Ayahuasca is a botanical hallucinogenic beverage used by indigenous groups throughout the Northwestern Amazon. Active ingredients include the tryptamine hallucinogen DMT, and beta-carboline monoamine oxidase inhibitors which allow for oral activity of DMT[1]. In Brazil, its use occurs also within syncretic religious organizations and its religious consumption is protected by law[2]. In the last decades, religious use of ayahuasca has spread from South America to the United States and Europe. In these new environments, therapeutic and recreational use also occur. Here we report the case of a young adult male, who experienced two psychotic paranoid episodes – separated by one year – during and after participation in ayahuasca rituals. The original citation for this text is: Santos, R.G., and Strassman, R.J. 2008, Br. J. Psychiatry (Online), 3 December. Available at http://bjp.rcpsych.org/cgi/eletters/190/1/81-a#22556.