Elsevier

General Hospital Psychiatry

Volume 33, Issue 5, September–October 2011, Pages 525-526
General Hospital Psychiatry

Short Communication
Hallucinatory delirium following use of MDPV: “Bath Salts”

https://doi.org/10.1016/j.genhosppsych.2011.05.014Get rights and content

Section snippets

Case 1

A young male presented to an emergency room of a tertiary care hospital following initiation of involuntary commitment for paranoia. The patient had been repeatedly phoning 911 to report unidentified groups tapping on his window. He had interpreted these as attempts to harass him, focusing responsibility on his wife with whom he had recently separated. In the wake of separation, he began to use “Bath Salts” that he purchased at a local convenience store and used by mixing in water and drinking.

Case 2

A young housewife was admitted to a community hospital on an involuntary commitment initiated by her husband. The patient complained that people were repeatedly invading her home. She described several in vivid detail. She was fearful that these individuals would harm her and her family. Her husband revealed that the patient had been using Bath Salts branded as “White Horse” that she used daily by nasal insufflation for 2 weeks prior to admission. He also reported anxiety, anorexia and

Case 3

Sheriff's deputies bought a middle-aged single male to the emergency department of a tertiary care hospital. He was transported there for psychiatric examination following his call to the police that people had entered his home and were shooting him with laser beams and applying a Taser to his body. He reported that he had been using “synthetic cocaine” labeled “White Horse” obtained at a local convenience store for about a week prior to admission. He was observed to be hyperactive, sleepless,

Review

The cases presented here have features in common that suggest that use of these substances produced a drug-induced delirium. The features common to each case include severe inattention, sleeplessness and vivid, dreamlike hallucinations of threatening intruders experienced in multiple modalities, with a coincident mood of fearfulness. Each patient showed incomplete recollection of the drug-using sessions including details such as amount, frequency and route of administration of the involved

Summary

Our patients met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for drug intoxication delirium [7]. The presence of attentional deficits and memory disturbances supports a diagnosis of delirium rather than one of substance-induced psychotic disorder [8]. Treatment with hospitalization and low-dose typical or atypical antipsychotics was followed by rapid resolution of psychotic symptoms. Memory for the period of substance use appeared to be impaired. Primary

Acknowledgments

The authors wish to acknowledge the assistance in the preparation of this manuscript of Richard Bloch, PhD, Director of Research, Brody School of Medicine and advice on analysis of samples from Allan Smith, MD, Research Associate Professor, Department of Pathology, Brody School of Medicine.

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