Constantinides Prometheas, Vincent Philippe
Department of Psychiatry, Louis-H. Lafontaine Hospital, 7401 Hochelaga, Montreal, Quebec, Canada.
Cases J. 2009 Jul 10;2:7520. doi: 10.4076/1757-1626-2-7520.
Gamma-hydroxybutyric-acid is a potentially addictive drug known for its use in "rave" parties. Users have described heightened sexual drive, sensuality and emotional warmth. Its euphoric, sedative and anxiolytic-like properties are also sought by frequent users. Abrupt gamma-hydroxybutyric-acid withdrawal can rapidly cause tremor, autonomic dysfunction and anxiety, and may later culminate in severe confusion, delirium, auditory, visual or tactile hallucinations, or even death.
A 23-year-old woman presented to the emergency room with paranoid delusions and auditory hallucinations. Her psychiatric history included two brief psychotic episodes induced by amphetamines and marijuana. In the last six months, she had demonstrated bizarre behaviour, had been more isolated and apathetic, and unable to take care of daily chores. The patient reported occasional use of gamma-hydroxybutyric-acid, but her initial accounts of drug use were contradictory. Since the toxicology urine screen was negative, a schizophrenic disorder was initially suspected and an antipsychotic medication was prescribed. A few hours after her admission, signs of autonomic dysfunction (tachycardia and hypertension) appeared, lasting 24 hours. Severe agitation and confusion were also present. Restraints and a cumulative dose of 7 mg lorazepam were used to stabilize her. The confusion resolved in less than 72 hours. The patient then revealed that she had been using gamma-hydroxybutyric-acid daily for the last six months as self-medication to treat insomnia and anxiety, before stopping it abruptly 24 hours prior to her visit.
In our opinion, this original case illustrates the importance of considering gamma-hydroxybutyric-acid withdrawal delirium in the differential diagnosis of a first-break psychosis. In this case, the effects of chronic GHB use were incorrectly identified as the negative symptoms of schizophrenia prodrome. Likewise, severe gamma-hydroxybutyric-acid withdrawal syndrome was initially mistaken for acute positive symptoms of schizophrenia, until autonomic dysfunction manifested itself more clearly.
γ-羟基丁酸是一种具有潜在成瘾性的药物，因其在“锐舞”派对中的使用而闻名。使用者称其能增强性欲、性感和情感热度。其欣快感、镇静作用以及类似抗焦虑的特性也受到频繁使用者的追捧。突然停用γ-羟基丁酸会迅速导致震颤、自主神经功能障碍和焦虑，随后可能发展为严重的意识模糊、谵妄、听觉、视觉或触觉幻觉，甚至死亡。
一名23岁女性因妄想和幻听被送往急诊室。她的精神病史包括由安非他明和大麻诱发的两次短暂精神病发作。在过去六个月里，她表现出怪异行为，更加孤僻冷漠，无法料理日常琐事。患者报告偶尔使用γ-羟基丁酸，但她最初关于用药的描述相互矛盾。由于毒理学尿液筛查呈阴性，最初怀疑为精神分裂症并开具了抗精神病药物。入院几小时后，出现自主神经功能障碍迹象（心动过速和高血压），持续24小时。还伴有严重的躁动和意识模糊。使用了约束措施以及累计7毫克的劳拉西泮来使其稳定。意识模糊在不到72小时内得到缓解。患者随后透露，在就诊前24小时突然停用γ-羟基丁酸之前，她在过去六个月里每天使用γ-羟基丁酸自我治疗失眠和焦虑。
我们认为，这个原始病例说明了在初发性精神病的鉴别诊断中考虑γ-羟基丁酸戒断谵妄的重要性。在这个病例中，长期使用γ-羟基丁酸的影响被错误地认定为精神分裂症前驱期的阴性症状。同样，严重的γ-羟基丁酸戒断综合征最初被误诊为精神分裂症的急性阳性症状，直到自主神经功能障碍更明显地表现出来。
