Abstract
BACKGROUND: Inhalants are volatile organic compounds (VOCs) abused to achieve psychostimulant effects. VOCs are found in substances such as paint thinners, glues, and adhesives. CASE PRESENTATION: This case illustrates a 27-year-old unmarried, unemployed man from rural Andhra Pradesh with a three-year history of volatile inhalant use, specifically Fevicol. His inhalant use began during college and escalated from occasional use to daily consumption of up to 1 Liter per day through huffing and bagging. He reported a feeling of euphoria and occasional drowsiness accompanied by redness of the eyes. Parallel to the increase in his inhalant use, noticeable behavioral changes, including decreased social interaction, self-talking, irritability, frequent disputes with family members, and multiple job changes, were observed. Upon interview, psychotic symptoms including auditory hallucinations and persecutory delusions, started around one year ago, prompting inpatient psychiatric admission. A diagnosis of volatile inhalant-induced psychotic disorder (ICD-11) was made. Management relied on antipsychotics (risperidone) as the cornerstone, along with cognitive behavioral therapy, motivational enhancement therapy and relapse prevention for sustained recovery. DISCUSSION: This case highlights distinctive aspects, including prolonged duration of psychotic symptoms following chronic inhalant exposure, as well as the aggravation of psychotic symptoms (mainly auditory hallucination) occurring 15-20 minutes after acute inhalant use. The nicotine self-medication hypothesis has been proposed to explain this phenomenon, suggesting that nicotine may alleviate distress during acute use. CONCLUSION: The focus was not only to explain the psychiatric sequelae of inhalant abuse but also to underscore the importance of comprehensive management strategies for adequate recovery and to unveil the roles of gamma-aminobutyric acid (GABA) disinhibition, glutamate, and dopamine dysregulation. Ultimately, the combination of pharmacotherapy and behavioral interventions is essential. To decrease experimentation with inhalants, regulation alone is insufficient without education and awareness-raising. A specific combination of strategies at three different levels, the government (consistent stringent rules at state and national levels, restriction of sales to minors, and community and school-based interventions), producers (adding deterrents and replacing harmful chemicals with safer alternatives), and consumers (education on health consequences and legal implications), can be implemented in India.