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Background and Objectives: Synthetic cannabinoid use is associated with severe problems, including psychosis, kidney failure, and death. Given that young adults are especially vulnerable to using synthetic cannabinoids, the current study sought to identify factors and consequences related to use within this population., Methods: 1140 undergraduates completed an online survey of synthetic cannabinoid use, consequences, and related constructs., Results: The prevalence of lifetime synthetic cannabinoid use was 7.9% (n = 90), 15.6% (n = 13) of which were regular users, meaning they used once a year or more often. Synthetic cannabinoid users reported multiple adverse effects (e.g., anxiety, paranoia, tachycardia, lightheadedness) and 16.7% (n = 15) of users said they considered or did go to the Emergency Room while using synthetic cannabinoids. In the entire sample, participants believed their friends (t = 18.3, p < .001) and students in general (t = 46.0, p < .001) use synthetic cannabinoids more than they do. Natural cannabis users were associated with increased odds of having tried synthetic cannabinoids than those who had never used natural cannabis, OR = 7.63 (4.44 to 13.14) p < .0001, and 92.2% (n = 83) of synthetic cannabinoid users reported lifetime use of natural cannabis. Common reasons for use were legality, not appearing on drug tests, and availability, not that students enjoyed using synthetic cannabinoids or thought they were safe to use., Discussion and Conclusions: Synthetic cannabinoid use is associated with a variety of negative consequences. The data also supports a strong link between natural cannabis use and synthetic cannabinoid use., Scientific Significance: Natural cannabis users appear to be a high-risk group for using synthetic cannabinoids. There are multiple negative effects associated with synthetic cannabinoid use and reasons for use relate to convenience vs. enjoyment. Data have important implications for prevention and treatment efforts., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this review is to heighten the awareness of the increased use and risks of synthetic cannabinoids (SCs) and associated clinical manifestations among adolescents and young adults., Conclusions: Reviewed case studies suggest that the use of SCs have unpredictable negative psychological and physiological effects. Predominant manifestations reported were anxiety, agitation, paranoia, hallucinations, tachycardia, nausea and vomiting, and diaphoresis., Practice Implications: Nurses provide the most direct and supportive care to patients who present for medical treatment after the use of SCs. Knowledge of clinical manifestations can facilitate supportive management of patients suspected of SCs use., (© 2013, Wiley Periodicals, Inc.)

Abuse of the psychoactive "designer drug" methylenedioxypyrovalerone (MDPV) has become a serious international public health concern because of the severity of its physical and behavioral toxicities. MDPV is the primary ingredient in so-called "bath salts," labeled as such to avoid criminal prosecution and has only been classified recently as a controlled substance in the United States and some other countries. However, it remains a danger because of illegal sources, including the Internet. MDPV is a synthetic, cathinone-derivative, central nervous system stimulant and is taken to produce a cocaine- or methamphetamine-like high. Administered via oral ingestion, nasal insufflation, smoking, intravenous or intramuscular methods, or the rectum, the intoxication lasts 6 to 8 hours and has high addictive potential. Overdoses are characterized by profound toxicities, causing increased attention by emergency department and law enforcement personnel. Physical manifestations range from tachycardia, hypertension, arrhythmias, hyperthermia, sweating, rhabdomyolysis, and seizures to those as severe as stroke, cerebral edema, cardiorespiratory collapse, myocardial infarction, and death. Behavioral effects include panic attacks, anxiety, agitation, severe paranoia, hallucinations, psychosis, suicidal ideation, self-mutilation, and behavior that is aggressive, violent, and self-destructive. Treatment is principally supportive and focuses on counteracting the sympathetic overstimulation, including sedation with intravenous benzodiazepines, seizure-prevention measures, intravenous fluids, close (eg, intensive care unit) monitoring, and restraints to prevent harm to self or others. Clinical presentation is often complicated by coingestion of other psychoactive substances that may alter the treatment approach. Clinicians need to be especially vigilant in that MDPV is not detected by routine drug screens and overdoses can be life-threatening., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Psychoactive bath salts are a relatively new group of designer drugs sold as tablets, capsules, or powder and pur-chased in places such as tobacco and convenience stores, gas stations, head shops, and the Internet. Bath salts are stimulant agents that mimic cocaine,lysergic acid diethylamide, methamphetamine, or methylenedioxymethamphetamine (ecstasy). The most common bath salts are the cathinone derivatives 3,4-methylenedioxypyrovalerone(MDPV), 4-methylmethcathinone(mephedrone), and 3,4-methylenedioxy-N-methylcathinone (methylone). The drugs cause intense stimulation, eu-phoria, elevated mood, and a pleasurable "rush" Tachycardia, hypertension,peripheral constriction, chest pain, hallucinations, paranoia, erratic behavior,inattention, lack of memory of substance use, and psychosis have been observed in those who have used bath salts. The U.S. Drug Enforcement Administration recently exercised an emergency authority to name three key ingredients in bath salts as Schedule I, thereby making them illegal to possess or sell in the United States. Nursing implications related to both clinical and educational settings are discussed.

Background: There has been an increase in the popularity of designer drugs known as "Bath Salts" in the United States. These products commonly contain mephedrone, mephylone, methylenedioxypyrovalerone (MDPV), or other cathinone derivatives with psychoactive properties similar to amphetamine and cocaine. Although recently outlawed, abuse of these products continues to occur in Mississippi., Methods: We report a 19-year-old male who presented with paranoia and auditory as well as visual hallucinations. Auditory effects included voices that prompted him to kill people. The patient displayed anxiety, paranoia, and exhibited repeated bouts of inappropriate laughter. Urine toxicology analysis via GC/ MS detected MDPV, a compound structurally similar to methylenedioxymethamphetamine (MDMA)., Conclusions: Clinicians should be aware that these designer drugs are not detected with common immunoassay drug screens. Symptoms most commonly associated with these substances include tachycardia, delusions, hallucinations, and paranoia. Psychosis, self harm, and death have been associated with some cases.

Background: This study reports a new measure of psychotomimetic states in the context of cannabis and ketamine use. The Psychotomimetic States Inventory (PSI) has sub-scales of Delusory Thinking, Perceptual Distortions, Cognitive Disorganization, Anhedonia, Mania and Paranoia., Methods: The PSI was administered in two independent group, repeated measures designs: an experimental study of ketamine and a naturalistic study of cannabis., Results: Both cannabis and ketamine produced reliable increases in ratings of psychotomimetic state effects across several sub-scales., Conclusions: The PSI is a potentially useful measure of the nature and extent of the phenomenological effects of psychotropic drugs in schizophrenia-related research.

Cocaine-induced paranoia (CIP) remains an important drug-induced model of idiopathic paranoia for which no psychophysiologic marker has yet emerged. Measures of pupillary oscillation were able to significantly distinguish a group of abstinent crack cocaine abusers endorsing past CIP (n = 32) from another group of crack addicts who denied past CIP (n = 29).

There has been the clinical impression that people with higher levels of anxiety and central arousal are more prone to develop cocaine-induced paranoia (CIP), but this notion has not been formally studied. In the current study, we examined the differences between 28 CIP-endorsing and 16 CIP-denying chronic cocaine users in their levels of state and trait anxiety as measured by the Spielberger State-Tait Anxiety Inventory. We also studied levels of central arousal and reactivity using pupil size measures both during exposure to neutral, abstract, non-drug cues, and after exposure to a cocaine cue. Levels of trait (but not state) anxiety were significantly higher in the CIP group than in the non-CIP group. Moreover, while there were no significant pupil size differences or changes between the two groups while viewing neutral, abstract video images, the CIP group had significantly greater pupillary dilation in response to a video image of crack cocaine than did the non-CIP group. These significant differences remained even after covarying for anxiety scores. The study findings seem relevant to studies of autonomic reactivity in response to drug cues in cocaine-dependent patients; such studies might remain attentive to potential cue reactivity differences between patients endorsing and those denying CIP. Finally, this is the first study showing higher trait anxiety in patients with CIP.

Phenylpropanolamine (PPA) is a sympathomimetic drug contained in numerous over-the-counter and prescription decongestants and appetite suppressants. A range of adverse effects have been reported, including neuropsychiatric reactions in patients known to be taking recommended doses. Given that psychiatric symptoms are not included in the manufacturer's lists of adverse drug reactions, the incidence may be significantly higher. We report a cae of paranoid psychosis following use of a decongestant containing PPA and summarize the case report literature of psychiatric adverse effects to PPA in which doses were known and stated to be within recommended guidelines. A pattern of possible risk factors emerges from these reports. These may include 1) symptoms or history of mood spectrum disorder, 2) history of psychosis, 3) female sex, 4) family history of psychiatric disorder. The possibility that a higher incidence of adverse events occurs in a vulnerable population has not been systematically addressed, and seems called for. We recommend that physicians specifically inquire about patients' use of decongestants and diet aids. In half of the above cases, symptoms resolved without the use of antipsychotics.

Chronic MAP abuse may produce a lasting vulnerability of the brain which leads to a paranoid delusional psychosis with hallucinations similar to schizophrenia. This view is based on the clinical observations that duration of the psychotic episodes could last quite long after excretion of MAP in the urine, and that reuse of MAP, alcohol ingestion and nonspecific psychological stressors lead to acute recurrence of psychotic episodes whose clinical features are almost identical to the initial episode in patients with prior MAP psychosis. The experimental studies indicate that a lasting change at the nerve terminal membranes, namely transporters of MAP and dopamine at the uptake sites, in the striatum and nucleus accumbens may be a cause for induction and expression of stimulant-induced sensitization, which may relate to vulnerability to schizophrenia-like psychotic episodes in MAP psychosis.

The authors describe two cases of tamoxifen-induced organic delusional syndrome that resulted from administration of 40 mg daily for the adjuvant treatment of breast carcinoma. After discontinuation of the tamoxifen therapy, the psychiatric episode resolved within 2 to 4 weeks. Because tamoxifen might cause delusional syndrome, the authors recommend full psychiatric evaluation in appropriate cases.

Background: Chronic stimulant use can produce a paranoid psychosis that is similar to acute paranoid schizophrenia. While this phenomenon has been systematically explored in amphetamine abusers, it has been relatively unexplored in a systematic fashion in cocaine abusers., Method: The experience of cocaine-induced psychosis was evaluated in 55 individuals consecutively admitted for treatment of DSM-III-R cocaine dependence. Each subject was interviewed about their experiences of psychosis while intoxicated by means of a standardized, semistructured interview., Results: Fifty-three percent (29/55) of those interviewed reported experiencing transient cocaine-induced psychosis. There was no significant difference in lifetime amount of cocaine use or amount of cocaine use in the month before admission between those who experienced psychosis and those who did not. The psychosis-positive group used significantly more cocaine in the year prior to admission (p less than or equal to .02) and had a longer duration of use (p less than or equal to .01). Males were significantly (p less than or equal to .05) more likely than females to develop psychosis. Ninety percent (26/29) developed paranoid delusions directly related to drug use. Ninety-six percent (28/29) of the subjects experienced hallucinations: 83% (24/29), auditory hallucinations; 38% (11/29), visual hallucinations; and 21% (6/29), tactile hallucinations. Twenty-seven percent (15/55) of subjects developed transient behavioral stereotypies., Conclusion: Cocaine-induced paranoia is a common experience among chronic users. Amount and duration of use are related to its development. Implications for a kindling model of cocaine-induced psychosis will be discussed.

Objective: The aim of this study was to determine whether individuals who experience transient cocaine-induced paranoia are vulnerable to psychosis., Method: The subjects were 20 cocaine-dependent men who had been using more than 5 g of cocaine per week and were undergoing substance abuse treatment; half reported binge-limited cocaine-induced paranoia. The men were assessed with the Perceptual Aberration Scale and the Magical Ideation Scale, self-report measures of symptoms thought to precede the development of functional psychosis., Results: The combined scores on the Perceptual Aberration Scale and Magical Ideation Scale were strongly correlated with a history of cocaine-induced paranoia. The sensitivity, specificity, and positive and negative predictive power were 80.0%, 90.0%, 88.9%, and 81.8%, respectively., Conclusions: Heavy cocaine users who experience transient paranoia while intoxicated may be at higher risk for development of psychosis than cocaine users who do not experience paranoia.

Objective: The authors' objective was to assess the frequency and nature of cocaine-induced paranoia., Method: They interviewed 50 cocaine-dependent men consecutively admitted to a 28-day rehabilitation program., Results: Thirty-four (68%) of the 50 men reported highly distressing transient paranoid states in the context of cocaine use. The men who experienced paranoia did not differ from those who did not in age, race, or measures of cocaine use. The mean duration and amount of cocaine use before development of paranoia of the men who reported paranoia were not significantly different from the mean lifetime duration and amount of cocaine used by the men who did not report paranoia. Paranoia became more severe and developed more rapidly with continued cocaine use., Conclusions: The transient paranoid state appears to be a common feature of cocaine dependence and does not seem to be simply a result of exceeding a threshold of use. Rather, affected individuals might possess a predisposition to this drug-induced state. The fact that paranoia became more severe and developed more rapidly with continued drug use is consistent with a sensitization model of cocaine-induced paranoia. In vulnerable individuals, limbic sensitization may underlie its expression, but localization to a specific brain region is speculative. Quantity of use and route of administration do not appear directly to predispose to this phenomenon. Future investigations must be aimed at uncovering the markers and meaning of vulnerability to transient paranoia in heavy cocaine users.

Twelve male patients with chronic drug consumption including cannabis (ICD = 304.3) and morphine (ICD = 304.7), who required inpatient treatment for drug-induced paranoid hallucinatory states (ICD = 292.1) were investigated using computed tomography for macroscopic structural changes in the brain. The findings were compared with those in a control group of schizophrenic patients who did not consume drugs. The brain scans were measured and not show any significant morphological differences between the two groups.

1. The paper describes the mental disturbances of 44 abusive cases of "BRON," an over-the-counter (OTC) cough suppressant solution containing methylephedrine, codeine, caffeine, and chlorpheniramine. 2. Major psychiatric symptoms observed included hallucinatory-paranoid state and affective disorder. There also were groups which exhibited a combination of the two states and abuse only. 3. The hallucinatory-paranoid state group had a relatively small BRON usage amount, short usage term and few withdrawal symptoms. The affective disorder group, in contrast, had large usage amount, longer usage term, and showed significant autonomic nerve disorders during withdrawal. These tendencies were seen more clearly in the mixed state group. 4. The hallucinatory-paranoid state group showed little or no physical dependence, while that of the affective disorder group was thought to be firmly established. Thus, in the former group, methylephedrine was considered the major behavior modifying drug, while in the latter, it was thought to be codeine.

A case is presented of a young woman with a serious addiction to levodopa who over the years developed an extrapyramidal syndrome and chronic paranoid psychotic behaviour. The possible pathophysiological mechanism is discussed.

A 29-year-old woman with no history of paranoia or homicidal behavior developed paranoia, homicidal behavior, and seizures after abusing a preparation containing phenylpropanolamine. The paranoia and seizures were replicated in a controlled inpatient setting following phenylpropanolamine challenge.

A case is reported in which a lady suffered long-term personality change, a paranoid psychosis of several months duration, and an acute delirium, secondary to abuse of Vicks Sinex Nasal Spray and Vicks Vaporub. The problems were reversible on withdrawal of these well used products which have not previously been reported to cause psychological disturbance.

Analeptic-induced paranoid psychosis occasionally occurs in the treatment of narcolepsy. Two cases illustrate how analeptic abuse can contribute to the development of paranoid psychosis in narcolepsy and greatly complicate treatment.

Addictive use of the stimulant drug pemoline caused a delusional disorder in a middle-aged man. Discontinuance of use of the drug promptly reversed the psychosis, which subsequently recurred when pemoline was again used. Pemoline seems to be an addictive drug and has an additional property that heretofore has been attributed mainly to amphetamines--precipitation of a paranoid psychosis.

Widespread use of certain drugs (amphetamines, L.S.D., hypnotics) in France, allowed us to observe more than 200 cases of acute or chronic psychoses among addicts. Sometimes these are transitory outburst but the occurrence of a delusional psychosis with long range evolution raises a difficult diagnosis problem in relation to functional psychoses. The emphasis should be put on respective roles of the drug and of a predisposed mental state. Circumstances of beginning, apparently direct relationship between drug taking and pathological symptoms, therapy efficiency, absence of earlier pathological traits (as in many of our patients) and relapse when intoxication starts again, are in favour of a pharmacological origin of the troubles.

BECAUSE OF MARIJUANA'S apparent widespread and growing use, and possible future decriminalization, there is understandable concern about the effects of marijuana on behavior. However, in any serious deliberation about effects on behavior, two divergent views are equally unacceptable: that of the naive medical moralizer, who believes that marijuana turns people into vicious criminals; and that of the uncritical humanist, who holds that it affects everyone differently. The first position, characterized here as medical, moves from drug to behavior as though the latter were wholly physiological and a more or less predictably invariant function of the former. The second position, uncritical humanism, views the world as a composite of more of less free human elements which remain inscrutable and unpredictable, regardless of whether any individual is straight or high. Somewhere between these antipodal positions of absolute uniformity and absolute uniformity and absolute diversity lies the reality of patterned variability--i.e., types of users and types of effects of use. Situational factors such as when, where, with whom, and the like are admittedly important, but I propose here to limit attention to the user as social psychological actor in order to reduce analysis to a manageable number of parameters.

Clinical observation suggests that cannabis is implicated in some types of psychiatric disturbance. A record of admissions to two urban and four rural hospitals in Jamaica is examined along with details of individual cases. One-third of male admissions to the psychiatric hospital have used cannabis. Of 74 males admitted to another psychiatric service over a 12-month period, 29 had used cannabis. Ten of these patients were diagnosed as "ganja psychosis," and four others were classified as "marijuana-modified mania." At another psychiatric service, 54 of 223 admissions (24.2%) for functional psychosis presented with cannabis usage as a comtributory factor. These 54 patients included 14 and seven cases of hypomanic and depressive reactions, respectively. At three other rural general hospitals, psychiatric admissions for psychosis showed 11 of 51, seven of 18, and 39 of 75 patients, respectively, in whom cannabis was considered directly responsible. These findings lend support to the idea of causation of illness or modification of existing illness. The negative findings of controlled studies in the same country are not inconsistent. A suggested classification for adverse reactions to cannabis offered by one author is recommended, because it is in accord with common local clinical experience.

It is well established that psychosis may arise in the context of the abuse of certain prescribed or illicit drugs. Two cases of paranoid psychosis are described in which proprietary preparations containing amphetamine-like drugs were abused. The role of these drugs is discussed with reference to previous case reports, and it is emphasised that initial clinical assessment and urinary screening for drugs may fail to reveal the relevant history with respect to proprietary medicines.