Short CommunicationHallucinatory delirium following use of MDPV: “Bath Salts”
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.
References (8)
Designer drugs: past history and future prospects
J Forensic Sci
(1988)- et al.
Mephadronemethylmethcathinone (“meowmeow”): chemical, pharmacological and clinical issues
Psychopharmacology
(2010) - et al.
Mephedrone, a new kid for the chop
Addiction
(2010) Hallucinogens legally sold as ‘bath salts’ a new threat
Cited by (73)
The exogenous model of psychotic experience induced by novel psychoactive substances: A clinical overview
2024, Emerging Trends in Drugs, Addictions, and HealthA death involving a “bath salt” methylenedioxypyrovalerone and tramadol
2020, Toxicology Cases for the Clinical and Forensic LaboratoryMDPV in forensic routine cases: Psychotic and aggressive behavior in relation to plasma concentrations
2018, Forensic Science InternationalDrugs of Abuse
2018, Side Effects of Drugs AnnualCitation Excerpt :Moreover, these events derive not just from the sympathomimetic effects of these drugs, but also from thrombotic conditions. Drug-induced psychosis has been reported for many cathinones [113A], sometimes with death subsequently resulting from consequent accidental injuries, but sometimes resulting from the end course of excited delirium, i.e., cardiorespiratory collapse [114R]. A case series (n = 50 cases) from Germany of individuals arrested for various crimes found to be positive for MDPV [115c].
Atypical dopamine efflux caused by 3,4-methylenedioxypyrovalerone (MDPV) via the human dopamine transporter
2017, Journal of Chemical NeuroanatomyErratum: Cathinones: What do we currently know? (Toxicologie Analytique et Clinique (2014) 26 (148-155))
2014, Toxicologie Analytique et Clinique