Severe Delirium of Uncertain Origin in a German Psychiatric Unit – Caused by Gamma-Butyrolactone Withdrawal

Introduction

Gamma-Hydroxybutyrate (GHB) and its non-hydrolysed precursor molecule gamma-butyrolactone (GBL) are in the recent past – not only in U.S., but also in Europe – increasingly being abused as a party drogue [3] [12] [14].

GHB, which is synthesised endogenously in the human brain in low doses, was first produced synthetically in 1960 as a blood-brain barrier-penetrating GABA analogue. GHB binds on specific GHB receptors, localised in cortical, hippocampal and central dopaminergic structures and is likewise regarded as a neurotransmitter [18].

In a medical context, the substance was first used to introduce anaesthesia. A possible benefit in the treatment of alcohol and opioid withdrawal syndrome has been discussed for a few years [1]. In Germany, a sodium solution of GHB is permitted to treat narcolepsy [18]. Because of its amnestic and sleep-inducing effects and its solubility in drinks the substance sometimes was abused as ‘date rape drug’ or ‘KO drops’. GHB became a schedule I controlled substance in the U.S. in March 2000 [16], in Germany it has been regulated by the narcotics prescription law since 2002 [9].

Because of its – in low doses – euphoric and relaxing effects, gamma-hydroxybutyrate became popular on the U.S. west coast first as ‘liquid ecstasy’ or ‘Georgia Home Boy’ as a party drug. Recently there has been a noted increase of case reports on GHB abuse or overdose in Europe and also in the German-speaking area [7] [10] [11] [19].

While a GHB overdose commonly induces coma, vegetative instability, myoclonia and respiratory insufficiency, GHB-withdrawal can produce miscellaneous symptoms such as fear, sleep disorders and lighter vegetative changes. GHB withdrawal can also evoke severe delirious states [2].

References

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