[Liquid ecstasy in general psychiatry: a case series]

Area of Science:

• Psychiatry and Addiction Medicine
• Pharmacology and Toxicology

Context:

• Liquid ecstasy (LE), encompassing GHB, GBL, and 1,4-B, is recognized for severe intoxications in emergency medicine but is less understood in general psychiatry.
• This study addresses the under-recognized role of LE in general psychiatric settings, focusing on user demographics and clinical challenges.

Purpose:

• To investigate the prevalence, characteristics, and clinical management of patients using liquid ecstasy (LE) within a general psychiatry department.
• To identify typical users, common clinical problems, and effective treatment strategies for LE intoxication and withdrawal.

Summary:

• A retrospective study identified 19 LE users over 14 years, predominantly young men with polysubstance abuse, with GBL being the most common form.
• Severe and sudden withdrawal symptoms necessitated intermediate care for a third of patients, highlighting LE withdrawal as a significant clinical issue.
• Detoxification in psychiatry was achievable with high-dose benzodiazepines, and three patients met criteria for GBL dependence.

Impact:

• This research underscores the importance of considering LE use and withdrawal in cases of unexplained coma or delirium, prompting closer collaboration between psychiatry and intermediate care units.
• The findings emphasize that while LE prevalence in psychiatry is low, the severity of withdrawal necessitates clinical awareness and preparedness.
• The difficulty in detecting LE in routine screenings poses diagnostic challenges, reinforcing the need for clinical suspicion and targeted management strategies.