Aniket Tatugade, MBBS PGY-4 General Psychiatry Resident
Ranjan Avasthi, MD Assistant Professor
Peter F. Buckley, MD Professor and Dean
Department of Psychiatry and Health Behavior Medical College of Georgia Augusta University Augusta, Georgia
Mr. R, age 19, who has no psychiatric history, experiences new-onset catatonia after ingesting a synthetic cannabinoid with the street name ‘Spice.’ How would you care for him?
Case 2. A 17-year-old male with no history of psychosis exhibited catatonic symptoms after smoking an estimated 2 to 3 g/d of K2 over 2 months.18 Similar to the case of Mr. R, he plateaued after lorazepam treatment, and then received 6 ECT treatments, which resulted in complete resolution of symptoms. He was discharged with olanzapine.
As our patient, and the 2 cases cited, show, ECT seems to be an effective option for Spice-induced catatonia. Unlike those published cases, however, our patient achieved only brief resolution of symptoms after an acute course of ECT. There appears to be a subset of patients who require maintenance ECT or prolonged benzodiazepine therapy after Spice-induced catatonia.
Bottom Line The use of synthetic cannabinoids is on the rise because of availability, cost, and problems with detection. They are full agonists at the cannabinoid receptors, and contain no protective cannabidiol—making them potentially more dangerous than Cannabis. Spice has been implicated in several cases of first-onset catatonia. Electroconvulsive therapy is an effective treatment for catatonia when benzodiazepines fail.
Related Resources
Centers for Disease Control and Prevention. Emergency department visits after use of a drug sold as “bath salts”—Michigan, November 13, 2010–March 31, 2011. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a6.htm.
Pierre JM. Cannabis, synthetic cannabinoids, and psychosis risk: what the evidence says. Current Psychiatry. 2011;10(9):49-51,55-57,A.
Spiller HA, Ryan ML, Weston RG, et al. Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States. Clin Toxicol (Phil). 2011;49(6):499-505.
Jerry J, Collins G, Streem D. Synthetic legal intoxicating drugs: the emerging ‘incense’ and ‘bath salt’ phenomenon. Clev Clin J Med. 2012;79(4):258-264.
Jerry J, Collins G, Streem D. Synthetic legal intoxicating drugs: the emerging ‘incense’ and ‘bath salt’ phenomenon. Clev Clin J Med. 2012;79(4):258-264.
Disclosures Drs. Williams, Tatugade, and Avasthi report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
In the past 12 months, Dr. Miller has received grant support from the National Institute of Mental Health (NIMH), Augusta University, and the Stanley Medical Research Institute; research support from the National Institutes of Health Clinical Loan Repayment Program; and honoraria from Psychiatric Times.
Dr. Buckley has served as a consultant for the NIMH, and has received grant/research support from the NIMH, Ameritox, and Posit Science.
