A 25 years old, unemployed man that was graduated from primary school applied to the inpatient clinic of Samsun Mental Health and Disorders Hospital, on March 2021. He reported that he has been using oxybutynin for 8 years, and wanted to give up the drug. He had been taking a box of oxybutynin almost every day. A box of drugs consisted of 100 pills, so this means he was taking 500 mg/day at once.
During the interview, he reported that he was used cannabis and methamphetamine before, for 3 years, intermittently. He has started to use oxybutynin on a friend's advice to give up these substances. He stopped using substances, but he was using oxybutynin for 8 years. He could reach the drug easily from pharmacies without any prescription. While, he was taking 125–150 mg/day of oxybutynin (25–30 pills in a day) initially, the dosage had reached 500 mg in a short time, quickly. He stated that he had taken 250–300 pills in some days (1000–1500 mg/day). He had last taken the drug two weeks ago, because he was trying to stop taking oxybutynin by himself. He described agitation, irritability and, anxiety, sometimes. When he take oxybutynin he felt more energic, relaxed, decreased anxiety, and did not need other substances. However, he described some psychotic symptoms as visual and auditory hallucinations, reference thoughts, and persecution delusions when he was under the effect of the oxybutynin. But, the psychotic symptoms were resolving after the drug’s effect has ended. He did not describe any withdrawal symptoms. He had some side effects related to the anticholinergic effects of the drug, such as constipation, dry mouth, blurred vision, sweating and, impaired attention and concentration. However, he was unpleased because to be dependent on this drug. He was feeling discomfort and craving. He had applied to some inpatient clinics-two of them to the Alcohol-Drug Addiction Treatment and Training Centers for five times to ‘get out of’ the drug, but the treatment failed again and again. He had been in prison 8 times for various in the past years. One of his crimes was because of plundered a pharmacy because of obtaining oxybutynin. He had attempted suicide two times when he broke up with his girlfriend, one by taking pills and the other by jumping.
In the psychiatric examination, he was looking at his age, had old scars caused by self mutilative behavior on his arms. His appearance was compatible with his socioeconomic level. He was conscious and oriented to place, time, and person. His intelligence was clinically normal, the speech was spontaneous and on normal rhythm. He was looking anxious and nervous. No pathology on his thought process. No symptoms were defined on his routine physical examination.
The Montreal Cognitive Assessment Scale (MoCA) score was 23 that means no significant cognitive impairment. The Symptom Check List (SCL-90) indicated mild pathological evidence on the somatization scale. The Minnesota Multiphasic Personality Inventory (MMPI) demonstrated that hypersensitivity to criticism, tendency to blame others, no self-confidence and no self-esteem, emotional instability, excessive idealization, bad interpersonal relationships. His medical and familial history does not contain any features. No abnormalities were determined on serum biochemistry, hemogram, and thyroid function tests. He took 9 points from Hamilton Anxiety Scale, and 7 points from Hamilton Depression Scale.
The patient was diagnosed with Other Substance Use Disorders according to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria. Carbamazepine 400 mg/day, olanzapine 10 mg/day, and lorazepam 2.5 mg/day treatments were started. Withdrawal symptoms did not observe. But, on the follow-up, he had trouble controlling his anger, so risperidone 1 mg/day was added to the medication. At the end of the five weeks, both symptoms improved completely. In the follow-up, he had no psychiatric symptoms two months after the discharge. He was not using any substance or addictive drugs; working regularly in his father’s family business.