A novel psychoactive substance poses a new challenge in the management of paranoid schizophrenia

Abstract

SUMMARYNovel psychoactive substances (NPS), or 'legal highs' are becoming more commonly used as recreational substances in the UK. Their clinical effects are little known and vary considerably between substances. This case discusses a psychiatric inpatient who repeatedly used a stimulant NPS called 'el blanco' while on leave, precipitating relapses of his schizophrenia. The patient initially denied drug use, considering legal highs as different from drugs. The relationship between NPS use and mental state was eventually revealed on careful direct questioning. He recovered and was discharged following treatment with clozapine and education about NPS use. We suggest that specific questioning about NPS usage is added to routine psychiatric history taking and that patients using NPS should be educated about the substances' use. BACKGROUND

Novel psychoactive substance consumption is more represented in bipolar disorder than in psychotic disorders: A multicenter‐observational study

“…These substances are often synthesized in underground laboratories, simply modifying the molecular structure of controlled drugs, hence raising further concerns in terms of the presence of contaminating agents (UNODC, ). NPS are raising a growing number of sanitary concerns, but so far, their clinical effects are still poorly known, and may vary considerably between substances (Anderson, Morrell, & Marchevsky, ). A consistent body of clinical evidence currently demonstrates the potential acute and chronic health harms associated with the use of NPS (Schifano, Orsolini, Papanti et al, ); however, these substances are still often unknown to health professionals, mainly because of the lack of evidence‐based sources of information (Simonato, Corazza, Santonastaso et al, ).…”

A systematic review of the effects of novel psychoactive substances ‘legal highs’ on people with severe mental illness

“…Four studies were conducted in inpatient or acute psychiatric clinics (Anderson et al . and Smith et al . in the United Kingdom; Celofiga et al .…”

“…In most cases, NPS use was identified based on self‐report (n = 9), although two patients denied drug use at first and admitted taking drugs only after several weeks of treatment resistance (McClean et al . ) or after repeated hospitalization (Anderson et al ., ). Five patients were reported to have been seen taking drugs by clinical staff (Celofiga et al .…”

“…Only 5 of the 12 authors reported having done any testing of the substances used. In seven cases a standard urine drug/toxicology screen was performed, usually negative for the NPS taken by the patient (Anderson et al ., ; Boucher et al . , Celofiga et al .…”

“…ported). Four studies were conducted in inpatient or acute psychiatric clinics (Anderson et al 2015 andSmith et al 2013…”