{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:02:29Z","timestamp":1788994949568,"version":"build-2803163510"},"reference-count":6,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:00:00Z","timestamp":1639612800000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Patients with gamma-hydroxybutyric acid withdrawal symptoms are at high risk of developing organic delirium, which can be fatal. The recommended first-line treatment is benzodiazepines, but treatment-resistant cases are frequent. Here we describe a case of\u00a0successful bilateral electroconvulsive therapy in a patient with severe and highly agitated acute organic delirium induced by gamma-hydroxybutyric acid withdrawal and complicated by polydrug use resistant to first-line treatment. To our knowledge, this is the first report on the effect of electroconvulsive therapy on treatment-resistant delirium caused by gamma-hydroxybutyric acid withdrawal.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 21-year-old Danish man diagnosed with untreated attention deficit hyperactivity disorder developed severely agitated acute organic delirium caused by gamma-hydroxybutyric acid withdrawal in a Danish psychiatric ward. The patient was subjected to physical restraints and transferred to the intensive care unit for treatment. During the next 10\u00a0days, the patient showed no clinical improvement despite first-line, high-dose benzodiazepines along with intense supportive treatment with propofol, phenobarbital, and antipsychotics. On day 11, bilateral frontotemporal electroconvulsive therapy treatment was initiated and full clinical recovery was obtained after four sessions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>The full clinical remission after four electroconvulsive therapy sessions, strongly supports that electroconvulsive therapy may be an effective treatment when severe delirium induced by gamma-hydroxybutyric acid withdrawal is resistant to conventional first-line treatment with benzodiazepines. Moreover, this case illustrates that clinically effective seizures were achieved despite intensive concurrent exposure to anticonvulsive drugs. Therefore, this case report encourages consideration of electroconvulsive therapy in patients with gamma-hydroxybutyric acid delirium who are resistant to psychopharmacological treatment.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-03182-w","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:03:37Z","timestamp":1639613017000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report"],"prefix":"10.1186","volume":"15","author":[{"given":"Mads F.","family":"Kj\u00e6rgaard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poul","family":"Videbech","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens J.","family":"N\u00f8rb\u00e6k","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2590-5055","authenticated-orcid":false,"given":"Bj\u00f8rn H.","family":"Ebdrup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,16]]},"reference":[{"key":"3182_CR1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.2174\/1570159X13666141210215423","volume":"13","author":"FP Busard\u00f3","year":"2015","unstructured":"Busard\u00f3 FP, Jones AW. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Curr Neuropharmacol. 2015;13:47\u201370.","journal-title":"Curr Neuropharmacol"},{"key":"3182_CR2","unstructured":"The WHO International Statistical Classification of Diseases and Related Health Problems 10th Revision. https:\/\/icd.who.int\/browse10\/2019\/en#\/F00-F09. Accessed 31 Oct 2021."},{"key":"3182_CR3","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.drugalcdep.2016.11.014","volume":"170","author":"BA Dijkstra","year":"2017","unstructured":"Dijkstra BA, Kamal R, van Noorden MS, et\u00a0al. Detoxification with titration and tapering in gamma-hydroxybutyrate (GHB) dependent patients: the Dutch GHB monitor project. Drug Alcohol Depend. 2017;170:164\u201373.","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"3182_CR4","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1097\/ADM.0000000000000214","volume":"10","author":"RM Kamal","year":"2016","unstructured":"Kamal RM, Dijkstra BA, Loonen AJ, et\u00a0al. The effect of co-occurring substance use on gamma-hydroxybutyric acid withdrawal syndrome. J Addict Med. 2016;10(4):229\u201335.","journal-title":"J Addict Med"},{"key":"3182_CR5","unstructured":"Nancy Greer,\u00a0Rebecca Rossom,\u00a0Pauline Anderson, et\u00a0al. Delirium: screening, prevention, and diagnosis\u2014a systematic review of the evidence. US Department of Veterans Affairs Health Services Research & Development Service [VA Evidence-based Synthesis Program Report]. Sep. 2011. US Department of Veterans Affairs Health Services Research & Development. https:\/\/www.hsrd.research.va.gov\/publications\/esp\/delirium-report.pdf. Accessed 24 Jan 2021."},{"key":"3182_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2014.05.012","author":"RM Nielsen","year":"2014","unstructured":"Nielsen RM, Olsen KS, Lauritsen AO, Boesen HC, et\u00a0al. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit\u2014five cases and a review. J Crit Care. 2014. https:\/\/doi.org\/10.1016\/j.jcrc.2014.05.012.","journal-title":"J Crit Care"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-03182-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-021-03182-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-03182-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:03:55Z","timestamp":1639613035000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-021-03182-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":6,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["3182"],"URL":"https:\/\/doi.org\/10.1186\/s13256-021-03182-w","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"1 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable for case reports according to Danish regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MK, JN, and PV declare no conflicts of interest. BE has received lecture fees and\/or is part of Advisory Boards of Bristol-Myers Squibb, Eli Lilly and Company, Janssen-Cilag, Otsuka Pharma Scandinavia AB, Takeda Pharmaceutical Company, Boehringer Ingelheim, and Lundbeck Pharma A\/S.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"596"}}