Case-report, Literature review and Discussion.

AB was a 29 year old transsexual admitted with a two week history of paranoid delusions and auditory hallucinations. He had recently reduced his Oestrogen tablets from 4 mg to 2 mg per day. He had also been taking Meizitang “a natural herbal” slimming pill, bought online. He presented with paranoid, persecutory delusions, first and third person auditory hallucinations and poor insight. He was treated with Quetiapine, recovered completely within 2 weeks and was discharged.

We propose that the reduction in Oestrogen levels, the intake of Meizitang and the cognitive dissonance associated with his gender identity contributed to the development of psychosis. Our literature review revealed several studies that implicated Sibutramine (which Meizitang is known to be adulterated with) as an aetiological factor for psychosis. We also report on studies that demonstrated the anti-psychotic effects of Oestrogen.

This case highlights the need for further studies on both the protective effects of Oestrogen in psychosis and the psychogenic effects of Meizitang. We recommend increased awareness amongst clinicians about the potential risk of psychosis associated with Meizitang.