Peculiarities of Clinical Symptoms, Somatic Complications, Approaches to Therapy and Outcomes of Delirium Induced by Exposure to Synthetic Cannabinoids: Systematic Review

Synthetic cannabinoids (SCs) can cause delirium after a single small dose or during withdrawal 2–4 days after last use. The delirium includes schizophrenic-like symptoms such as threatening hallucinations, paranoid delusions, aggression, and thought disorders, along with severe somatic complications like rhabdomyolysis, acute kidney failure, cardiomyopathy, and infections. Treatment involves detoxification, antipsychotics, and sometimes intensive care. Delirium lasts hours to days and usually resolves with amnesia and asthenia, but fatal outcomes occur from accidents, suicide, or somatic complications such as multi-organ failure.

Study at a glance

Abstract

INTRODUCTION: The use of synthetic cannabinoids (SCs) is an urgent healthcare problem, due to, among other things, a high number of complications. AIM: To systematize the peculiarities of clinical presentation, somatic complications, effectiveness of empirical approaches to therapy, and probable outcomes of delirium induced by exposure to SCs. MATERIALS AND METHODS: The analysis of scientific publications selected by the keywords in eLibrary, СNKI, PubMed databases, was conducted. According to PRISMA recommendations, 20 articles were taken for analysis. RESULTS: Today, it is impossible to predict the period when SC-induced delirium may occur. It can start after one-time intake of even small dose, and can occur both due to intoxication and with the underlying withdrawal state on the 2nd4th days after the last use. Besides classic symptoms, the clinical picture of delirium is characterized by many symptoms of schizophrenic psychoses: hallucinations of threatening or drug-addicted content; secondary paranoid delusion, less expressed than hallucinations; aggressiveness and agitated behavior; some formal thinking disorders; rarely, KandinskiClerambault and oneiroid syndromes. There are reported cases of severe somatic complications in the form of depression of consciousness, rhabdomyolysis, acute renal failure, cardiomyopathy, myocardial infarction, epilepsy, infectious complications with the underlying weakened immunity. Therapy of SC-induced delirium includes detoxification and metabolic therapy, administration of antipsychotics and tranquilizers; use of resuscitation measures in case of depression of consciousness and development of life-threatening conditions. SC-induced delirium lasts from several hours to several days. In most cases, it terminates with complete recovery with amnesia of the period of confusion and asthenia, but in some cases fatal outcomes are reported caused not only by accidents such as road accidents or suicide, but also by somatic complications (most often of infectious character, or multi-organ failure). CONCLUSION: SСs remain relevant due to high frequency of their use and continuous emergence of new analogs to substances of this group. They have multidirectional effect, and so far it is difficult to predict at what period the delirium induced by them may occur.