F. D. Zepf et al.: A 16-Year-Old Boy with Severe Gamma-Butyrolactone (GBL) Withdrawal Delirium. Pharmacopsychiatry 2009; 42: 202–203

The case report of “A 16-year-old boy with severe gamma-butyrolactone (GBL) withdrawal delirium” (Pharmacopsychiatry 2009; 42: 202–203) warrants comment as to diagnosis and treatment. The description of delirium, delusions, and disorganized aggressive behavior as a neurotoxic response meets criteria for “delirious mania” [1]. The patient was treated with measured doses of diazepam with daily maximums of 30 mg. The modest response to these dosages encouraged the clinicians to continue the dosing schedule, with a slow gradual response temporarily worsened by the administration of haloperidol. Recovery required two weeks.

The case report is meant to educate the clinician but this message is faulty. For the relief of such delirious states with lorazepam, dosages to 20 mg/day are necessary [1] [2] [3]. The equivalent dosing for diazepam would by considerably higher than that used when we consider the dose relationship of lorazepam to diazepam as 1:5.

Further, it is puzzling why ECT was not used. The response of toxic deliria to ECT is well documented [1] [2] [3].

References

• 1 Fink M.. Delirious mania. Bipolar Disorders. 1999 1: 54-60
• 2 Fink M.. The interaction of delirium and seizures. In: PT Trzepacz (Ed.). Seminars in Clinical Neuropsychiatry. 2000. 5: 31-35
• 3 Fink M., Taylor MA. Catatonia: A Clinicians Guide to Diagnosis and Treatment. Cambridge UK: Cambridge University Press; 2003

Correspondence