In recent years, a widely popular phenomenon has emerged as exemplified in thousands of videos available on the Internet. Referred to using the impressive sounding term "Autonomous Sensory Meridian Response" (abbreviated ASMR), followers claim that ASMR videos evoke a special "tingling" sensation that is regarded as highly pleasurable and relaxing. The popularity of this phenomenon is reflected in individual ASMR videos receiving more than 43 million views and a reddit ASMR forum with over 130,000 subscribers. Two exploratory studies are reported. In the first study, a content analysis was carried out on 30 popular ASMR videos, and compared with 30 videos employing two different control methods. In the second study, a content analysis was carried out on 3,600 comments on discussion forums and accompanying ASMR videos. The results indicate that ASMR videos typically employ a quiet, private scene, with a relaxed, friendly, and intimate actor ("ASMRtist"). Although ASMR is evoked by non-musical stimuli, the physiological responses to ASMR (skin-related tingling and goosebumps) strongly resemble the classic frisson experience—a phenomenon that has received considerable attention among music perception researchers. Careful consideration of ASMR stimuli and responses suggest that ASMR is consistent with Huron's (2006) theory of frisson.

Objectives: This systematic review aimed to identify published articles that evaluated all phenibut toxicity and withdrawal cases to understand better their clinical presentations and treatments. Methods: A comprehensive literature search was conducted using Medline (Ovid), Embase (Ovid), and Cochrane Library databases to capture all published cases on the presentations and management of phenibut toxicity or withdrawal. Results: Sixty-two cases from 36 studies on presentation and management of phenibut toxicity or phenibut withdrawal were identified. Of all subjects, 80.7% were male. The average age was 30.9 years (SD, 13.2 years; range, 0-71 years). A total of 86.8% reported obtaining phenibut online, and 63.2% reported concomitant substance use with other addictive agents; benzodiazepines and alcohol were the most combined drugs. The average length of hospital stay was 5.0 days (n = 25; SD, 5.4 days; range, 1-25 days) for phenibut toxicity and 7.7 days (n = 20; SD, 7.8 days; range, 0-30 days) for phenibut withdrawals. The most common symptoms reported during phenibut toxicity were altered mental status, somnolence, psychosis, and movement disorders. Of the phenibut toxicity cases, 48.7% required intubation. Benzodiazepines and antipsychotics were most used to treat phenibut toxicity. For phenibut withdrawal cases, 95.7% reported daily use. The most common symptoms reported during phenibut withdrawals were anxiety, irritability or agitation, insomnia, and psychosis. Sixteen (69.6%) of phenibut withdrawal cases required multiple medications for treatment. Benzodiazepines, baclofen, atypical antipsychotics, gabapentanoids, and barbiturates were commonly used to treat phenibut withdrawals. Conclusions: The seriousness of presentations, combined with the assortments of medications used for both syndromes, reflects the potential dangers of phenibut use and the need for systematized treatment protocols.