Roncero Carlos, Ros-Cucurull Elena, Palma-Álvarez Raúl Felipe, Abad Alfonso Carlos, Fadeuilhe Christian, Casas Miquel, Grau-López Lara
*Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital; †Department of Psychiatry, Autonomous University of Barcelona; ‡Psychiatry Service, Vall Hebron University Hospital, Barcelona; §University of Salamanca Health Care Complex (Complejo Asistencial Universitario de Salamanca/CAUSA), Salamanca; and ‖Institute of Biomedicine of Salamanca (IBSAL), Salamanca Spain.
Clin Neuropharmacol. 2017 Nov/Dec;40(6):281-285. doi: 10.1097/WNF.0000000000000252.
Episodes of agitation are frequent in intoxicated patients who have a substance use disorder, a psychiatric disorder or both (dual diagnosis). For managing the agitation, it is necessary to act promptly in a safe environment and addressing any underlying etiology. Inhaled loxapine improves symptoms of agitation in adults with psychiatric disorders (eg, schizophrenia) within 10 minutes of administration. Recently, some reports have documented the usefulness of loxapine in dual diagnoses patients with agitation. However, the efficacy of loxapine in intoxicated patients has not been deeply addressed.
This report describes a case series of 12 patients (with addiction or dual disorder) who received inhaled loxapine for symptoms of psychomotor agitation during intoxication with different substances (eg, alcohol, cannabis, or cocaine) at 1 center in Spain.
Data from 12 patients were reviewed, 5 patients were attended at the emergency room, 4 at the addiction and dual diagnosis unit, and 3 were treated during hospitalization for detoxification. All patients were under effects of substances. They had substance use disorder (including cannabis, cocaine, alcohol, hypnotics, and hallucinogens), and almost all (90%) presented 1 or more psychiatric disorders. One dose of inhaled loxapine was effective in 9 patients (75%), and in 3 patients, a second dose was required. Only mild dizziness was reported in 1 patient after the second dose.
The acute agitation was effectively and quickly managed with inhaled loxapine in all intoxicated patients and enabled the appropriate clinical evaluation of the agitated state and the patient's management.
躁动发作在患有物质使用障碍、精神障碍或两者皆有的中毒患者（双重诊断）中很常见。为了处理躁动，有必要在安全的环境中迅速采取行动并解决任何潜在病因。吸入洛沙平可在给药后10分钟内改善患有精神障碍（如精神分裂症）的成年人的躁动症状。最近，一些报告记录了洛沙平在双重诊断且伴有躁动的患者中的有效性。然而，洛沙平在中毒患者中的疗效尚未得到深入研究。
本报告描述了一个病例系列，12名（患有成瘾或双重障碍）患者在西班牙的1个中心因不同物质（如酒精、大麻或可卡因）中毒期间出现精神运动性躁动症状而接受吸入洛沙平治疗。
对12名患者的数据进行了回顾，5名患者在急诊室接受治疗，4名在成瘾和双重诊断科室，3名在住院戒毒期间接受治疗。所有患者均处于物质影响之下。他们患有物质使用障碍（包括大麻、可卡因、酒精、催眠药和致幻剂），几乎所有患者（90%）都有一种或多种精神障碍。一剂吸入洛沙平对9名患者（75%）有效，3名患者需要第二剂。第二剂后仅1名患者报告有轻微头晕。
吸入洛沙平能有效且迅速地处理所有中毒患者的急性躁动，有助于对躁动状态进行适当的临床评估和患者管理。
