In recent years there is the rising trend of anticholinergics use among high school students especially it is common to mix alcohol with anticholinergics. The characteristic features of anticholinergic intoxication are the rapid onset of alterations in mood, cognition and perception in the presence of a clear sensorium and following the ingestion of the drug in a commonly distributable form. But if psychotic symptoms are present in the absence of retained reality testing a diagnosis of substance-induced psychotic disorder may be warranted. Therefore, in same cases clinical picture presents a differential diagnostic dilemma.

The authors present the case report of twenty-one year old male with dependence of multiple drug use (according the criteria of ICD-X), who was observed in department of alcoholism. In early adolescence period he used different psychoactive substances (opioids and non-opioid psychoactive substances). At last two years he episodically consumed anticholinergics. Upon the mixed use of alcohol with anticholinergics he experienced auditory hallucinations, rapid and incoherent speech and paranoid ideation. He acted out his imperative hallucinations aggressively with violent behavior.

During hospital treatment he was treated with antipsychotic medications, benzodiazepines and supportive and educational therapies.

On this regiment psychotic symptoms resolved completely after two weeks.

Results of complete psychiatric-psychological examination did not indicate psychotic disorder.