Excited delirium following use of synthetic cathinones (bath salts).
Synthetic analogs of the cathinone molecule have seen increasing recreational use as substitutes for cocaine, 3,4-methylenedioxymethamphetamine (ecstasy) and methamphetamine. Repeated use of these drugs is associated with a paranoid hallucinatory delirium. A subset of patients using these substances develops a syndrome of extreme agitation and violent behavior that has been reported following the use of other stimulant drugs that also produce rapid changes in brain monoamines. This syndrome, characterized as "excited delirium," presents to the acute care setting with a challenging combination of paranoia, severe agitation and violent behavior. These patients frequently suffer from dehydration, skeletal muscle damage and renal failure that may lead to multiorgan failure and death. Management of these individuals requires careful consideration of the consequences of interventions commonly implemented in medical settings to control dangerous aggressive behavior.
Department of Psychiatric Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA. penderst@ecu.edu
Thomas M
TM
Penders
Richard E
RE
Gestring
Dmitry A
DA
Vilensky
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000150:complications; D000328:Adult; D000470:Alkaloids / Q000506:poisoning*; D052117:Benzodioxoles / Q000506:poisoning*; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D003617:Dangerous Behavior; D003681:Dehydration / Q000139:chemically induced* / Q000150:complications; D003693:Delirium / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning; D008297:Male; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000150:complications; D010258:Paranoid Behavior / Q000139:chemically induced / Q000150:complications; D011595:Psychomotor Agitation / Q000150:complications; D011759:Pyrrolidines / Q000506:poisoning*; D012206:Rhabdomyolysis / Q000139:chemically induced / Q000150:complications; D013577:Syndrome; D000094982:Synthetic Cathinone
D000470:Alkaloids; D052117:Benzodioxoles; D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D011759:Pyrrolidines; C023665:cathinone; D000094982:Synthetic Cathinone