Panic Attack after Spice Abuse in a Patient with ADHD

Abstract

To the best of our knowledge, we here report the first case of a panic attack based on Spice consumption in a 21-year-old male patient with attention deficit hyperactivity disorder (ADHD). The condition had been treated over several years with methylphenidate, but which had been taken irregularly. Within minutes after a third-ever consumption of Spice, the patient developed both blurred vision and an unsteady gait as well as an acute onset of an agonal state with the fear of ignorance of his friends. This panic attack was accompanied by a vegetative hyperirritability that lasted for more than two hours. After admission to the emergency department, acute cardiac disease was ruled out and the patient was transferred to our Department of Psychiatry where fixation became necessary. After intravenous application of 2 mg lorazepam and isotonic fluid substitution, the patient recovered over night. In light of the previously presumed association of panic attacks and consumption of cannabinoids, we here discuss the potential de-masking of panic attacks after Spice consumption (as a synthetic cannabinoid) by ADHD-based imbalances of the dopaminergic and norepiphrenic receptor profiles.