Novel Psychoactive Substances – GHB- and Mephedrone-Induced Delirium Treated with Olanzapine

Aim: Delirium is a sudden disturbance in mental functioning characterized by impaired attention, reduced concentration, and disorientation. A rising cause of delirium are novel psychoactive substances (NPS) – emerging drugs designed to mimic the effects of controlled substances while evading legal restrictions. The management of NPS-induced delirium remains challenging due to the lack of established guidelines. Treatment is primarily symptomatic, managing symptoms with benzodiazepines and typical antipsychotics (mostly haloperidol). This paper highlights olanzapine as a potentially effective option for treating NPS-induced delirium, particularly in cases where gamma-hydroxybutyrate (GHB) is abused. Case report: A patient dependent on NPS (GHB and mephedrone) developed delirium due to withdrawal syndrome. The patient presented with hallucinations, disorientation, dissociative speech, agitation, insomnia, attention and concentration disturbances, and autonomic instability. In addition to the usual delirium therapy (haloperidol, anxiolytics), the patient was treated with oral olanzapine, resulting in symptom resolution. This paper demonstrates the successful treatment of NPS-induced delirium with olanzapine. Conclusion: Broad receptor binding profile of olanzapine in the brain contributes to its efficacy in alleviating hallucinations, agitation, and autonomic disturbances. However, there is a need for further research to establish optimal treatment protocols for NPS-induced delirium to ensure the best possible care for patients affected by this challenging condition.