Three months later, the man showed up at his local emergency room. His neighbor, he said, was trying to poison him. Though extremely thirsty, the man was paranoid about accepting the water that the hospital offered him, telling doctors that he had begun distilling his own water at home and that he was on an extremely restrictive vegetarian diet. He did not mention the sodium bromide or the ChatGPT discussions.
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Case Recap
- Man, 60 years old
- Background: Studied nutrition in college → partial health knowledge but not medical training
- Action: Eliminated sodium chloride from diet; replaced with sodium bromide after AI-assisted self-research
- Timeline: ~3 months of substitution → toxic bromide buildup (bromism)
- Admission:
- Walked into his local emergency room himself
- Told staff his neighbor was trying to poison him
- This delusional belief was his presenting complaint
- Hospital course:
- Refused to drink hospital water
- Auditory + visual hallucinations developed
- Attempted escape from hospital
- Placed on involuntary psychiatric hold
- Cause: Bromide toxicity disrupting nerve and brain function
- Treatment: Aggressive saline diuresis + antipsychotic
- Outcome: Psychosis resolved after toxin cleared → confirms state psychosis, not chronic SZ
Key Learnings
- Positive symptoms can be triggered by an external, reversible cause — here, bromide toxicity.
- Toxic psychosis often presents to care through delusional framing (“I’m being poisoned”) rather than an admission of illness.
- Multi-sensory hallucinations (auditory + visual) are more common in toxic/metabolic psychosis than in SZ.
- Partial domain knowledge + AI advice without hazard interrogation can lead to dangerous substitution logic.
- Not prodromal SZ — onset and full resolution matched a toxic rupture, not a gradual architectural shift.
From: ChatGPT
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