Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report
Abstract Background 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 el...
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-021-03182-w |
| _version_ | 1819177205221031936 |
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| author | Mads F. Kjærgaard Poul Videbech Jens J. Nørbæk Bjørn H. Ebdrup |
| author_facet | Mads F. Kjærgaard Poul Videbech Jens J. Nørbæk Bjørn H. Ebdrup |
| author_sort | Mads F. Kjærgaard |
| collection | DOAJ |
| description | Abstract Background 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. Case presentation 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. Discussion 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. |
| first_indexed | 2024-12-22T21:22:57Z |
| format | Article |
| id | doaj.art-55495a8e7be84ebc8c4203e239d1198c |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-22T21:22:57Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-55495a8e7be84ebc8c4203e239d1198c2022-12-21T18:12:08ZengBMCJournal of Medical Case Reports1752-19472021-12-011511510.1186/s13256-021-03182-wGamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case reportMads F. Kjærgaard0Poul Videbech1Jens J. Nørbæk2Bjørn H. Ebdrup3Mental Health Centre Glostrup, University of CopenhagenMental Health Centre Glostrup, University of CopenhagenMental Health Centre Glostrup, University of CopenhagenMental Health Centre Glostrup, University of CopenhagenAbstract Background 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. Case presentation 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. Discussion 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.https://doi.org/10.1186/s13256-021-03182-wElectroconvulsive therapy (ECT)Gamma-hydroxybutyric acid (GHB)WithdrawalDeliriumIntensive care unit (ICU) |
| spellingShingle | Mads F. Kjærgaard Poul Videbech Jens J. Nørbæk Bjørn H. Ebdrup Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report Journal of Medical Case Reports Electroconvulsive therapy (ECT) Gamma-hydroxybutyric acid (GHB) Withdrawal Delirium Intensive care unit (ICU) |
| title | Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report |
| title_full | Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report |
| title_fullStr | Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report |
| title_full_unstemmed | Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report |
| title_short | Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report |
| title_sort | gamma hydroxybutyric acid induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy a case report |
| topic | Electroconvulsive therapy (ECT) Gamma-hydroxybutyric acid (GHB) Withdrawal Delirium Intensive care unit (ICU) |
| url | https://doi.org/10.1186/s13256-021-03182-w |
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