'There is a widely held belief that MDMA is a “safe” drug, but a growing body of literature has documented both medical and psychiatric adverse reactions to MDMA. Acute psychotic reaction are reported in the literature. Their occurrence was reported in chronic heavy users or in vulnerable individuals with a history of mental illness and/or a family history of psychiatric problems. However, persistent psychosis after a single dose of MDMA is unusual.
This is a case of recurrent psychotic episodes. The first episode occurred few hours after a single ingestion of ecstasy in a patient with no previous history of psychosis. Regardless the abstinence from the substance, a second episode occurred after medication discontinuation. In the case of substance-induced psychosis, the effects typically subside after the drug wears off. Nonetheless, this is not always the case, the impact could last for years after the substance use ceases.
Ecstasy use should be considered in patients presenting paranoid psychosis. The increasing use of MDMA should aware clinicians to inquire carefully about MDMA use and to include MDMA in toxicology screenings. Further researchers should clarify the etiology of persistent psychosis after MDMA use.'