mephedrone and Psychotic-Disorders

This article presents information on the predominant synthetic cathinones used in the Western world, mephedrone and methylenedioxypyrovalerone (MDPV). Synthetic cathinones are commonly used drugs of abuse in the United States and Europe, with numerous cases of patient harm and death. Patients exhibit many neurological, cardiovascular, and muscular adverse events and frequently require therapy to control psychotic or agitated states and acute kidney injury resulting from myopathy or rhabdomyolysis. There are potential genetic polymorphisms and drug interactions that might accentuate risk, but there are no studies evaluating to what extent this occurs or if it is clinically relevant. Clinicians should be aware of the known pharmacology, pharmacokinetics, and reports of effects to detect potential issues and treat patients presenting with these adverse effects.

Topics: Animals; Benzodioxoles; Humans; Illicit Drugs; Methamphetamine; Psychotic Disorders; Psychotropic Drugs; Pyrrolidines; Substance-Related Disorders; Synthetic Cathinone

Mephedrone (4-methylmethcathinone) is a synthetic stimulant drug of the cathinone class. Similar effects to those of cocaine and ecstasy are reported by users, with a high addictive potential. Given its increasing rate of consumption in Europe, it is getting more and more attention from the addiction field. In spite of that, little is known about the long-term consequences of prolonged heavy use. The two following cases might depict some of them. Case 1 was a middle-age man who reported three years of intravenous use of mephedrone. He used to binge for several days in a row. Psychotic symptoms appeared after a few months, especially paranoid delusions. Sent to aftercare in a therapeutic community, delusions kept reappearing after prolonged abstinence. A good response to risperidone was observed. Case 2 was a young man who used mephedrone heavily for two years, always snorted. Upon admission to the therapeutic community, the patient reported auditory hallucinations that partially remitted with olanzapine. Both cases showed a good insight and no personality deterioration. Given its similarities to other substances that are known to induce psychotic symptoms, and the increasing consumption of mephedrone around Europe, similar cases are expected in the near future. Conventional antipsychotic treatment seems a reasonable pharmacological approach.. La mefedrona (4-methylmethcathinone) es un estimulante sintético del grupo de las catinonas. Los usuarios refieren efectos similares a los de la cocaína y el éxtasis, con un potencial adictivo elevado. Dada la creciente tasa de consumo en Europa, cada vez recibe más atención desde el campo de las adicciones. No obstante, poco se sabe sobre las consecuencias a largo plazo de su consumo abusivo. Los dos siguientes casos pueden servir para mostrar alguna de ellas. El caso 1 es un hombre de mediana edad, quien refería un consumo intravenoso de mefedrona de 3 años de duración. Su patrón de uso consistía en atracones que duraban varios días. Tras varios meses de consumo, aparecieron síntomas psicóticos, especialmente delirios paranoides. Tras ser enviado a una comunidad terapéutica, los síntomas psicóticos se continuaron produciendo pese a mantener una abstinencia prolongada. Se observó una buena respuesta a la risperidona. El caso 2 es un hombre joven, con un consume abusivo de 2 años de duración, vía nasal. A su llegada a la comunidad terapéutica, el paciente refirió alucinaciones auditivas que remitieron parcialmente con olanzapina. Ambos casos mostraron una buena conciencia de enfermedad, así como ausencia de deterioro en su personalidad. Dadas las similitudes bioquímicas con otras sustancias con potencial para inducir síntomas psicóticos, y el creciente consumo de mefedrona en Europa, casos similares son esperables en un futuro cercano. El uso de antipsicóticos convencionales parece una estrategia razonable de tratamiento.

Topics: Adult; Humans; Male; Methamphetamine; Psychotic Disorders; Substance-Related Disorders; Time Factors