title: Psychiatric aspects of acute withdrawal from gamma-hydroxybutyrate (GHB) and its analogue gamma-butyrolactone (GBL): implications for psychiatry services in the general hospital.
abstract: OBJECTIVE
  The objective of this study was to describe the psychiatric symptoms, management and outcomes in a consecutive series of patients being managed medically for symptoms of withdrawal from gamma-hydroxybutyrate (GHB) and its analogue gamma-butyrolactone (GBL) in a general hospital setting.
  
  
  METHODS
  A toxicology database was used to identify patients presenting with a history suggestive of withdrawal from GHB and analogues. Electronic and paper medical records were searched for demographic features, neuropsychiatric symptoms, psychiatric management while in hospital and overall outcome.
  
  
  RESULTS
  There were 31 presentations with withdrawal from the drugs involving 20 patients. Of these 17 (54%) were referred to and seen by the liaison psychiatry team. Anxiety (61.3%) and agitation (48.4%) were the most common symptoms. Of the 17 cases seen by the liaison psychiatry team, 52.9% required close constant observation by a mental health nurse and 29.4% required to be detained in hospital under mental health legislation.
  
  
  CONCLUSIONS
  The significant proportion of patients presenting with neuropsychiatric symptoms and requiring intensive input from the liaison psychiatry team during withdrawal from GHB and its analogues points to the importance of close liaison between medical and psychiatric teams in managing these patients in the general hospital.
authors.affiliation: Department of Liaison Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Debajeet
authors.initials: D
authors.lastname: Choudhuri
authors.forename: Sean
authors.initials: S
authors.lastname: Cross
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
authors.forename: Gopinath
authors.initials: G
authors.lastname: Ranjith
mesh_terms: D015107:4-Butyrolactone / Q000009:adverse effects*; D000328:Adult; D001007:Anxiety / Q000150:complications / Q000175:diagnosis; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D011595:Psychomotor Agitation / Q000150:complications / Q000175:diagnosis; D012978:Sodium Oxybate / Q000009:adverse effects* / Q000031:analogs & derivatives*; D013375:Substance Withdrawal Syndrome / Q000150:complications / Q000523:psychology*; D063189:Symptom Assessment / Q000523:psychology
chemical_list: D012978:Sodium Oxybate; D015107:4-Butyrolactone