In Type 2, the frequency, duration, and intensity can increase over time,23 and it has been suggested that this may convert into persistent psychotic illness. A systematic review found very few well-designed studies examining hallucinogen persisting perception disorder,22 making it difficult to summarize effective approaches for managing this condition. His medical workup was unremarkable except for a urine toxicology screen, which was positive for amphetamines and cannabinoids. He also reported that over the summer he was not taking the mixed amphetamine extended release since he often woke up late in the day. Instead he took the immediate release medication and would occasionally take three to four times the prescribed dose when he was tired.
Publication types
Individuals predisposed to developing PPD might also have a predisposition to using substances and/or substance use may accelerate the course of an underlying psychotic disorder. We did not find previous reports of ischemic strokes caused by α-PVP, although cardiovascular events such as myocardial infarction had been previously reported 3. Structurally and pharmacologically synthetic cathinones are similar to amphetamine, and physiological changes include hypertension, arrythmia, and vasoconstriction, which are known to cause strokes 5. Transthoracic and transesophageal echocardiography showed no evidence of endocarditis or intracardial thrombi.
A Case of Alpha-Pyrrolidinopentiophenone (Flakka)-Induced Ischemic Stroke
A part of the cathinone class, Flakka is a very addictive substance created in laboratories in order to produce euphoric symptoms in people trying to obtain a cheap, quick high. Cathinones have been found to stimulate the release of dopamine and inhibit the reuptake of epinephrine, norepinephrine, and serotonin in the central nervous system. Since cathinones are hydrophobic molecules, they can easily cross cell membranes and the blood brain barrier, allowing them to heavily interact with the monoamine transporters in the synaptic cleft between neurons 2.
On the following day, the patient needed full assistance from the staff with her activities of daily living and continued to act bizarre and illogical. Although unable to fully communicate due to her altered thought process, she mentioned that she might have been given Flakka by a “friend.” A noncontrast CT scan of the head was ordered to rule out any organic causes, which came back negative. Similar symptoms continued to be apparent on the third hospital day, where the patient remained bizarre, disorganized, and psychotic, repeating the phrase “Thank you, thank you Jesus.” She again mentioned that she might have taken Flakka but remains vague about the incident. Since the patient received intramuscular Olanzapine and Lorazepam multiple times since being admitted, it was deemed appropriate to start the patient on scheduled Olanzapine to target her symptoms. By the fifth hospital day, the patient was taking Olanzapine 10 mg twice a day routinely with Lorazepam every four hours as needed for agitation. Finally, on day six, the patient became coherent, alert and oriented to person, place, time, and situation, and capable of completing her activities of daily living.
Research Chemicals and “Club Drugs”
Patients who screen positive for at-risk substance use should be further evaluated for a SUD—which assesses how the substance is affecting the patient’s functioning—for each substance they are using since polysubstance use is common in youth. Insight into SUD severity is often low, so collateral information from family and toxicology screening can be useful. Norepinephrine buildup triggers “fight-or-flight” responses, such as increased heart rate, high blood pressure, and hyper-alertness. Many flakka users become agitated or panicked, sometimes exhibiting violent outbursts. Flakka, sometimes called alpha-pyrrolidinopentiophenone (α-PVP), is a synthetic cathinone known for its stimulant properties and unpredictable potency. Flakka is a synthetic substance that has earned sensational nicknames like the “zombie drug.” However, there’s a lot more to it regarding its chemistry, effects, and impact on the community.
- A full thrombophilia workup was negative and along with a normal complete blood count ruled out most common thrombophilias and hematological disorders.
- Instead he took the immediate release medication and would occasionally take three to four times the prescribed dose when he was tired.
- He also reported that over the summer he was not taking the mixed amphetamine extended release since he often woke up late in the day.
- The ischemic lesions were located in the middle cerebral artery and deep watershed areas of the left cerebral hemisphere.
- Although the focus of this chapter is on the psychosis, it is important to evaluate and treat any comorbid substance use disorder (SUD).
In South Florida, there has been a highly addictive new synthetic drug flooding the streets for people looking for a cheap high. Alpha-PVP, better known as Flakka, is an illegal substance that sells on the streets for as little as $5 a hit and delivers an instant high that can last from hours to days with lingering effects for weeks after it has been ingested. Although people use Flakka for its potential euphoric high, symptoms are known to easily escalate into frightening delusions, paranoid psychosis, extreme agitation, flakka-induced prolonged psychosis pmc and a multitude of other altered mental states. According to the National Institute on Drug Abuse, Florida appears to be the nation’s hot spot for reports of Flakka. In this case report, a 17-year-old female with no prior psychiatric diagnosis presents to the hospital under a 72-hour involuntary placement for altered mental status with agitation and psychotic behaviors.
Alcohol Use Disorder
A urine drug screen was positive for benzodiazepines, and the patient reported occasional use of benzodiazepines. A full thrombophilia workup was negative and along with a normal complete blood count ruled out most common thrombophilias and hematological disorders. A Finnish male patient in his sixties with hepatitis C and osteoarthrosis of both knees was admitted to the emergency department because of acute right-sided hemiparesis that had started a day before the admission. Prior to the onset of hemiparesis, the patient’s friend had injected a dose of α-PVP into the patient’s neck.
What are the Effects of Flakka?
Sometimes having multiple community members identified as “part of the team” can be helpful, but alliance with the youth is likely best preserved if he or she feels involved in the selection of a limited number of adults. The description and classification of SUD changed substantially with the publication of the DSM-5. In place of the prior discrete categories of “abuse” and “dependence, SUD is now classified by severity. Each SUD (alcohol use disorder, cannabis use disorder, etc.) has eleven criteria, which differ little between different types of substances. The following article will review substance induced psychosis (SIP) including the definition, epidemiology, causes, treatment, and prognosis.
- He seems to have improved insight into some of his symptoms, and no longer believes that there are intruders in his home.
- In the emergency room, Kevin told staff that he was afraid of “shadow government agents.” He described that they had been observing him through electronic devices for several weeks, and this evening he had seen shadowy figures in his home out of the corner of his eye.
- One approach is referred to as “parallel treatment,” and involves simultaneous treatment for both disorders, but by different agencies or providers with expertise in their specific area.
- Before the injection, the drug had been mixed with tap water and injected using a clean needle and a microfilter provided by a nonprofit organization aimed at diminishing health complications from drug use.
- Flakka, sometimes called alpha-pyrrolidinopentiophenone (α-PVP), is a synthetic cathinone known for its stimulant properties and unpredictable potency.
Cannabis almost certainly contributed and abstinence from cannabis use will be important. You recommend treatment with a non-stimulant medication, atomoxetine, and start that medication now, since it takes a longer time to take effect and the new school year is a month away. You explain that these changes may be enough for all of his symptoms to resolve—or they may not.
While flakka may not be as widespread as opioids or methamphetamine, it has made substantial inroads in specific regions, particularly in pockets of the Southeastern United States. However, dopamine depletion or receptor damage can lead to crashes, depression, or psychosis over time.
His parents agree to engage in parent guidance at the nearby adolescent SUD clinic to learn more about SUD and psychosis, as well as ways they can support Kevin’s engagement in treatment. After a few more meetings with you and encouragement from his parents, Kevin agrees to attend individual and group sessions at the adolescent SUD clinic, as well. Effective integrated treatment programs for adults with schizophrenia and SUD highlight the importance of social support.45 Leveraging pro-social connections may also be of benefit for youth with SIP and SUD. Identifying a relationship with an adult trusted by the adolescent such as a teacher, coach, or work supervisor might be helpful in monitoring the youth’s symptoms, substance use, and functioning.
We present a case report of an acute ischemic stroke following the recreational use of α-PVP. The ischemic lesions were located in the middle cerebral artery and deep watershed areas of the left cerebral hemisphere. Occupational therapy and physiotherapy were initiated, and the patient was discharged with only a mild right hemiparesis. The patient was originally brought to the hospital at the request of the patient’s mother who noticed an acute onset of these bizarre behaviors. During the initial evaluation, the patient was drowsy and not coherent enough to give an accurate history of the events leading up to her current altered state.
Manufacturers frequently mix α-PVP with cheap fillers such as caffeine or sugar to alter appearance and maximize profit. These additives rarely affect the psychoactive strength of the drug but can further complicate health risks. In the emergency room, Kevin told staff that he was afraid of “shadow government agents.” He described that they had been observing him through electronic devices for several weeks, and this evening he had seen shadowy figures in his home out of the corner of his eye.