Excited delirium following use of synthetic cathinones (bath salts)

• Published in: General hospital psychiatry Vol. 34; no. 6; pp. 647 - 650
• Main Authors: Penders, Thomas M., M.D, Gestring, Richard E., M.D, Vilensky, Dmitry A., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2012; Elsevier
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - complications; Addictive behaviors; Adult; Adult and adolescent clinical studies; Alkaloids - poisoning; Benzodioxoles - poisoning; Biological and medical sciences; Cathinones; Central Nervous System Stimulants - poisoning; Dangerous Behavior; Dehydration - chemically induced; Dehydration - complications; Delirium; Delirium - chemically induced; Delirium - complications; Drug abuse; Drug addiction; Drug addictions; Humans; Male; Medical sciences; Multiple Organ Failure - chemically induced; Multiple Organ Failure - complications; Organic mental disorders. Neuropsychology; Paranoid Behavior - chemically induced; Paranoid Behavior - complications; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychomotor Agitation - complications; Psychopathology. Psychiatry; Psychosis; Pyrrolidines - poisoning; Rhabdomyolysis - chemically induced; Rhabdomyolysis - complications; Stimulants; Street Drugs - poisoning; Syndrome; Toxicology; Delirium; Psychosis; Drug abuse; Cathinones; Stimulants; Human; Drug addiction; CNS stimulant; Psychotropic; Toxicity; Male; Substance abuse; Sympathomimetic; Cathinone; Recommendation; Organic mental disorder; Case study; Alkaloid; Clinical management; Young adult; Mental confusion; Recreational drug
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2012.06.005

Abstract 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.