Numerous food and drug combinations, also ‘legal highs', may precipitate
serotonin syndrome, yet it appears to be rarely diagnosed. This may be
explained by diagnostic overshadowing when physical symptoms are
misattributed to mental illness. Some symptoms of serotonin syndrome
(agitation, tremor and rigidity) overlap with presentations in mental
illness. Diagnostic confusion may occur in patients receiving polypharmacy,
those receiving medications with previously unknown serotonergic properties
or where unforeseen drug interactions occur. Acute medical presentations
with hyperthermia and clonus should prompt holistic review to exclude other
possible aetiologies. Discontinuation of the suspected agent may avert an
array of possible serious outcomes.