Delirium following ingestion of marijuana present in chocolate cookies.

OBJECTIVE: To describe a case of marijuana-induced delirium and the techniques used to detect psychoactive agents and metabolites in urine. METHODS: A case of delirium following involuntary ingestion of cannabis is described. A urine sample was analyzed applying various chemical procedures, using high-resolution gas chromatography coupled with mass spectrometry technique. 11-Nor-delta9-tetrahydrocannabinol-9-carboxylic acid was quantified by the methodology for steroids and cannabis. RESULTS: A 26-year-old man was hospitalized with severe agitation and psychotic behavior 36 hours after suspected involuntary ingestion of cannabis contained in a brigadeiro, a typical Brazilian cookie, consumed during a party. Treatment with neuroleptics resulted in complete regression of the symptoms over 2 weeks. The urine sample revealed marijuana ingestion, demonstrated by the presence of its metabolite, 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid in high concentration. No other investigated substance was found in the patient's urine. CONCLUSION: Severe delirium can follow oral ingestion of cannabis integrated into homemade cookies.

Predictors of recovery following involuntary hospitalization of violent substance abuse patients.

The goal of this study was to evaluate the results and predictors of good recovery following involuntary hospitalization of violent substance abuse patients. Twenty patients (16 male, aged 13 to 53 years [mean+/-s.d.=32.9+/-10.2]) were admitted in 1997 with a median hospital time of 73.5 days (20 to 455) for exhibiting violent behavior following drug abuse and a loss of self-control. They were treated with psychiatric medication, a 12-step program (Minnesota), psychotherapy and family therapy, and, following hospitalization, counselling, psychotherapy, and participation in self-help groups. Follow-up ranged from 3 to 24 months (17.8+/-4.9). We studied the probability of maintenance of complete abstinence and social adaptation (professional-educational, family and legal parameters) using T and Fisher tests (significance level p< or =0.05). Of the twenty, thirteen patients (65%) achieved excellent social reintegration, and twelve maintained total abstinence. Two patients died (AIDS, hepatic cirrhosis). The chances of complete abstinence and social reintegration were increased by lower age at admission (p=0.02), some form of treatment following hospitalization (p=0.007), adherence to the entire period of treatment (p=0.05), and regular attendance at self-help groups (p=0.05). No significant differences were found in terms of other demographic parameters, drugs used (number or class), previous hospital admissions, length of hospitalization, or follow-up. Sixty percent of patients can expect an excellent outcome over a period of 18 months, according to strict clinical and social criteria. Early intervention and factors increasing adherence to prolonged treatment increase abstinence and social reintegration and thus should be further explored.