We report a case of delirium with anticholinergic symptoms in a 19-year-old female patient with schizophrenia. On the day the symptoms emerged, the patient received olanzapine long-acting injection and a higher dose of paliperidone. We observed symptoms ranging from confusion to delirium as well as some anticholinergic symptoms. The delirium lasted 24 hours and was managed by intravenous fluid substitution and oral benzodiazepines. Olanzapine pamoate, paliperidone and cannabis are central nervous system (CNS) depressants, and their combination can increase the risks of CNS depression. In this case report, we review the symptoms of delirium in a case of antipsychotic overdose and provide general guidelines for managing these symptoms. We also review possible complications in combined use of cannabis, olanzapine and paliperidone.

Semaglutide is a glucagon-like peptide-1 receptor agonist used in the treatment of type 2 diabetes mellitus and management of obesity. Associations of glucagon-like peptide-1 receptor agonist use with psychiatric adverse events and suicidal behavior have been reported. A man in his late 70s with type 2 diabetes and no history of psychiatric illness or cognitive deficits was admitted to our clinic after his first suicide attempt involving the impulsive ingestion of brush cleaner liquid. A month before his presentation, he reported restlessness and depressive mood without any apparent trigger. This period was consistent with the time of semaglutide introduction. His psychiatric symptoms improved after semaglutide discontinuation. This case report highlights the importance of regular monitoring of depression and anxiety symptoms and the possibility of suicidal ideation in individuals with type 2 diabetes treated with semaglutide. This may enable early detection and prevention of serious psychiatric adverse events.

Medical procedures have the potential to elicit feelings of anxiety, which have been associated with reduced health-related quality of life and cardiac dys