{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T08:53:22Z","timestamp":1788252802240,"version":"build-2803163510"},"reference-count":21,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,4,8]]},"abstract":"<jats:p>Novel psychoactive substances (NPS), or \u2018legal highs\u2019 are becoming more commonly used as recreational substances in the UK. Their clinical effects are little known and vary considerably between substances. This case discusses a psychiatric inpatient who repeatedly used a stimulant NPS called \u2018el blanco\u2019 while on leave, precipitating relapses of his schizophrenia. The patient initially denied drug use, considering legal highs as different from drugs. The relationship between NPS use and mental state was eventually revealed on careful direct questioning. He recovered and was discharged following treatment with clozapine and education about NPS use. We suggest that specific questioning about NPS usage is added to routine psychiatric history taking and that patients using NPS should be educated about the substances\u2019 use.<\/jats:p>","DOI":"10.1136\/bcr-2015-209573","type":"journal-article","created":{"date-parts":[[2015,5,6]],"date-time":"2015-05-06T06:50:43Z","timestamp":1430895043000},"page":"bcr2015209573","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["A novel psychoactive substance poses a new challenge in the management of paranoid schizophrenia"],"prefix":"10.1136","volume":"2015","author":[{"given":"Caroline","family":"Anderson","sequence":"first","affiliation":[{"name":"Milton Keynes Hospital, Milton Keynes, Buckinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Morrell","sequence":"additional","affiliation":[{"name":"Milton Keynes Hospital, Milton Keynes, Buckinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Marchevsky","sequence":"additional","affiliation":[{"name":"Campbell Centre, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,5,6]]},"reference":[{"key":"2025082703045492000_2015.may06_1.bcr2015209573.1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20174"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.2","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2011.645952"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2012.04.017"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.4","doi-asserted-by":"publisher","DOI":"10.1002\/dta.274"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.5","first-page":"1","article-title":"Novel psychoactive substances in young adults with and without psychiatric comorbidities","volume":"2014","author":"Martinotti","year":"2014","journal-title":"BioMed Res Int"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.6","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/j.1600-0447.2007.01135.x","article-title":"Illicit drug use in patients with psychotic disorders compared with that in the general population: a cross-sectional study","volume":"117","author":"Ringen","year":"2008","journal-title":"Acta Psychiatr Scand"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.7","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.181.4.321"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.8","unstructured":"Revealed: The cocktail of chemicals in legal highs sold on Britain's high streets [Internet]. Mirror. (cited 20 Jan 2015). http:\/\/www.mirror.co.uk\/news\/uk-news\/revealed-cocktail-chemicals-legal-highs-2472206"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.9","unstructured":"Novel psychoactive substances report (2011)\u2014Publications\u2014GOV.UK [Internet]. (cited 20 Nov 2014). https:\/\/www.gov.uk\/government\/publications\/novel-psychoactive-substances-report-2011"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.10","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcs107"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.11","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq134"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.12","doi-asserted-by":"publisher","DOI":"10.1002\/dta.1671"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2010.06.030"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.14","doi-asserted-by":"publisher","DOI":"10.3109\/09638237.2012.682265"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.15","doi-asserted-by":"crossref","first-page":"364","DOI":"10.3109\/10826084.2013.841243","article-title":"Are \u201clegal highs\u201d users satisfied? Evidence from online customer comments","volume":"49","author":"Bruneel","year":"2013","journal-title":"Subst Use Misuse"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.16","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2014.944291"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.17","first-page":"89","article-title":"Legal highs: safe and legal heavens? A study on the diffusion, knowledge and risk awareness of novel psychoactive drugs among students in the UK","volume":"49","author":"Corazza","year":"2014","journal-title":"Riv Psichiatr"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.18","first-page":"139","article-title":"Effects and risks associated with novel psychoactive substances: mislabeling and sale as bath salts, spice, and research chemicals","volume":"111","author":"Hohmann","year":"2014","journal-title":"Dtsch Arzteblatt Int"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.19","doi-asserted-by":"crossref","unstructured":"Soussan C , Kjellgren A . Harm reduction and knowledge exchange\u2014a qualitative analysis of drug-related Internet discussion forums. Harm Reduct J 2014 (cited 1 Nov 2014). http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=25200686 .http:\/\/dx.doi.org\/10.1186\/1477-7517-11-25","DOI":"10.1186\/1477-7517-11-25"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.20","doi-asserted-by":"crossref","unstructured":"Smith C , Williams M , Shaikh M . Novel psychoactive substances: a novel clinical challenge. BMJ Case Rep 2013 (cited 1 Nov 2014). http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=23964049 .http:\/\/dx.doi.org\/10.1136\/bcr-2013-200663","DOI":"10.1136\/bcr-2013-200663"},{"key":"2025082703045492000_2015.may06_1.bcr2015209573.21","doi-asserted-by":"publisher","DOI":"10.1080\/15504263.2012.697447"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2015-209573","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:05:08Z","timestamp":1756289108000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2015-209573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5,6]]},"references-count":21,"alternative-id":["10.1136\/bcr-2015-209573"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2015-209573","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5,6]]}}}