a Department of Psychiatry , University Clinical Center Maribor , Ob zeleznici 30, 2000 , Maribor , Slovenia , Europe.
J Dual Diagn. 2014;10(3):168-73. doi: 10.1080/15504263.2014.929364.
An increasing number of synthetic cannabinoids have become available on the black market in recent years, and health professionals have seen a corresponding increase in use of these compounds among patients with psychiatric disorders. Unfortunately, there is almost no research available in the literature on this topic, and what little exists is based on case reports of individuals without psychiatric disorders. Synthetic cannabinoids are functionally similar to, but structurally different from, delta-9-tetrahydrocannabinol, the active principle in cannabis, and are problematic for many reasons. The psychotropic action of synthetic cannabinoids in patients with schizophrenia is unpredictable, with very diverse clinical presentations. These drugs can be much more potent than delta-9-tetrahydrocannabinol, they are readily available and difficult to detect. The gold standard for identification of synthetic cannabinoids is gas chromatography with mass spectrometry, but even this is difficult because new formulations of these designer drugs are constantly emerging. In this manuscript, we provide an overview and discussion of synthetic cannabinoids and present four cases of patients with synthetic cannabinoid intoxication who were hospitalized in our intensive psychiatric unit at the time of intoxication. All patients had a history of schizophrenia and had been hospitalized several times previously. While hospitalized, they smoked an unknown substance brought in by a visitor, which was then confirmed using gas chromatography with mass spectrometry to be the synthetic cannabinoid AM-2201. Our patients experienced predominantly psychiatric adverse clinical effects. We observed the appearance of new psychotic phenomena, without exacerbation of their previously known psychotic symptoms, as well as the occurrence or marked worsening of mood and anxiety symptoms. Despite several similar reactions, and even though they ingested the same exact substance, the clinical picture differed markedly between individual patients. We assume that the acute effects of synthetic cannabinoids in patients with schizophrenia would be different from those in persons without psychotic disorders. The reasons for this difference could be the actual symptomatology of the presenting disorder, the impact of psychopharmacotherapy, individual patient differences and probably many, as yet unknown, factors. The long-term consequences of synthetic cannabinoid use on preexisting psychotic disorders are unclear.
近年来，越来越多的合成大麻素在黑市上出现，精神科医生也注意到患有精神障碍的患者使用这些化合物的情况相应增加。不幸的是，文献中几乎没有关于这个主题的研究，而且现有的研究都是基于没有精神障碍的个体的病例报告。合成大麻素在功能上与大麻中的有效成分 δ-9-四氢大麻酚相似，但结构不同，由于多种原因，它们存在问题。精神分裂症患者使用合成大麻素的精神作用不可预测，临床表现非常多样化。这些药物可能比 δ-9-四氢大麻酚更有效，而且它们很容易获得且难以检测。鉴定合成大麻素的金标准是气相色谱-质谱联用，但即使这样也很困难，因为这些设计药物的新配方不断出现。在本文中，我们提供了合成大麻素的概述和讨论，并介绍了我们精神科重症监护病房在合成大麻素中毒时收治的 4 例患者。所有患者均有精神分裂症病史，此前曾多次住院。住院期间，他们吸食了一名访客带来的未知物质，然后使用气相色谱-质谱联用确认该物质为合成大麻素 AM-2201。我们的患者主要表现出精神科不良临床效应。我们观察到出现了新的精神病现象，而没有加重其先前已知的精神病症状，以及情绪和焦虑症状的出现或明显恶化。尽管有类似的反应，甚至他们摄入了完全相同的物质，但个体患者之间的临床表现差异很大。我们假设，精神分裂症患者使用合成大麻素的急性效应与没有精神障碍的人不同。这种差异的原因可能是患者目前的疾病的实际症状、精神药物治疗的影响、个体差异以及可能还有许多未知因素。合成大麻素使用对现有精神障碍的长期后果尚不清楚。
