Exacerbation of Psychotic Symptoms Associated With Mushroom-Based Supplementation in a Patient With Cerebral Palsy

Routine inquiry about supplement use is essential in psychiatric assessments to prevent avoidable exacerbations. We present a case illustrating the potential neuropsychiatric risks associated with mushroom-based dietary supplements in individuals with neurological vulnerabilities, underscoring the necessity for comprehensive psychiatric evaluations that include inquiries about nonprescribed remedies.¹

Case Report

A 24-year-old man from India with a history of cerebral palsy and global developmental delay presented to the psychiatry outpatient department with a 2-month history of auditory hallucinations. Born at term, he experienced a delayed cry at birth, neonatal fever, and infantile seizures treated with antiepileptics for 2 years. Developmental milestones were markedly delayed in motor and speech domains, resulting in significant functional limitations. He had no formal education and relied on caregivers for daily activities. He had no psychiatric or substance use history and no familial history of psychotic disorders.

The physical examination revealed an abnormal truncal posture, poor postural control, spastic involvement of all limbs, impaired fine motor coordination, dysarthric speech, increased muscle tone, brisk deep tendon reflexes, and bilateral extensor plantar responses. He was wheelchair-dependent, consistent with spastic quadriplegic cerebral palsy. Psychological assessment via the Vineland Social Maturity Scale yielded a social quotient of 66, indicative of mild intellectual disability aligned with his adaptive functioning.

The patient described second-person auditory hallucinations as a female voice originating externally, commenting on his actions and occasionally delivering derogatory remarks, causing substantial distress for 8 weeks prior to presentation. These hallucinations occurred multiple times daily, unrelated to sleep or altered consciousness, without command elements. Caregivers noted concurrent irritability, restlessness, and agitation. No visual hallucinations, thought disturbances, delusions, or passivity phenomena were evident.

Mental status examination showed an anxious, distracted patient with sparse, reduced-spontaneity speech; reactive affect; and perceptual abnormalities limited to auditory hallucinations. Cognitive function matched his baseline intellectual impairment.

Initial management involved risperidone 0.5 mg twice daily (adjusted to 0.5 mg in the morning and 1 mg at night) alongside etizolam 0.25 mg twice daily and propranolol 20 mg (half tablet twice daily) for anxiolysis and autonomic control. Within days, hallucinations diminished in frequency and intensity, with improved anxiety and behavior.

Despite this clinical improvement, family members independently administered an over-the-counter mushroom-based supplement containing per serving (2 capsules): lion’s mane extract 280 mg, shiitake extract 280 mg, reishi extract 260 mg, advanced reishi extract 200 mg, and a mushroom blend (turkey tail, chaga, Cordyceps, and Tremella extracts) 260 mg, totaling ∼1,280 mg of mushroom extracts. Marketed for cognitive and immune support, it was initiated without medical advice. Within 48–72 hours of supplement initiation, previously improving psychotic symptoms re-exacerbated dramatically: Auditory hallucinations intensified in frequency, clarity, and distress, accompanied by heightened fearfulness and agitation. Prescribed medications remained unchanged, eliminating them as confounders.

Recognizing the temporal correlation, the supplement was promptly discontinued. Over subsequent days, symptoms regressed progressively, returning to pre-supplementation, stabilized levels, demonstrating a positive dechallenge. Continued psychotropic therapy without recurrence further supported causality.

Discussion

This case posits a probable link between mushroom-based supplementation and re-exacerbation of previously improving psychotic symptoms in a patient with cerebral palsy on stable antipsychotic treatment. Mushrooms like lion’s mane promote neurotrophic factors such as nerve growth factor, potentially modulating dopaminergic, serotonergic, or glutamatergic pathways. In those with perinatal brain injury or neurodevelopmental disorders, such interventions may disrupt fragile neurotransmitter equilibria, precipitating or worsening psychosis. While most reports of mushroom-related psychiatric adverse effects involve psilocybin-containing (“magic”) mushrooms, often in predisposed individuals leading to acute or prolonged psychosis,^2,3 analogous risks from nonhallucinogenic medicinal mushroom blends remain understudied but plausible given neurotrophic and immunomodulatory properties. Analogous reports exist for other herbal supplements inducing psychiatric symptoms, often resolving upon cessation.^4,5

The underreporting of supplement-related adverse events, coupled with their unregulated status, heightens risks. Clinicians must routinely probe for such usage, especially in vulnerable populations, to avert preventable deteriorations. This report advocates for heightened awareness, regulatory scrutiny, and patient education on supplement safety.

Article Information

Published Online: August 4, 2026. https://doi.org/10.4088/PCC.26cr04200
© 2026 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2026;28(4):26cr04200
Submitted: January 13, 2026; accepted April 17, 2026.
To Cite: Kaur K, Garg S. Exacerbation of psychotic symptoms associated with mushroom-based supplementation in a patient with cerebral palsy. Prim Care Companion CNS Disord 2026;28(4):26cr04200.
Author Affiliations: Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India (Kaur, Garg).
Corresponding Author: Shobit Garg, MD, DPM, Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Shri Guru Ram Rai University, Dehradun, Uttarakhand, 248001 India ([email protected]).
Financial Disclosure: None.
Funding/Support: None.
Patient Consent: Written informed consent for publication of the case details was obtained from the patient’s legal guardian, and information has been de-identified to protect patient anonymity.
ORCID: Shobit Garg: https://orcid.org/0000-0001-5913-9021