Use of Synthetic Cannabinoids in Patients With Psychotic Disorders: Case Series

Olanzapine is a readily available atypical antipsychotic usually prescribed in adults for psychotic disorders. Olanzapine overdose or poisoning is rarely seen in children. It is often due to accidental intake of drug and sometimes suicidal.We are reporting two case of olanzapine poisoning in children presenting with altered sensorium and pinpoint pupils. The mainstay of treatment of olanzapine poisoning is supportive and symptomatic measures. Both children recovered well and were discharged.

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T195. PSYCHOTIC DISORDERS IN PATIENTS WHO USE SYNTHETIC CANNABINOIDS: CLINICAL CHARACTERISTICS AND PATIENT PROFILE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.755 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S305-S306

Author(s):

Valentin Skriabin ◽

Maria Vinnikova

Keyword(s):

Clinical Characteristics ◽

Psychotic Disorders ◽

Clinical Presentation ◽

Violent Behavior ◽

Synthetic Cannabinoids ◽

Psychotic Episode ◽

Patient Profile ◽

Observational Cohort ◽

Male Patients

Abstract Background Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) are the two principal ingredients of natural cannabis with counteracting functions. Synthetic cannabinoids (SCs) are much more potent than natural cannabis, since they act as a more potent full agonist at the cannabinoid subtype 1 receptor than THC, and they also lack cannabinoids such as CBD that may otherwise counteract psychoactive properties of THC. Therefore, SCs may induce a more severe clinical presentation than natural cannabis does: the use of SCs may be associated with agitation, anxiety, tachycardia, hallucinations, irritability, memory and cognitive impairment, violent behavior, unresponsiveness, and psychosis. Clinical characteristics, specificity of the disease course and patient profile of the SC-induced psychoses are still poorly characterized in the scientific literature. The present study was therefore designed to evaluate the psychotic disorders in patients with synthetic cannabinoid use disorder in terms of patient profile and clinical characteristics with reference to their follow-up. Methods A total of 60 male patients (n=60; mean (standard deviation [SD]) age: 23.6 (3.5) years) diagnosed with psychotic disorder induced by the SC use who were hospitalized at the intensive care unit or emergency department of the Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare were included in this single-centre, longitudinal, observational cohort study. The catamnestic follow-up period was up to 2 years. Results We evaluated different clinical cases of SC-induced psychoses and identified four clinical types of them on the ground of leading psychopathological syndrome during the patient’s entire length of hospitalization: Then we performed a catamnestic follow-up of patients to reveal the possible schizophrenic process manifestation in patients who use SC. Catamnestic follow-up revealed that manifestation of the schizophrenic process was present in 8 patients (13% of cases). Discussion Our results revealed that SC-induced psychoses affect young adults primarily. Consistent with the statement that the majority of first-time SC users are experienced marijuana smokers, SC was used following other transitional substances rather than as the first substance in the majority of our patients, with cannabis being the most popular antecedent substance. SC was not the first substance used in the majority of our patients, and it had been preceded by use of other transitional substances, such as cannabis in most cases. Despite the exogenous nature, structurally such psychoses are often endoformic. For instance, even the delirium is atypical and includes the elements of Kandinsky-Clerambault’s syndrome. Psychopathologically hallucinations and delusions dominate in the clinical presentation of the psychoses (with predominant hallucinatory symptoms or affective paranoid symptoms). Development of substance-induced psychoses is often associated with the manifestation of the schizophrenic process (in our study it was revealed in 13% of cases). It is extremely difficult to create a differential diagnosis between such psychotic disorders and a primary endogenous psychotic episode. In such cases the appearance of deficit symptoms specific for schizophrenia becomes crucial.

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The Association ofSalvia divinorumand Psychotic Disorders: A Review of the Literature and Case Series

Journal of Psychoactive Drugs ◽

10.1080/02791072.2015.1073815 ◽

2015 ◽

Vol 47 (4) ◽

pp. 286-292 ◽

Cited By ~ 8

Author(s):

Joseph El-Khoury ◽

Nayiri Sahakian

Keyword(s):

Psychotic Disorders ◽

Case Series ◽

Review Of The Literature

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Clinical Variants of Psychopathological Disorders in Users of Synthetic Cannabinoids (Spices)

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2146 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S199-S200

Author(s):

N. Bokhan ◽

G.Y. Selivanov

Keyword(s):

Psychotic Disorders ◽

Late Onset ◽

Paranoid Schizophrenia ◽

Synthetic Cannabinoids ◽

Designer Drug ◽

Addiction Psychiatry ◽

Continuous Type ◽

Icd 10 ◽

Group 5 ◽

Group 2

IntroductionThe problem of mental health of synthetic (“designer”) drug or “spice” users draws the increasing attention of experts of various areas in psychiatry, addiction psychiatry and psychotherapy.Research objective To classify and describe the psychotic states arising after the use of “spice”; to define the personality changes and probable consequences of the use observed in patients in the conditions of a hospital.Material and methodsOne hundred and one patients (93 men and 8 women; mean age 27.8 ± 7.6 years) with dependence on “spice” revealed between 2014 and 2015 were examined. History taking, clinical-psychopathological investigation and experimental psychological testing were used.Results and discussionAs a result of research the patients were divided into 5 groups according to criteria of ICD-10:– group 1: acute intoxication with delirium (n = 16; 15.84%);– group 2: residual and late-onset psychotic disorders like flashbacks (n = 9; 8.92%);– group 3: withdrawal state with delirium (n = 32; 31.68%);– group 4: psychotic disorder, mainly hallucinatory (n = 30; 29.70%);– group 5: paranoid schizophrenia (n = 14; 13.86%).The use of synthetic cannabinoids (“spice”) can initiate transient psychotic episodes, serve as the contributing factor of development of paranoid schizophrenia, continuous type of the course, leads to “accentuation” of schizoid, paranoid and psychopathic traits of the personality. It is proposed to make up a question of the possibility of additional use of the clarifying designation “synthetic cannabinoids/spice” at reference of patients using synthetic cannabinoids to the section of ICD-10 F12 “Mental and behavioural disorders due to use of cannabinoids” the agenda of clinicians.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Signs and symptoms associated with synthetic cannabinoid toxicity: systematic review

Australasian Psychiatry ◽

10.1177/1039856216663733 ◽

2016 ◽

Vol 24 (6) ◽

pp. 598-601 ◽

Cited By ~ 21

Author(s):

Julie Courts ◽

Virginia Maskill ◽

Andrew Gray ◽

Paul Glue

Keyword(s):

Systematic Review ◽

Emergency Services ◽

Case Reports ◽

Synthetic Cannabinoids ◽

Case Series ◽

Signs And Symptoms ◽

Synthetic Cannabinoid ◽

Symptom Reporting ◽

Presenting Symptoms ◽

Study Population

Aims: Use of synthetic cannabinoids is associated with significant physical and psychological harms. This research quantified reported toxicities from published reports and assessed the influence of size of the reported study population on rates of symptom reporting. Methods: Systematic review of published case reports and case series of toxicity associated with use of synthetic cannabinoids. Results: Symptoms associated with synthetic cannabinoid toxicity were reported for 3695 individuals, predominantly young males. Symptoms included physiological (e.g. tachycardia, hypertension, nausea/vomiting), emotional (e.g. agitation, irritability, paranoia), behavioural (e.g. drowsiness, aggression) and perceptual (e.g. hallucinations) domains. Most common symptoms were tachycardia (30.2% of cases), agitation (13.5%), drowsiness (12.3%), nausea/vomiting (8.2%) and hallucinations (7.6%). Death or serious medical complications were uncommon (e.g. death 0.2%, stroke 0.1%, myocardial infarction 0.09%). Case reports/smaller case series ( n<10) reported statistically significantly higher rates for 29/34 symptoms than larger case series ( n≥10), which could represent selection bias. Conclusions: Symptoms of synthetic cannabinoid toxicity are variable and cover a number of physical and psychological domains. Symptom reporting varies by study population size. Due to the variable presenting symptoms of synthetic cannabinoid toxicity, clinicians in emergency services should consider synthetic cannabinoid toxicity when evaluating young adult male patients presenting with unexplained agitation or cardiovascular symptoms.

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Clinical analysis of the case of the psychotic disorder due to the combined abuse of psychoactive substances

Ukrains'kyi Visnyk Psykhonevrolohii ◽

10.36927/2079-0325-v27-is4-2019-19 ◽

2019 ◽

Author(s):

Lyudmyla Yuryeva ◽

Viktor Kokashynskyi ◽

Tetiana Rachynska

Keyword(s):

Substance Abuse ◽

Psychotic Disorder ◽

Clinical Picture ◽

Psychotic Disorders ◽

Bipolar Affective Disorder ◽

Synthetic Cannabinoids ◽

Clinical Analysis ◽

Psychoactive Substances ◽

Second Generation Antipsychotic ◽

Mental And Behavioral Disorders

The clinical and social pathomorphism of mental and behavioral disorders due to the use of psychostimulants and cannabinoids actualized the problem of diff erential diagnosis and therapy of these patients. The most popular among young people are cannabinoids (including synthetic cannabinoids), psychostimulants and hallucinogens. In clinical practice, intoxication psychoses are more and more common due to the use of psychoactive substances, often occurring as schizophrenic-like disorders, which entails the diffi culties of diff erential diagnosis with endogenous disorders. The relevance of the "problem of psychotic potential" of psychostimulants is also due to the discussion about the advisability of medical use of cannabinoids in a number of serious diseases. The article describes the clinical picture and dynamics of the development of psychotic disorder due to the combined (cannabinoids, psychostimulants, hallucinogens) substance abuse. The presented clinical analysis and diff erential diagnosis between psychotic disorders due to substance abuse with schizophreniform symptoms and psychoses of endogenous origin (schizophrenia, bipolar affective disorder. The relevance of this case is the similarity of the clinical picture with endogenous disorders and the resulting diagnosis difficulties, differential and treatment of these disorders. The article discusses aspects of the use of second-generation antipsychotic drug olanzapin (Egolanza) in the treatment of psychotic disorders of exogenous etiology. Key words: cannabinoids, psychostimulants, hallucinogens, diff erential diagnosis of intoxication and endogenous psychoses, psychotic disorder, dependence on psychoactive substances, therapeutic tactics, olanzapine

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New psychoactive substances: psychiatrist's view

Interactive science ◽

10.21661/r-497066 ◽

2019 ◽

pp. 57-67

Author(s):

Andrey Viktorovich Antsyborov ◽

Irina Vladimirovna Dubatova

Keyword(s):

Opioid Receptors ◽

Psychotic Disorders ◽

Synthetic Cannabinoids ◽

Designer Drugs ◽

New Psychoactive Substances ◽

Psychoactive Substances ◽

Gaba A ◽

Psychoactive Effects ◽

Legal High ◽

Derivatives Of

Appearing not long ago, new psychoactive substances (designer drugs), including synthetic cannabinoids, derivatives of cathinone, phenethylamines, new stimulants, synthetic opioids, tryptamine derivatives, phencyclidine, piperazine, the GABA (A/B) receptors agonists, have become a serious problem for consumers and for physicians. Consumers of these substances are attracted primarily by the intensity of psychoactive effects, and the «legal high» declared by the black manufacturers, which indicates that significant difficulties in a laboratory identification of new surfactants. Designer drugs, when ingested, can be influenced on many neurotransmitter pathways/receptors: dopamine, cannabinoid (CB1), GABA (A/B), 5-HT2A, glutamate, and k-opioid receptors (KOR), the imbalance of which leads to the development of polymorphic psychotic disorders.

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Neuroimmune and Acute Psychotic Disorders had an Overlapping Immune-Signature in Adolescents and Young Adults; A Case Series

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2021/v6i330197 ◽

2021 ◽

pp. 17-24

Author(s):

Jose Irazuzta ◽

Nicolas Chiriboga Salazar

Keyword(s):

Psychotic Disorders ◽

Clinical Symptoms ◽

Adaptive Immune Response ◽

Case Series ◽

Adaptive Immune System ◽

Treg Cells ◽

T Cell Subsets ◽

Clinical Phase ◽

Adaptive Immune ◽

Cohort Group

A misguided auto-reactive injury is responsible for diverse types of central nervous system (CNS) conditions. We suspect that, in some of these conditions, the adaptive immune system have a common cellular immune pathogenesis, driven predominantly by T cells, despite variability on the phenotypical clinical presentation. Aim: the main goal of this study is to characterize a portion of the adaptive immune response (AIR) on patients presenting with clinical symptoms compatible with monophasic acute neuroimmune disorders (NID) including Psychotic Disorders (PD). Methodology: flow cytometry with deep immunophenotyping of T effector (Teff) and T regulatory (Treg) cells was performed on peripheral blood obtained during the acute clinical phase and compared it to the one from an age-matched cohort group [Co). Results: our preliminary findings point toward the presence of common “immunosignature” in individuals affected by NID or PD. We also found a shared dysregulation of immune related neurogenes in NID and PD that were not present in normal cohorts. Conclusions: this preliminary report gives some insights into the underlying shared pathobiology. If we can improve our capacity for early accurate diagnosis and meaningful disease monitoring of pathogenic T cell subsets, we will both expedite disease detection and may serve as a guide the administration of effective immunotherapeutic agents.

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