Long-term Dextromethorphan Use and Acute Intoxication Results in an Episode of Mania and Autoenucleation.

: The pharmacologic and neuropsychiatric sequelae of long-term dextromethorphan use and acute dextromethorphan intoxication are reviewed in this case report. Dextromethorphan ingestion at the high end of toxicity, although rare, can cause violence to oneself and others, even in those previously without any history of such behaviors. In this article, the neuropsychiatric consequences of dextromethorphan toxicity are highlighted in a case report of a 37-year-old woman who had been using dextromethorphan for 5 years. She presented to a large urban emergency department in a psychotic and manic state after attempting autoenucleation. She reported to consult liaison psychiatry staff that she had taken a total of 1400 mg of dextromethorphan over the course of 3 days with intent to experience altered state of consciousness. Toxicology screens on admission did not reveal any other substances in her system. She had no formal psychiatric history and no history of mania, psychosis, or self-harm. To our knowledge, this is the first case of autoenucleation resulting from dextromethorphan-induced mania with psychotic features.

A longitudinal, mixed methods study of sexual position identity, behavior, and fantasies among young sexual minority men.

Recent evidence suggests that young sexual minority men's sexual position identities (e.g., "top," "bottom," "versatile") may be governed by dynamic influences. Yet, no study has prospectively examined whether, how, and why this aspect of sexual minority men's sexuality changes over time. Consequently, the present study investigated the extent to which young sexual minority men use sexual position identities consistently over time, typical patterns of position identity change, explanations given for this change, and the correspondence of changing sexual position identities with changing sexual behavior and fantasies. A total of 93 young sexual minority men indicated their sexual position identity, behavior, and fantasies at two assessment points separated by 2 years. Following the second assessment, a subset (n = 28) of participants who represented the various sexual position identity change patterns provided explanations for their change. More than half (n = 48) of participants changed their sexual position identity. Participants showed a significant move away from not using sexual position identities toward using them and a significant move toward using "mostly top." Changes in position identity were reflected, although imperfectly, in changes in sexual behavior and largely not reflected in fantasy changes. Participants offered 11 classes of explanations for their identity changes referencing personal development, practical reasons, changing relationships, and sociocultural influences. Previous investigations of sexual minority men's sexual position identities have not adequately attended to the possibility of the changing use of the sexual position categories "top," "bottom," and "versatile" across young adulthood. Results of the present study suggest the possibility of a more fluid, context-dependent use of these terms than previously documented.