescent psychiatry unit. Discharge occurred against medical advice after approximately two weeks, followed by treatment discontinuation and refusal of outpatient follow-up. <bold>Conclusions</bold> This case documents a nutmeg-induced acute psychosis and alerts clinicians — emergency physicians, pediatricians, and psychiatrists — to the psychotomimetic potential of this common domestic substance. As with cannabis or amphetamines, individual vulnerability modulates the clinical expression without diminishing the causal role of the substance. </p>