Cases That Test Your Skills

Psychosis and catatonia after dancing with a dangerous partner

Current Psychiatry. 2015 November;14(11):58-63

References

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4. Papoutsis I, Nikolaou P, Stefanidou M, et al. 25B-NBOMe and its precursor 2C-B: modern trends and hidden dangers. Forensic Toxicology. 2015;3(1):1-11.
5. Caudevilla-Gálligo F, Riba J, Ventura M, et al. 4-Bromo-2, 5-dimethoxyphenethylamine (2C-B): presence in the recreational drug market in Spain, pattern of use and subjective effects. J Psychopharmacol. 2012;26(7):1026-1035.
6. National Drug Intelligence Center. Information bulletin: 2C-B (Nexus) reappears on the club drug scene. http:// www.Justice.gov/archive/ndic/pubs0/665. Published May 2001. Accessed June 12, 2015.
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The authors’ observations
Randomized clinical trials studying the effectiveness of ECT for catatonia are limited. Much of what we know about ECT comes from case reports that describe excellent outcomes for a variety of treatment-resistant illnesses, including catatonia in mood disorders, schizophrenia, autism, and other organic brain disease.¹²

Although benzodiazepines often are the first-line treatment for catatonia caused by any underlying illness, one study showed only 1 of 41 patients achieved remission with benzodiazepines, compared with 100% of those treated with ECT¹³; another study supported these results with 8 of 9 lorazepam non-responders responding to ECT.¹⁴ There are few case reports of substance-induced catatonia in the absence of other chronic mental illness, although none report use of ECT. However, a study showed no significant difference in the effectiveness of ECT for catatonia caused by an affective disorder or schizophrenia.¹⁵

Mr. D’s case exemplifies complete remission of catatonia induced by a psychoactive substance.

OUTCOME Steady improvement
Mr. D is followed in the outpatient clinic for 1 month after discharge; lorazepam is tapered successfully. During this time frame, psychotic and catatonic symptoms do not re-emerge. He reports some initial working memory deficits that improve steadily. There is no evidence of any significant psychiatric signs or symptoms, including neurovegetative symptoms of depression, mania or hypomania, perceptual disturbances, or disorganized thoughts or behaviors. He remains abstinent from alcohol, tobacco, and all psychoactive substances.

Bottom Line
Persistent psychosis and catatonia after the use of newer designer drugs such as 2C-B are rare, but these drugs carry serious potential complications that clinicians should be aware of. Benzodiazepines and electroconvulsive therapy have been proved effective for catatonia that is related to a number of psychiatric illnesses, often resulting in good outcomes. However, current evidence on their use is limited, particularly regarding treatment of substance-induced psychosis and catatonia.

Related Resources
• Meyer MR, Maurer HH. Metabolism of designer drugs of abuse: an updated review. Curr Drug Metab. 2010;11(5):468-482.
• Rickli A, Luethi D, Reinisch J, et al. Receptor interaction profiles of novel N-2-methoxybenzyl (NBOMe) derivatives of 2,5-dimethoxy-substituted phenethylamines (2C drugs). Neuropharmacology. 2015;99:546-553.

Drug Brand Names
Haloperidol • Haldol
Lorazepam • Ativan
Olanzapine • Zyprexa

Disclosures
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Psychosis and catatonia after dancing with a dangerous partner

References

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