Abstract
Objectives: St. John's wort (Hypericum perforatum) is a popular, over-the-counter herbal remedy for depression. This is a case report of a psychotic episode associated with St. John's wort.Case: A 76-year-old female began taking St. John's wort three weeks prior to developing delirium and psychosis. Final diagnosis was underlying Alzheimer's dementia with acute psychotic delirium associated with use of St. John's wort.Conclusion: After careful elimination of alternative diagnoses, the delirium with psychotic features is thought to be associated with use of St. John's wort. It is likely the patient's underlying but undiagnosed dementia predisposed her to this adverse event. Use of over-the-counter products by older adults can be complicated by age and disease-related changes in product pharmacokinetics, efficacy, and side-effect profile.
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