Fortschr Neurol Psychiatr 2016; 84(03): 150-154
DOI: 10.1055/s-0042-103425
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Akute Psychose nach Konsum von synthetischen Cannabinoiden

Acute Psychosis after Consumption of Synthetic Cannabinoids
S. Mörkl
1   Universitätsklinik für Psychiatrie, LKH Universitätsklinikum Graz
,
C. Blesl
1   Universitätsklinik für Psychiatrie, LKH Universitätsklinikum Graz
,
W. E. Wurm
2   Klinik für Psychiatrie, Medizinische Universität Graz
,
A. Tmava
1   Universitätsklinik für Psychiatrie, LKH Universitätsklinikum Graz
› Author Affiliations
Further Information

Publication History

Publication Date:
30 March 2016 (online)

Zusammenfassung

Einleitung: „Mocarz“ ist ein Legal high, das aus getrockneten Pflanzenteilen besteht, die mit synthetischen Cannabinoiden versetzt sind. Zurzeit gibt es nur begrenzte Information über dessen Toxizität. Dieser Fallbericht handelt von einer akuten psychotischen Entwicklung im Zusammenhang mit dem Konsum von synthetischen Cannabinoiden.

Kasuistik: Wir berichten über einen 35-jährigen Patienten mit keiner psychiatrischen und medizinischen Vorgeschichte, der nach Konsum von „Mocarz“, das er über das Internet bezogen hatte, ein agitiert-paranoid-psychotisches Zustandsbild entwickelte.

Schlussfolgerung: Legal highs stellen eine zunehmende Herausforderung für die psychiatrische Akutversorgung dar, da diese unberechenbare Zustände mit Selbst- und Fremdgefährdung verursachen.

Abstract

Introduction: Mocarz is a Legal high that consists of dried parts of plants mixed with synthetic cannabinoids. There is currently limited information on its acute toxicity.

Case Report: We describe a 35-year-old patient with no previous medical and psychiatric history who was admitted to the psychiatric clinic after developing agitation and paranoid psychotic symptoms following the use of Mocarz purchased over the internet.

Conclusion: Legal highs are a challenge in psychiatric acute care, because they provoke unpredictable mental states endangering self and others.

 
  • Literatur

  • 1 Curtis B, Alanis-Hirsch K, Kaynak O et al. Using Web searches to track interest in synthetic cannabinoids (a/k/a 'herbal incense'). Drug and alcohol review 2015; 34: 105-108
  • 2 Celofiga A, Koprivsek J, Klavz J. Use of synthetic cannabinoids in patients with psychotic disorders: case series. Journal of dual diagnosis 2014; 10: 168-173
  • 3 Devane WA, Dysarz 3rd FA, Johnson MR et al. Determination and characterization of a cannabinoid receptor in rat brain. Molecular pharmacology 1988; 34: 605-613
  • 4 Pertwee RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. British journal of pharmacology 2008; 153: 199-215
  • 5 Schatz AR, Lee M, Condie RB et al. Cannabinoid receptors CB1 and CB2: a characterization of expression and adenylate cyclase modulation within the immune system. Toxicology and applied pharmacology 1997; 142: 278-287
  • 6 Atwood BK, Huffman J, Straiker A et al. JWH018, a common constituent of 'Spice' herbal blends, is a potent and efficacious cannabinoid CB receptor agonist. British journal of pharmacology 2010; 160: 585-593
  • 7 Lukasik-Glebock M, Sommerfeld K, Nawrocka K. Legal highs toxicity – symptomatology and clinical diagnosis in case series. Przeglad lekarski 2010; 67: 613-616
  • 8 Benzer TI, Nejad SH, Flood JG. Case records of the Massachusetts General Hospital. Case 40-2013. A 36-year-old man with agitation and paranoia. The New England journal of medicine 2013; 369: 2536-2545
  • 9 Wilkinson ST, Radhakrishnan R, D'Souza DC. Impact of Cannabis Use on the Development of Psychotic Disorders. Current addiction reports 2014; 1: 115-128
  • 10 Auwarter V, Dresen S, Weinmann W et al. 'Spice' and other herbal blends: harmless incense or cannabinoid designer drugs?. Journal of mass spectrometry: JMS 2009; 44: 832-837
  • 11 Ansell EB, Laws HB, Roche MJ et al. Effects of marijuana use on impulsivity and hostility in daily life. Drug and alcohol dependence 2015; 148: 136-142
  • 12 Harris CR, Brown A. Synthetic cannabinoid intoxication: a case series and review. The Journal of emergency medicine 2013; 44: 360-366
  • 13 Berry-Caban CS, Ee J, Ingram V et al. Synthetic cannabinoid overdose in a 20-year-old male US soldier. Substance abuse 2013; 34: 70-72
  • 14 Tung CK, Chiang TP, Lam M. Acute mental disturbance caused by synthetic cannabinoid: a potential emerging substance of abuse in Hong Kong. East Asian archives of psychiatry: official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi: Xianggang jing shen ke yi xue yuan qi kan 2012; 22: 31-33
  • 15 Hurst D, Loeffler G, McLay R. Psychosis associated with synthetic cannabinoid agonists: a case series. The American journal of psychiatry 2011; 168: 1119
  • 16 Hermanns-Clausen M, Kneisel S, Szabo B et al. Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction 2013; 108: 534-544
  • 17 Nacca N, Vatti D, Sullivan R et al. The synthetic cannabinoid withdrawal syndrome. Journal of addiction medicine 2013; 7: 296-298
  • 18 Macfarlane V, Christie G. Synthetic cannabinoid withdrawal: a new demand on detoxification services. Drug and alcohol review 2015; 34: 147-153
  • 19 Zimmermann US, Winkelmann PR, Pilhatsch M et al. Withdrawal phenomena and dependence syndrome after the consumption of "spice gold". Deutsches Arzteblatt international 2009; 106: 464-467
  • 20 Toyo'oka T, Kikura-Hanajiri R. A Reliable Method for the Separation and Detection of Synthetic Cannabinoids by Supercritical Fluid Chromatography with Mass Spectrometry, and Its Application to Plant Products. Chemical & pharmaceutical bulletin 2015; 63: 762-769
  • 21 Bonnet U, Mahler H. Synthetic cannabinoids: spread, addiction biology & current perspective of personal health hazard. Fortschritte der Neurologie-Psychiatrie 2015; 83: 221-231
  • 22 Felthous AR, Wenger PJ, Hoevet R. Acute psychosis associated with dissociated sleep-wakefulness state after mirtazapine treatment. Pharmacotherapy 2010; 30: 145e-150e
  • 23 Normann C, Hesslinger B, Frauenknecht S et al. Psychosis during chronic levodopa therapy triggered by the new antidepressive drug mirtazapine. Pharmacopsychiatry 1997; 30: 263-265
  • 24 Ruberto A, Girardi P, Marco MC et al. Remission of mood disorder with psychotic features after treatment with mirtazapine. International journal of psychiatry in clinical practice 2004; 8: 181-183
  • 25 Godschalx-Dekker JA, Siegers HP. Reduction of parkinsonism and psychosis with mirtazapine: a case report. Pharmacopsychiatry 2014; 47: 81-83
  • 26 Habermeyer B, Bayer U, Muller-Spahn F. Mania associated with mirtazepine treatment and mixed depression. Pharmacopsychiatry 2010; 43: 37-38
  • 27 Basavraj V, Nanjundappa GB, Chandra PS. Mirtazapine induced mania in a woman with major depression in the absence of features of bipolarity. The Australian and New Zealand journal of psychiatry 2011; 45: 901
  • 28 Wichniak A, Jarkiewicz M, Okruszek L et al. Low Risk for Switch to Mania during Treatment with Sleep Promoting Antidepressants. Pharmacopsychiatry 2015; 48: 83-88
  • 29 Liu CC, Liang KY, Liao SC. Antidepressant-associated mania: soon after switch from fluoxetine to mirtazapine in an elderly woman with mixed depressive features. Journal of psychopharmacology 2009; 23: 220-222
  • 30 Holm NB, Nielsen LM, Linnet K. CYP3A4 Mediates Oxidative Metabolism of the Synthetic Cannabinoid AKB-48. The AAPS journal 2015; 17: 1237-1245
  • 31 Timmer CJ, Sitsen JM, Delbressine LP. Clinical pharmacokinetics of mirtazapine. Clinical pharmacokinetics 2000; 38: 461-474