Entzugsdelir nach Missbrauch von GHB-(Gamma-Hydroxybutyrat) und seiner Vorstufen
Grundlagen und Bedeutung für die Kinder- und Jugendpsychiatrie
Abstract
Hintergrund: Der chronische Missbrauch von Gamma-Hydroxybutyrat (GHB) als Designerdroge, sowie seiner beiden physiologischen Vorläufermoleküle Gamma-Butyrolakton (GBL) und 1,4-Butanediol (1,4-BD), stellt eine Problematik für den Kinder- und Jugendpsychiater dar. Vor allem der akute Entzug von GHB ist aufgrund seines zum Teil protrahierten Verlaufs mit deliranten und kardiovaskulären Symptomen auch für den Kinder- und Jugendpsychiater von Bedeutung. Methodik: In der vorliegenden Arbeit werden biologische und theoretische Grundlagen zum GHB-/GBL-/1,4-BD-Entzugssyndrom, sowie ausgewählte bisher in der Literatur berichtete Kasuistiken eines schweren GHB-/GBL-Entzugssyndroms in Bezug auf eine mögliche Therapie zusammengestellt. Ergebnisse: Bei der Therapie eines akuten GHB-Entzugssyndroms zeigte sich in mehreren Fällen eine hoch dosierte Verabreichung von Benzodiazepinen als eine wirksame und günstige Therapieoption. Berichtete Komplikationen waren neben den pharmakologischen Nebenwirkungen einer Therapie mit Benzodiazepinen vor allem Symptome einer Dystonie nach einer meist zuerst begonnenen erfolglosen Neuroleptika-Therapie. Weitere Probleme stellten vegetative Entgleisungen, EKG-Veränderungen bis hin zu tödlichen kardialen Komplikationen, und Rhabdomyolyse bis hin zum akuten Nierenversagen dar. Schlussfolgerungen: Das GHB-Entzugssyndrom stellt ein lebensbedrohliches Krankheitsbild dar, dessen Behandlung intensivmedizinischer und internistischer stationärer Maßnahmen bedarf. Die rechtzeitige Diagnose ist für den Kinder- und Jugendpsychiater von entscheidender Bedeutung.
Background: The chronic abuse of Gamma-Hydroxybutyrate (GHB) as a designer drug as well as it’s physiological precursors Gamma-Butyrolactone (GBL) and 1,4-Butandiole (1,4-BD) confronts child and adolescent psychiatrists with new challenges. The acute withdrawal of GHB with its cardiovascular and delirant symptoms is of particular importance for child and adolescent psychiatrists. Methods: In the present paper theoretical and biological aspects of acute GHB-/GBL-/1,4-BD-withdrawal syndrome are presented, and selected cases are discussed as regards potential treatment. Results: High dose treatment with benzodiazepines was successful in some cases of acute GHB-/GBL-/1,4-BD-withdrawal syndrome. Complications were severe dystonia under neuroleptic treatment, and also side-effects of treatment with benzodiazepines. Further problems were vegetative symptoms, electrocardiographic changes, rhabdomyolysis, acute renal failure, and death. Conclusion: Acute GHB-withdrawal syndrome is a life-threatening condition which requires immediate intensive care treatment along with continuous monitoring of vital parameters. As acute GHB-withdrawal syndrome can present with symptoms close to psychotic episodes or acute alcohol withdrawal this condition is relevant for child and adolescent psychiatrists.
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in press ). A 16-year old boy with severe Gamma-Butyrolactone (GBL) withdrawal delirium – A case report. Pharmacopsychiatry.
