Mr. A, 37 years old, used ecstasy between the ages of 21 and 30. For the first 2 years, he took 5 tablets every weekend, escalating to an average daily use of 3.5 tablets for the next 3 years, and further escalation to an average of 25 tablets daily over the next 4 years. An estimate of lifetime consumption yielded a total intake of more than 40,000 tablets. …
Mr. A reported current cannabis consumption, together with a previous history of polydrug misuse (i.e., solvents, benzodiazepines, amphetamines, LSD, cocaine, heroin). After three episodes of "collapsing" at parties, Mr. A finally stopped his ecstasy use. For a few months, he felt as if he was still under the influence of ecstasy and suffered several episodes of "tunnel vision."
He eventually developed severe panic attacks, recurrent anxiety, depression, muscle rigidity (particularly at the neck and jaw levels), functional hallucinations, and paranoid ideation…. The Mini-Mental State Exam revealed disorientation to time, poor concentration, and short-term memory difficulties…. Although Mr. A was able to fully understand the instructions given, his concentration and attention were so impaired that he was unable to follow the sequence of the tasks required. A structural MRI brain scan revealed no focal cerebral lesions…There was no evidence to suggest atrophy. Mr. A was then prescribed olanzapine 10 mg and admitted to a brain-injury unit, where there was some improvement of his memory skills as a result of the use of compensatory strategies.
