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Toxicity, Mushroom - Hallucinogens

Author: C Crawford Mechem, MD, MS, FACEP, Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department
Coauthor(s): Diane F Giorgi, MD, FACEP, Attending Physician, Department of Emergency Medicine, Brooklyn Hospital Center
Contributor Information and Disclosures

Updated: Jul 9, 2008

Introduction

Background

Hallucinogenic fungi have been used in divinatory or religious contexts for at least 3000 years. However, not until the 1950s were the involved species of fungi identified and the chemical nature of active substances determined.

In general, 2 groups of mushrooms with significant psychoactive effects exist.

  • Mushrooms containing ibotenic acid and muscimol (isoxazoles), including Amanita gemmata, Amanita muscaria (fly agaric), and Amanita pantherina (the panther), comprise the first group. These are not to be confused with deadly Amanita phalloides, Amanita verna, and Amanita virosa. For centuries, A muscaria has been consumed in central Asia as a hallucinogen. Some Siberian tribes report that 3 fresh A muscaria mushrooms can be lethal, while others claim that eating as many as 21 of these mushrooms is safe.
  • Psilocybin-containing mushrooms, including Psilocybe caerulipes, Psilocybe cubensis, Gymnopilus spectabilis, Panaeolus species (eg, Panaeolus foenisecii), and Psathyrella foenisecii, comprise the second group of mushrooms with psychoactive effects.

Mushrooms containing ibotenic acid and muscimol and those containing psilocybin are New World fungal hallucinogens. Reports of toxicity associated with this group of mushrooms have increased because of their growing popularity as hallucinogens.

Pathophysiology

Ibotenic acid is an agonist at central glutamic acid receptors; its decarboxylated derivative is an agonist at gamma-amino butyric acid receptors. Central effects of these hallucinogenic mushrooms are thought to be caused by these actions. Although muscarinic acid originally was isolated from A muscaria, the clinical syndrome does not suggest marked significance; in fact, anticholinergic findings may be observed.

The psilocybin group contains the indoles psilocybin and psilocin. Psilocin and its phosphate ester, psilocybin, are similar in structure to lysergic acid diethylamide (LSD). They are structural analogues of serotonin (5-hydroxytryptamine); thus, hallucinogenic effects probably are mediated through effects on serotonergic receptors.

Frequency

United States

Estimating frequency of hallucinogenic mushroom use is difficult. Psilocybin-containing mushrooms are popular recreational drugs of abuse.

Mortality/Morbidity

Mortality from hallucinogenic mushrooms is very rare.

Age

While little data exist on the age of users of hallucinogenic mushrooms, college students are known to abuse psilocybin mushrooms.

Clinical

History

Hallucinogenic mushrooms usually are ingested for their psychoactive properties.

  • Mushrooms containing ibotenic acid and muscimol
    • Symptoms begin 30 minutes to 1 hour postingestion; however, symptom onset rarely may be delayed as long as 3 hours.
    • Hallucinations may be accompanied by dysarthria, ataxia, and muscle cramps and may persist for as long as 8 hours. However, a recent case report describes an otherwise healthy 48-year-old man who accidentally ingested A muscaria mushrooms. He experienced a 5-day paranoid psychosis accompanied by visual and auditory hallucinations. By the sixth day, he had returned to baseline, with no long-term adverse effects reported.
    • Central nervous system (CNS) effects range from agitation to coma.
    • Heavy intoxication may cause vomiting, diarrhea, and seizures.
    • Fatal A pantherina poisonings have been reported in the Pacific Northwest.
  • Psilocybin-containing mushrooms
    • Alterations in perception begin within 30 minutes and subside after 6 hours.
    • Widely varying CNS manifestations, including euphoria, visual and religious hallucinations, and feeling closer to nature have been reported. Visual hallucinations may include perceived motion of stationary objects or surfaces.
    • Patients presenting in the ED may experience more unpleasant effects such as fear, agitation, confusion, delirium, psychosis, and schizophrenialike syndromes.
    • Symptoms may include nausea and sympathomimetic activity such as mydriasis and tachycardia.
    • Symptoms in children include hyperpyrexia and seizures.

Physical

Predominant findings in these intoxications are neurologic.

Fever, tachycardia, and hypotension may occur because of agitation.

  • Neurologic findings
    • Ataxia
    • Incoordination
    • Confusion
    • Delirium
    • Psychosis

More on Toxicity, Mushroom - Hallucinogens

Overview: Toxicity, Mushroom - Hallucinogens
Differential Diagnoses & Workup: Toxicity, Mushroom - Hallucinogens
Treatment & Medication: Toxicity, Mushroom - Hallucinogens
Follow-up: Toxicity, Mushroom - Hallucinogens
References
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References

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  2. Borowiak KS, Ciechanowski K, Waloszczyk P. Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction. J Toxicol Clin Toxicol. 1998;36(1-2):47-9. [Medline].

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  16. Satora L, Pach D, Ciszowski K, Winnik L. Panther cap Amanita pantherina poisoning case report and review. Toxicon. Apr 2006;47(5):605-7. [Medline].

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Further Reading

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Keywords

mushroom toxicity, hallucinogenic mushroom, hallucinogen toxicity, hallucinogen poisoning, hallucinogen exposure, mushroom poisoning,fungal hallucinogens, Amanita gemmata, Amanita muscaria, fly agaric, Amanita pantherina, the panther, Amanita phalloides, Amanita verna, Amanita virosa, hallucinogenic fungi, psilocybin-containing mushrooms, Psilocybe caerulipes, Psilocybe cubensis, Gymnopilus spectabilis, Panaeolus species, Panaeolus foenisecii, Psathyrella foenisecii, ibotenic acid, muscimol

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Contributor Information and Disclosures

Author

C Crawford Mechem, MD, MS, FACEP, Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department
C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Diane F Giorgi, MD, FACEP, Attending Physician, Department of Emergency Medicine, Brooklyn Hospital Center
Diane F Giorgi, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American Association of Women Emergency Physicians, American College of Emergency Physicians, and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio
Miguel C Fernandez, MD, FAAEM, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael Hodgman, MD, Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare
Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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