Herbal mania: a diagnostic dilemma?

A case of affective psychosis and cognitive impairment is described. The pa tient had a history of cerebrovascular disease and had been ingesting large quantities of a complex herbal tonic prior to presentation. Diagnostic iss ues are discussed. Relevant literature on cerebrovascular disease and herba l remedies is reviewed. We propose a stress-diathesis model to account for this patient's illness and we advise caution in the use of complementary th erapies in patients with compromised cerebrovascular status. Appropriate pr actice guidelines are outlined.