Duccio Papanti

Spiceophrenia: a systematic overview of "spice"-related psychopathological issues and a case report.

The use of synthetic cannabimimetics (SC; “spice” drugs) is increasing, especially among teenagers and young adults. In parallel with this, the number of studies describing intoxication episodes associated with psychotic symptoms in SC users is growing. We present both a systematic review of the related literature and a case report, which seems to highlight the existence of a possible association between SC use and psychosis.

Profiling online recreational/prescription drugs' customers and overview of drug vending virtual marketplaces

Internet and social networking sites play a significant role in the marketing and distribution of recreational/prescription drugs without restrictions. We aimed here at reviewing data relating to the profile of the online drug customer and at describing drug vending websites.

“Noids” in a nutshell: everything you (don’t) want to know about synthetic cannabimimetics

Purpose – “Spice” products are synthetic cannabimimetics (SC; also called “synthetic cannabinoids”)-based designer drugs used as a legal alternative to cannabis for their very strong tetrahydrocannabinol (THC)-like effects. The purpose of this paper is to provide an analysis of more recent clinical and pharmacology/toxicology findings relating to SC and describe how they could impact on health, with a particular focus on mental health. Design/methodology/approach – A systematic search and descriptive analysis of the available evidence on psychopathological issues related to misuse was performed here, whilst taking into account the Pubmed/Medline databases, a range of conference proceedings and national/international agencies’ reports. Findings – While THC is a partial agonist, SC are full agonists on the cannabinoid receptors (CB-rs) and the administration of multiple SC can produce additive and/or synergistic agonistic interaction effects on the endocannabinoid system. These levels of strong CB-rs’ activ...

An adolescent with an altered state of mind

A 17 year old previously healthy adolescent presented to the emergency department with severe headache, vomiting, and an altered state of mind. His mother reported that he had returned home one hour before, looking confused and agitated; afterwards he mentioned a worsening headache and had vomited twice. On arrival at the emergency department he was conscious but drowsy and slow in answering simple questions. He reported frontal headache (8/10 on a visual analogue scale) and photophobia, and he was unable to stand unassisted. He was afebrile, his heart rate was 170 beats/min, and his blood pressure was 132/80 mm Hg. His pupils were mydriatic and poorly reactive to light. The remainder of the physical examination was unremarkable. He denied taking any drugs or medication, and a urine screen test was negative for cannabinoids, opioids, amphetamines, benzodiazepines, ethanol, and cocaine. Computed tomography of the brain and a basic set of blood tests were performed, and all results were normal. On further questioning by his parents he admitted having smoked “herbal incense” with friends in the afternoon, after which he reported having experienced visual and auditory hallucinations. ### 1. Which diagnosis does this story suggest? #### Short answer Acute intoxication by an emerging drug of misuse, probably a synthetic cannabinoid. Clues to the diagnosis include acute onset, otherwise unexplained, central nervous system and autonomic disturbances in a healthy young person with negative drug screening tests and a history of smoking herbal incense. #### Long answer The evaluation of an adolescent or young adult presenting to the emergency department with a change of mental status can be challenging. The differential diagnosis is extensive, comprising psychiatric conditions and medical conditions, including cerebrovascular events, unreported trauma, intoxication, carbon monoxide poisoning, …

Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial

BackgroundAs lithium treatment might be effective in reducing the risk of deliberate self-harm (DSH) in adult patients with unipolar affective disorders, we designed a pragmatic randomised trial to assess its efficacy in more than 200 patients with treatment-resistant depression. However, we randomised 56 patients only. The aim of this report is therefore twofold: first, to disseminate the results of this underpowered study which may be incorporated into future meta-analytical reviews; second, to analyse some critical aspects of the study which might explain failure to reach the target sample size.MethodsWe carried out a randomised, parallel group, assessor-blinded superiority clinical trial. Adults with a diagnosis of major depression, an episode of DSH in the previous 12 months and inadequate response to at least two antidepressants given sequentially at an adequate dose for an adequate time for the current depressive episode were allocated to add lithium to usual care (intervention arm) versus usual care alone (control arm). Suicide completion and acts of DSH during the 12 months of follow-up constituted the composite primary outcome.ResultsOf 58 patients screened for inclusion, 29 were allocated to lithium plus usual care and 27 were assigned to usual care without lithium. Six patients in the lithium plus usual care group and seven in the usual care group committed acts of DSH during the follow-up phase. The survival probability did not differ between the two treatment arms (Chi2 = 0.17, p =0.676). With regard to changes in the severity of depressive symptomatology from baseline to endpoint, no significant differences were detected.ConclusionsThe present study failed to achieve the minimum sample size needed to detect a clinically meaningful difference between the two treatment arms. Consequently, the finding that lithium, in addition to usual care, did not exert a positive effect in terms of reduction of DSH after 12 months of follow-up is likely due to the lack of sufficient statistical power to detect a difference, if a difference existed. The dissemination of the results of this underpowered study will inform future meta-analytical reviews on lithium and suicide-related outcomes.Trial registrationClinicalTrials.gov identifier: NCT00927550

An insight into the deep web; why it matters for addiction psychiatry?

Nowadays, the web is rapidly spreading, playing a significant role in the marketing or sale or distribution of “quasi” legal drugs, hence facilitating continuous changes in drug scenarios. The easily renewable and anarchic online drug‐market is gradually transforming indeed the drug market itself, from a “street” to a “virtual” one, with customers being able to shop with a relative anonymity in a 24‐hr marketplace. The hidden “deep web” is facilitating this phenomenon. The paper aims at providing an overview to mental healths and addictions professionals on current knowledge about prodrug activities on the deep web.

From concept(ion) to life after death/the grave: the ‘natural’ history and life-cycle(s) of Novel Psychoactive Substances (NPS)

A range of information needs should be met in order to better understand and predict the longevity/existence of novel psychoactive substances (NPS). This conceptual paper argues that one way of assessing how long a molecule may be around is to document how the life cycles or natural histories of ‘traditional’ drugs and NPS evolve. The earliest indication of the possible appearance of a new substance might be evidenced on the DeepWeb. However, this means they are less visible, in line with the clandestine nature of drug use and supply. Therefore, monitoring discussion groups/fora needs the development of new methods compared to those used in the Surface Net. Issues needing consideration in establishing NPS life cycles are outlined here, together with the probable outcomes that could result. The approach advocated means that it should be easier to identify which NPS are likely to come up or are emerging in real time, and, therefore, pre‐empt/prevent their supply.

Substance-related psychopathology and aggressiveness in a nightlife holiday resort: Results from a pilot study in a psychiatric inpatient unit in Ibiza

We aimed to describe a sample of subjects admitted to a psychiatric unit after the intake of psychoactive substances for recreational purposes.

Evolutionary considerations on the emerging subculture of the E-psychonauts and the novel psychoactive substances: A comeback to the shamanism?

Background: Evolutionary research on drug abuse has hitherto been restricted to proximate studies, considering aetiology, mechanism, and ontogeny. However, in order to explain the recent emergency of a new behavioral pattern (e.g. ‘the e-psychonaut style’) of novel psychoactive substances’ (NPS) intake, a complementary evolutionary model may be needed. Objective A range of evolutionary interpretations on the ‘psychonaut style’ and the recent emergency of NPS were here considered. Method The PubMed database was searched in order to elicit evolutionary theory-based documents commenting on NPS/NPS users/e-psychonauts. Results The traditional ‘shamanic style’ use of entheogens/plant-derived compounds may present with a range of similarities with the ‘e-psychonauts’ use of mostly of hallucinogen/psychedelic NPS. These users consider themselves as ‘new/technological’ shamans. Conclusion Indeed, a range of evolutionary mechanisms, such as: optimal foraging, costly signaling, and reproduction at the expense of health may all cooperate to explain the recent spread and diffusion of the NPS market, and this may represent a reason of concern.

Is there a potential of misuse for Magnolia officinalis compounds/metabolites?

Magnolia bark contains magnolol, metabolized to tetrahydromagnolol and honokiol, with both GABA‐ergic/cannabimimetic activities, hence of possible attraction to vulnerable individuals/recreational misusers.