Ophidic psychosis: brief psychotic episode in the context of a Bothrops snakebite

Abstract

Snakebite envenomation (ophidism) is a neglected tropical disease recognized by the World Health Organization. Although its physical complications are well documented, associated psychiatric manifestations, such as brief psychotic episodes, are rarely recognized in clinical practice. We present the case of a 53-year-old woman with no previous history of psychiatric illness who was hospitalized following a Bothrops snakebite to her right hand. She received antivenom and low-dose fentanyl (50 µg IV). On the fourth day of hospitalization, after being informed that amputation might be necessary, she developed psychomotor agitation, persecutory delusions, and hostile behavior, requiring mechanical and pharmacological restraint. Her symptoms completely remitted within 72 hours, and she subsequently retained complete memory of the events without psychiatric sequelae. This case highlights that acute psychiatric complications may occur in the context of snakebite envenomation, particularly following significant psychological stress. An interdisciplinary approach involving toxicology and psychiatry is therefore essential for timely detection and management. To our knowledge, this is one of the few reported cases in Latin America—and among the first associated with a Bothrops envenomation—of a brief reactive psychotic episode.