Psychiatric symptoms and synthetic cannabinoid use: Information for clinicians

Sweet, Gary; Kim, Sara; Martin, Samuel; Washington, Nicole B.; Brahm, Nancy C.

doi:10.9740/mhc.2017.07.156

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…A 47-year-old African-American man presented for involuntary inpatient psychiatric admission after being brought in by police secondary to bizarre behavior/hallucinations/agitation/delusions following SC intake (86). He was initially treated with olanzapine (10 mg daily), then switched to haloperidol intramuscularly and lorazepam due to aggressiveness and increasing levels of agitation towards clinicians.…”

Section: Resultsmentioning

confidence: 99%

“…He was initially treated with olanzapine (10 mg daily), then switched to haloperidol intramuscularly and lorazepam due to aggressiveness and increasing levels of agitation towards clinicians. The patient was observed and he refused any follow-up and/or medication after discharge (86).…”

Section: Resultsmentioning

confidence: 99%

“…From a therapeutic perspective, benzodiazepines are useful for managing anxiety, agitation, and seizure risk, together with a supportive/symptomatic therapy (1, 7, 30, 32, 36, 39, 41, 46, 48, 59–61, 71, 79, 81). Olanzapine, clozapine, quetiapine, and aripiprazole represent the main prescribed antipsychotic treatments in SC-induced psychoses (1, 7, 37, 50, 57, 60, 62, 65–67, 70, 75, 85, 86), while haloperidol, risperidone, and paliperidone have been prescribed/used in isolated cases (45, 53, 63, 73, 85).…”

Section: Discussionmentioning

confidence: 99%

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The Bridge Between Classical and “Synthetic”/Chemical Psychoses: Towards a Clinical, Psychopathological, and Therapeutic Perspective

et al. 2019

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The critical spread and dissemination of novel psychoactive substances (NPS), particularly among the most vulnerable youngsters, may pose a further concern about the psychotic trajectories related to the intake of new synthetic drugs. The psychopathological pattern of the “new psychoses” appears to be extremely different from the classical presentation. Therefore, clinicians need more data on these new synthetic psychoses and recommendations on how to manage them. The present mini-review aims at deepening both the clinical, psychopathological features of synthetic/chemical NPS-induced psychoses and their therapeutic strategies, according to the different NPS classes implicated, by underlining the main differences with the “classical” psychoses. A comprehensive review was conducted using the PubMed/Medline database by combining the search strategy of free-text terms and exploding a range of MESH headings relating to the topics of novel psychoactive substances and synthetic/chemical psychoses as follows: {(Novel Psychoactive Substances[Title/Abstract]) AND Psychosis[Title/Abstract])} and for each NPS categories as well, focusing on synthetic cannabinoids and cathinones, without time and/or language restrictions. Finally, an overview of the main clinical and psychopathological features between classical versus NPS-induced chemical/synthetic psychoses is provided for clinicians working with dual disorders and addiction psychiatry. Further insight is given here on therapeutic strategies and practical guidelines for managing patients affected with synthetic/chemical NPS-induced psychoses.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Bridge Between Classical and “Synthetic”/Chemical Psychoses: Towards a Clinical, Psychopathological, and Therapeutic Perspective

et al. 2019

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“…The literature on the subject draws attention to the fact that first-generation antipsychotics administered with or without anticholinergics, or with benzodiazepines, are superior to benzodiazepine monotherapy in patients with acute psychotic symptoms such as delusions, hallucinations and agitation (57). Sweet et al (58) report a case of a 47-year-old man who ingested a synthetic cannabinoid "King Kong, " and then was brought by the police to the emergency department with high fever, tachycardia, accelerated breathing and blood pressure of 153/103 mm Hg. The man was agitated, had delusions and hallucinations.…”

Section: Synthetic Cannabinoidsmentioning

confidence: 99%

“…The next day he was calm and able to take part in a medical interview. He admitted that he had smoked King Kong before and was involuntarily hospitalized each time (58).…”

Section: Synthetic Cannabinoidsmentioning

confidence: 99%

Pharmacotherapy of Patients Taking New Psychoactive Substances: A Systematic Review and Analysis of Case Reports

et al. 2021

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Background: In recent years, an increase in the frequency of hospitalizations of patients taking newer and newer psychoactive substances has been observed around the world. Each year, authors publish case reports of patients who consumed previously unknown NPS. Most publications of this type concern the period between 2014 and 2016. However, no publication systematically reviews the pharmacotherapy used in these cases. This study aims to review the case reports of patients taking NPS published between 2010 and 2019, as well as analyzing the pharmacotherapy used.Methods: We searched the Thomson (Web of Knowledge), PubMed/Medline, Science Direct, Scopus and Google Scholar databases. The search was performed using all possible combinations of the term “case report” describing the use of NPS, also referred to as designer medications, internet medications, research chemicals and herbal highs.Results: We analyzed 51 case reports on the intake of various types of NPS. Most of them (p < 0.001) concerned the use of synthetic cannabinoids (41.2%) and cathinones (31.4%). The pharmacotherapy applied primarily (p < 0.001) consisted of administering benzodiazepines to patients (62.7%), most of whom took only this group of medications (25.5%), followed by groups receiving benzodiazepines combined with neuroleptics (15.7%) and muscle relaxants (11.8%). Opioids were administered primarily to patients taking synthetic opioids (p < 0.001). Of the 5 cases of deaths from NPS reported in the literature, three relate specifically to the synthetic opioid MT-45. The later the time period, the more medications patients were administered (p = 0.02).Conclusion: In the pharmacotherapy for NPS poisoning, one should focus primarily on combating psychomotor agitation.

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Designer drugs: mechanism of action and adverse effects

2020

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Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at l-opioid receptors and c-aminobutyric acid-A (GABA A) or GABA B receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB 1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT 2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.

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Psychiatric symptoms and synthetic cannabinoid use: Information for clinicians

Cited by 3 publications

References 14 publications

The Bridge Between Classical and “Synthetic”/Chemical Psychoses: Towards a Clinical, Psychopathological, and Therapeutic Perspective

The Bridge Between Classical and “Synthetic”/Chemical Psychoses: Towards a Clinical, Psychopathological, and Therapeutic Perspective

Pharmacotherapy of Patients Taking New Psychoactive Substances: A Systematic Review and Analysis of Case Reports

Designer drugs: mechanism of action and adverse effects

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