Panic Attack after Spice Abuse in a Patient with ADHD

To the best of our knowledge, we here report the first case of a panic attack based on Spice consumption in a 21-year-old male patient with attention deficit hyperactivity disorder (ADHD). The condition had been treated over several years with methylphenidate, but which had been taken irregularly. Within minutes after a third-ever consumption of Spice, the patient developed both blurred vision and an unsteady gait as well as an acute onset of an agonal state with the fear of ignorance of his friends. This panic attack was accompanied by a vegetative hyperirritability that lasted for more than two hours. After admission to the emergency department, acute cardiac disease was ruled out and the patient was transferred to our Department of Psychiatry where fixation became necessary. After intravenous application of 2 mg lorazepam and isotonic fluid substitution, the patient recovered over night. In light of the previously presumed association of panic attacks and consumption of cannabinoids, we here discuss the potential de-masking of panic attacks after Spice consumption (as a synthetic cannabinoid) by ADHD-based imbalances of the dopaminergic and norepiphrenic receptor profiles.

References

• 1 Baldwin JS, Dadds MR. Examining alternative explanations of the covariation of ADHD and anxiety symptoms in children: a community study.  J Abnorm Child Psychol. 2008;  36 67-79
• 2 Faraone SV, Perlis RH, Doyle AE. et al . Molecular genetics of attention-deficit/hyperactivity disorder.  Biol Psychiatry. 2005;  57 1313-1323
• 3 Fergusson DM, Boden JM. Cannabis use and adult ADHD symptoms.  Drug Alcohol Depend. 2008;  95 90-96
• 4 Huffman JW, Thompson AL, Wiley JL. et al . Synthesis and pharmacology of 1-deoxy analogs of CP-47,497 and CP-55,940.  Bioorg Med Chem. 2008;  16 322-335
• 5 Huss M, Holling H, Kurth BM. et al . How often are German children and adolescents diagnosed with ADHD?Prevalence based on the judgment of health care professionals: results of the German health and examination survey (KiGGS).  Eur Child Adolesc Psychiatry. 2008;  17 ((Suppl 1)) 52-58
• 6 Kustanovich V, Ishii J, Crawford L. et al . Transmission disequilibrium testing of dopamine-related candidate gene polymorphisms in ADHD: confirmation of association of ADHD with DRD4 and DRD5.  Mol Psychiatry. 2004;  9 711-717
• 7 Marcellino D, Carriba P, Filip M. et al . Antagonistic cannabinoid CB1/dopamine D2 receptor interactions in striatal CB1/D2 heteromers A combined neurochemical and behavioral analysis.  Neuropharmacology. 2008;  54 815-823
• 8 Morgan CJ, Curran HV. Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis.  Br J Psychiatry. 2008;  192 306-307
• 9 Polanczyk G, de Lima MS, Horta BL. et al . The worldwide prevalence of ADHD: a systematic review and metaregression analysis.  Am J Psychiatry. 2007;  164 942-948
• 10 Wittchen HU, Frohlich C, Behrendt S. et al . Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10-year prospective-longitudinal community study in adolescents.  Drug Alcohol Depend. 2007;  88 ((Suppl 1)) S60-S70
• 11 Zvolensky MJ, Lewinsohn P, Bernstein A. et al . Prospective associations between cannabis use, abuse, and dependence and panic attacks and disorder.  J Psychiatr Res. 2008;  42 1017-1023

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