Abstract
IntroductionGamma-hydroxybutyric-acid is a potentially addictive drug known for its use in “rave” parties. Users have described heightened sexual drive, sensuality and emotional warmth. Its euphoric, sedative and anxiolytic-like properties are also sought by frequent users. Abrupt gamma-hydroxybutyric-acid withdrawal can rapidly cause tremor, autonomic dysfunction and anxiety, and may later culminate in severe confusion, delirium, auditory, visual or tactile hallucinations, or even death.Case presentationA 23-year-old woman presented to the emergency room with paranoid delusions and auditory hallucinations. Her psychiatric history included two brief psychotic episodes induced by amphetamines and marijuana. In the last six months, she had demonstrated bizarre behaviour, had been more isolated and apathetic, and unable to take care of daily chores. The patient reported occasional use of gamma-hydroxybutyric-acid, but her initial accounts of drug use were contradictory. Since the toxicology urine screen was negative, a schizophrenic disorder was initially suspected and an antipsychotic medication was prescribed. A few hours after her admission, signs of autonomic dysfunction (tachycardia and hypertension) appeared, lasting 24 hours. Severe agitation and confusion were also present. Restraints and a cumulative dose of 7 mg lorazepam were used to stabilize her. The confusion resolved in less than 72 hours. The patient then revealed that she had been using gamma-hydroxybutyric-acid daily for the last six months as self-medication to treat insomnia and anxiety, before stopping it abruptly 24 hours prior to her visit.ConclusionsIn our opinion, this original case illustrates the importance of considering gamma-hydroxybutyric-acid withdrawal delirium in the differential diagnosis of a first-break psychosis. In this case, the effects of chronic GHB use were incorrectly identified as the negative symptoms of schizophrenia prodrome. Likewise, severe gamma-hydroxybutyric-acid withdrawal syndrome was initially mistaken for acute positive symptoms of schizophrenia, until autonomic dysfunction manifested itself more clearly.
Highlights
Gamma-hydroxybutyric-acid is a potentially addictive drug known for its use in “rave” parties
The patient revealed that she had been using gamma-hydroxybutyric-acid daily for the last six months as self-medication to treat insomnia and anxiety, before stopping it abruptly 24 hours prior to her visit. In our opinion, this original case illustrates the importance of considering gammahydroxybutyric-acid withdrawal delirium in the differential diagnosis of a first-break psychosis
One day prior to her admission, the patient had decided to put an end to her GHB use, an abrupt interruption which provoked the onset of intense anxiety and paranoid delusions within 18 hours, followed by disorganisation, and auditory and visual hallucinations within 24 hours. In our opinion, this original case illustrates the importance of considering GHB withdrawal delirium in the differential diagnosis of a first break psychosis
Summary
Gamma-hydroxybutyric-acid (GHB) is a potentially addictive drug used in “rave” parties to heighten sexual drive, sensuality and emotional warmth. Abrupt GHB withdrawal will cause imbalance between under-stimulated GABA neurons and stimulatory input in the ventral tegmental area This will cause withdrawal symptoms - tremor, autonomic dysfunction and anxiety - to appear as soon as one to 24 hrs after the last dose, resulting in drug craving. Case presentation We report the case of a 23-year-old French Canadian woman who presented at the Emergency Room in summer 2006 with paranoid delusions and auditory hallucinations Her previous history included two brief psychotic episodes induced by substances (amphetamines and marijuana). The initial suspicion of a schizophrenic disorder was in accordance with the terms of this diagnosis as described in the DSM-IV: The patient presented an acute psychotic break (hallucinations and delusions, part of Criterion A of the DSM-IV diagnosis), preceded by a prodrome of negative symptoms (prolonged apathy and lack of motivation, part of Criterion A), lasting six months (Criterion C), with a significant decline in social and occupational functioning (Criterion B).
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