[Withdrawal syndrome after abuse of GHB (Gamma-Hydroxybutyrate) and its physiological precursors - its relevance for child and adolescent psychiatrists].
BACKGROUND
The chronic abuse of Gamma-Hydroxybutyrate (GHB) as a designer drug as well as it's physiological precursors Gamma-Butyrolactone (GBL) and 1,4-Butandiole (1,4-BD) confronts child and adolescent psychiatrists with new challenges. The acute withdrawal of GHB with its cardiovascular and delirant symptoms is of particular importance for child and adolescent psychiatrists.


METHODS
In the present paper theoretical and biological aspects of acute GHB-/GBL-/1,4-BD-withdrawal syndrome are presented, and selected cases are discussed as regards potential treatment.


RESULTS
High dose treatment with benzodiazepines was successful in some cases of acute GHB-/GBL-/1,4-BD-withdrawal syndrome. Complications were severe dystonia under neuroleptic treatment, and also side-effects of treatment with benzodiazepines. Further problems were vegetative symptoms, electrocardiographic changes, rhabdomyolysis, acute renal failure, and death.


CONCLUSIONS
Acute GHB-withdrawal syndrome is a life-threatening condition which requires immediate intensive care treatment along with continuous monitoring of vital parameters. As acute GHB-withdrawal syndrome can present with symptoms close to psychotic episodes or acute alcohol withdrawal this condition is relevant for child and adolescent psychiatrists.
Zepf
Florian D
FD
Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, RWTH Universität Aachen, Aachen. fzepf@ukaachen.de
Holtmann
Martin
M
Duketis
Eftichia
E
Maier
Joachim
J
Radeloff
Daniel
D
Schirman
Shella
S
Wagner
Angela
A
Poustka
Fritz
F
Wöckel
Lars
L
D015107:4-Butyrolactone / Q000009:adverse effects; D000208:Acute Disease; D000293:Adolescent; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002072:Butylene Glycols / Q000009:adverse effects; D002648:Child; D003422:Critical Care; D003702:Delusions / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D004347:Drug Interactions; D006801:Humans; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000188:drug therapy; D012978:Sodium Oxybate / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000534:rehabilitation*
D018686:Anesthetics, Intravenous; D014150:Antipsychotic Agents; D002072:Butylene Glycols; D001569:Benzodiazepines; D012978:Sodium Oxybate; C039681:1,4-butanediol; D015107:4-Butyrolactone