title: Intranasal substituted cathinone "bath salts" psychosis potentially exacerbated by diphenhydramine.
abstract: In this report, we describe a case of intranasal "bath salts"-associated psychosis. Symptoms developed during a 3-week binge and were potentially exacerbated by oral diphenhydramine taken for insomnia. The clinical case conference includes expert discussion from 3 disciplines: emergency medicine toxicology, behavioral pharmacology, and addiction medicine. It is hoped that the discussion will provide insight into the clinical aspects and challenges of addressing acute substituted cathinone toxicity, including acute psychosis, a major adverse effect of bath salts consumption.
authors.affiliation: University of Virginia School of Medicine, Charlottesville, VA, USA. erikgunderson@virginia.edu
authors.forename: Erik W
authors.initials: EW
authors.lastname: Gunderson
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Kirkpatrick
authors.forename: Laura M
authors.initials: LM
authors.lastname: Willing
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Holstege
mesh_terms: D000281:Administration, Intranasal; D000470:Alkaloids / Q000008:administration & dosage / Q000009:adverse effects; D001494:Baths; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects; D015198:Designer Drugs / Q000008:administration & dosage / Q000009:adverse effects; D004155:Diphenhydramine / Q000494:pharmacology*; D004347:Drug Interactions; D004638:Emergency Treatment / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D008297:Male; D011356:Product Labeling / Q000145:classification / Q000639:trends; D011605:Psychoses, Substance-Induced / Q000209:etiology / Q000523:psychology / Q000628:therapy; D012492:Salts; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000470:Alkaloids; D000697:Central Nervous System Stimulants; D015198:Designer Drugs; D006993:Hypnotics and Sedatives; D012492:Salts; C023665:cathinone; D004155:Diphenhydramine