Novel psychoactive substances: overdose of 3-fluorophenmetrazine (3-FPM) and etizolam in a 33-year-old man.

Though illegal in the UK, in many countries novel psychoactive substances are quasi-legal synthetic compounds that are widely available online under the guise of research chemicals. These substances are relatively cheap and are often undetectable in standard drug screens. Nearly 200 such compounds are introduced yearly, and little is usually known about their metabolism or physiological effects. Consequently, managing patients in overdose situations on largely unknown substances usually involves supportive care, however anticipating and managing atypical side effects are challenging in the absence of knowledge of these compounds. In this report, we discuss our encounter with a 33-year-old unconscious man presenting with coingestion of a novel stimulant 3-fluorophenmetrazine with a rarely used benzodiazepine etizolam. This patient developed seizure-like activity and delayed widespread T-wave inversions, both of which ultimately resolved without sequelae.

Clinical aspects of the treatment of obesity by drugs: a review.

The safety, short-term and long-term efficacy of appetite-suppressant drugs are reviewed. Seven drugs widely available on prescription under the UK national health service are discussed.

Effects of antenatal exposure to anorectic drugs.

In a large prospective, observational study of pregnancy and child development, the anorectic drugs (amphetamines and phenmetrazine) prescribed to gravid women during different stages of pregnancy were evaluated for their teratogenicity. The severe congenital anomaly rate (SCA) per 100 live-born children at age five years did not differ from the SCA rate of the group of children whose mothers did not use these drugs. There was, however, an excess of oral clefts in the offspring of mothers who had amphetamines prescribed in the first 56 days from the last menstrual period. A rought test of efficacy of anorectic drugs by comparing mean weight gains in four-week periods before and after the prescription showed only short-term and limited reduction of weight gain.

Suicide by aircraft: a case report.

A 36-year-old pilot took his plane on a brief, unauthorized flight that ended in a high-speed vertical crash next to the runway. A retrospective "psychological autopsy" yielded strong presumptive evidence of an unrecognized depression in a man with manipulative and mildly antisocial characteristics. His withdrawal from his usual patterns of behavior was, instead, regarded as a desirable return to "normal" behavior. This case report includes comments on the role of the psychological autopsy in aircraft accident investigation, anniversary reactions, the use of psychiatric diagnosis to support the agreed-upon decision on the desired disposition, some aspects of subintentional suicidal behavior, a brief review of the literature on suicide by aircraft, and consideration of the role of the flight surgeon in preventing such occurrences through early recognition of depression.

Rhabdomyolysis and shock after intravenous amphetamine administration.

Five patients who had injected intravenous (i.v.) phenmetrazine or methamphetamine developed marked prostration resembling septic shock, disseminated intravascular coagulation, rhabdomyolysis with myoglobinuria, and azotemia. Soon after injection, four noted chills, fever, sweats, nausea, and abdominal cramps. Within hours, they developed vomiting, myalgias, paresthesias, headache, and orthostasis. Cardiorespiratory arrest, accelerated bleeding, and noncardiac pulmonary edema were observed in one patient. From 4 to 11 litres of saline were required in the first 24 h to maintain blood pressure and urine output, suggesting that shock resulted from massive loss of intravascular volume into necrotic muscle. Recognition of this syndrome and treatment by aggressive volume replacement led to the recovery of all five patients.

A psychological theory of child abuse.

This paper presents a detailed study of two patients hospitalized in a closed psychiatric unit on which the treatment program emphasized dynamically oriented individual psychotherapy and family therapy. The first patient was hospitalized following physical abuse of her four-year-old daughter, while the second was hospitalized for a postpartum depression eight weeks following the birth of her first child, a girl. Although the presenting pictures in these two patients were markedly different, the psychodynamic patterns were so similar that a detailed comparison of the two cases seems to offer useful insight into some of the psychological causes of child abuse.