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547048 
Journal Article 
Psychosis Temporally Related to Supratherapeutic Manganese Supplementation 
Leikin, JB; Mottram, AR 
2008 
1 
Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 
46 
7 
7 
English 
WOS:000258052900258 
Background: Manganese(Mn)-induced psychosis has been well described in the occupational setting, to our knowledge it has not been described due to supplement use. We describe a suspected case. Case Report: A 44 yo male with no past medical history, on no medications, presented with a first psychotic episode to an Emergency Department. Symptoms included flat affect, insomnia, depressed mood, persecuting delusions, racing thoughts, disorganized speech and behavior, and diminished insight. Physical exam, lab, and neuroimaging were unremarkable. Symptoms resolved while on risperidone within 2 days. He had been taking excessive amounts of the "brain nutritional supplement" Focus Smart, resulting in ingestion of 4mg Mn daily for 2 weeks until 3 days prior to presentation. The patients serum Mn level was 1.3 ng/mL 5 weeks post presentation and 0.8 ng/mL at 8 weeks (reference range 0.4 to .85 ng/mL). Urine Mn was 0ug/L and 0.4 ug/L at 5 and 8 weeks. Hair Mn was 0.13 meg/gm (0.3-2.7 meg/gm). Blood, urine and hair levels of mercury, lead, arsenic, copper and chromium were normal. The patient was asymptomatic at 8 weeks. Case Discussion: The RDA for Mn is 2.3 mg/day for men. The tolerable upper limit intake is 11 mg/day based on a no observed adverse effect level for western diets. The neuropsychiatric effects of Mn toxicity are well documented for significant chronic toxicity, and are less likely in acute exposures. Our patient had ingested twice the RDA for two weeks, and had a serum Mn level at five weeks that was close to the upper limit of normal. His exposure was sub-acute, and resolved promptly both with removal of Mn supplementation and addition of risperidone. Conclusion: This patients neuropsychiatric disorder was temporally related to a supratherapeutic ingestion of Mn. Association between Mn dietary supplementation and neuropsychiatric disorders has not been reported in the literature. It is suspected that excessive Mn intake was a contributing factor to this patients psychosis. Future documentation of Mn exposure in patients with new onset psychosis would clarify if there is an association. 
Article Subject Terms: Manganese; Dietary supplements; Psychosis; Magnetoencephalography; Risperidone; Hair; Urine; Mental disorders; Toxicity; Chromium; Lead; Sleep disorders; Neuroimaging; Case reports; Mercury; Carcinoembryonic antigen; Mood; Copper; speech; Side effects; Arsenic; Chronic toxicity; Blood; Ingestion; Toxicology; Nutrition; emergency medical services; Diets; depression; Brain; Article; Geographic Terms: North America; N3 11028 Neuropharmacology & toxicology; X 24360 Metals; H 4000; Food and Drugs