{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T05:47:55Z","timestamp":1774590475237,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>St John's wort (SJW) is widely used as an herbal supplement for depressive symptoms and is generally regarded as safe. However, although extremely rare, manic and psychotic reactions have been reported, typically in individuals taking high doses, using psychotropic agents, or having a psychiatric history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We report a case of a Japanese male in his early twenties with only one prior psychiatric visit for interpersonal stress, who developed acute manic and psychotic symptoms while taking standard doses of SJW. Shortly after returning to a university training program following COVID\u201019 infection, he developed emotional instability, prominent grandiose and persecutory delusions, reduced sleep, and dangerous behavior. Blood tests, cerebrospinal fluid analysis, brain imaging, and cerebrospinal fluid antibody testing were normal. Upon admission, we provisionally diagnosed him with schizoaffective disorder and initiated treatment with aripiprazole, which led to rapid improvement and near remission within 1 week. During pre\u2010discharge psychoeducation, he reported taking SJW for several months, suggesting a possible association between SJW use and symptom onset. SJW was discontinued, and aripiprazole long\u2010acting injectable treatment was initiated after discharge. After 2 months of sustained clinical stability, antipsychotic treatment was discontinued based on shared decision\u2010making with the patient. Outpatient follow\u2010up is ongoing to monitor for any recurrence of symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates that acute manic and psychotic symptoms may occur even in young adults with no notable psychiatric history who take standard doses of SJW. Although SJW is regarded as safe, this case highlights that severe psychiatric reactions may still arise.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70292","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:42:37Z","timestamp":1769157757000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute mania and psychosis potentially triggered by St John's wort"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9775-2369","authenticated-orcid":false,"given":"Daisuke","family":"Yoshioka","sequence":"first","affiliation":[{"name":"Department of Psychiatry Yowa Hospital Yonago Japan"},{"name":"Department of Neuropsychiatry, Faculty of Medicine Tottori University Tottori Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehiko","family":"Yamanashi","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Faculty of Medicine Tottori University Tottori Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaaki","family":"Iwata","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Faculty of Medicine Tottori University Tottori Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"e_1_2_12_2_1","first-page":"CD000448","article-title":"St John's wort for major depression","volume":"2008","author":"Linde K","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2008.10.018"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2006.16.197"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2004.04.005"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1527-3458.2004.tb00022.x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200317080-00001"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v65n1105"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phymed.2005.07.005"},{"key":"e_1_2_12_10_1","first-page":"56","article-title":"Mania and psychosis associated with St. John's Wort and ginseng","volume":"2","author":"Joshi KG","year":"2005","journal-title":"Psychiatry (Edgmont)"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674370104600112"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.6055"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CHI.0000046900.27264.2A"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2005.15.293"}],"container-title":["Psychiatry and Clinical Neurosciences Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70292","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pcn5.70292","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70292","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T04:05:19Z","timestamp":1774584319000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pcn5.70292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/pcn5.70292"],"URL":"https:\/\/doi.org\/10.1002\/pcn5.70292","archive":["Portico"],"relation":{},"ISSN":["2769-2558","2769-2558"],"issn-type":[{"value":"2769-2558","type":"print"},{"value":"2769-2558","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"assertion":[{"value":"2025-12-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70292"}}