Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.
Center for Neuropsychiatric Depression Research, CNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, DK-2600, Glostrup, Denmark.
J Med Case Rep. 2021 Dec 16;15(1):596. doi: 10.1186/s13256-021-03182-w.
Patients with gamma-hydroxybutyric acid withdrawal symptoms are at high risk of developing organic delirium, which can be fatal. The recommended first-line treatment is benzodiazepines, but treatment-resistant cases are frequent. Here we describe a case of successful bilateral electroconvulsive therapy in a patient with severe and highly agitated acute organic delirium induced by gamma-hydroxybutyric acid withdrawal and complicated by polydrug use resistant to first-line treatment. To our knowledge, this is the first report on the effect of electroconvulsive therapy on treatment-resistant delirium caused by gamma-hydroxybutyric acid withdrawal.
A 21-year-old Danish man diagnosed with untreated attention deficit hyperactivity disorder developed severely agitated acute organic delirium caused by gamma-hydroxybutyric acid withdrawal in a Danish psychiatric ward. The patient was subjected to physical restraints and transferred to the intensive care unit for treatment. During the next 10 days, the patient showed no clinical improvement despite first-line, high-dose benzodiazepines along with intense supportive treatment with propofol, phenobarbital, and antipsychotics. On day 11, bilateral frontotemporal electroconvulsive therapy treatment was initiated and full clinical recovery was obtained after four sessions.
The full clinical remission after four electroconvulsive therapy sessions, strongly supports that electroconvulsive therapy may be an effective treatment when severe delirium induced by gamma-hydroxybutyric acid withdrawal is resistant to conventional first-line treatment with benzodiazepines. Moreover, this case illustrates that clinically effective seizures were achieved despite intensive concurrent exposure to anticonvulsive drugs. Therefore, this case report encourages consideration of electroconvulsive therapy in patients with gamma-hydroxybutyric acid delirium who are resistant to psychopharmacological treatment.
γ-羟基丁酸戒断症状的患者发生器质性谵妄的风险很高，这种谵妄可能是致命的。推荐的一线治疗药物是苯二氮䓬类药物，但经常出现治疗抵抗的情况。在此，我们描述了一例因γ-羟基丁酸戒断引起的严重且高度激越的急性器质性谵妄患者，该患者合并多药耐药，对一线治疗无效，采用双侧电惊厥治疗获得成功。据我们所知，这是首例关于电惊厥治疗对γ-羟基丁酸戒断引起的治疗抵抗性谵妄的疗效的报告。
一名 21 岁丹麦男性，患有未经治疗的注意缺陷多动障碍，在丹麦精神病院因γ-羟基丁酸戒断而出现严重激越的急性器质性谵妄。患者被实施了身体约束，并转入重症监护病房进行治疗。在接下来的 10 天里，尽管给予了一线、大剂量苯二氮䓬类药物以及丙泊酚、苯巴比妥和抗精神病药物的强化支持治疗，但患者的临床状况没有改善。在第 11 天，开始进行双侧额颞叶电惊厥治疗，在进行了 4 个疗程后获得了完全的临床康复。
在进行了 4 个电惊厥治疗疗程后，患者获得了完全的临床缓解，这强烈支持了电惊厥治疗可能是一种有效的治疗方法，适用于因γ-羟基丁酸戒断而引起的严重谵妄对苯二氮䓬类药物的常规一线治疗产生抵抗的情况。此外，该病例表明，尽管同时存在强化的抗惊厥药物暴露，仍然可以获得有效的临床发作。因此，该病例报告鼓励在对精神药理学治疗产生抵抗的γ-羟基丁酸谵妄患者中考虑电惊厥治疗。
