Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-14T08:22:14.213Z Has data issue: false hasContentIssue false
  • English
  • Français

Benzylpiperazine-induced acute delirium in a patient with schizophrenia and an incidental temporal meningioma

Published online by Cambridge University Press:  13 June 2014

John Tully ,
Brian Hallahan  and
Colm McDonald
John Tully*
Affiliation:
University College Hospital Galway, Ireland
Brian Hallahan
Affiliation:
Roscommon County Hospital, Roscommon and Honorary Research Fellow, National University of Ireland Galway, Ireland
Colm McDonald
Affiliation:
University College Hospital Galway and National University of Ireland Galway, Ireland
*
*Correspondence E-mail: john.tully2@hse.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Benzylpiperazine is a psychotropic compound that has been widely available until recently from licensed premises such as ‘head shops’. This report describes a case of a 48 year old man with schizophrenia who developed an acute delirium secondary to benzylpiperazine use, although he initially presented as a diagnostic conundrum. Investigation of his delirium unearthed a temporal meningioma which appears to be an incidental finding. This is the first documented case of delirium due to benzylpiperazine use. Benzylpiperazine has significant abuse potential and psychiatric complications. Its sale and possession have recently been made illegal in Ireland, which may limit its abuse in the future.

Keywords

BenzylpiperazineAbuseDelirium
Type
Case report and review
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 1 , March 2011 , pp. S14 - S16
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gee, P, Fountain, J. Party on? BZP party pills in New Zealand. N Z Med J 2007; 120: 1249.Google Scholar
2.White, R, Standen, O. Piperazine in the treatment of threadworms in children: report on a clinical trial. BMJ 1953; 4839: 755–7.CrossRefGoogle Scholar
3.Standen, O. Activity of piperazine, in vitro, against Ascaris lumbricoides. BMJ 1955; 4930: 20–2.CrossRefGoogle Scholar
4.Campbell, H, Cline, W, Evans, M, Lloyd, J, Peck, A. Comparison of the effects of dexamphetamine and 1-benzylpiperazine in former addicts. Eur J Clin Pharmacol. 1973; 6: 170–6.CrossRefGoogle ScholarPubMed
5.Drugs Enforcement Administration. Schedules of Controlled Substances: Placement of 2,5-Dimethoxy-4- (n)-propylthiophenethylamine, N-Benzylpiperazine and 1-(3-Trifluoromethylphenyl)piperazine Into Schedule I of the Controlled Substances Act. 21 CFR Part 1308, 1996.Google Scholar
6.Butler, RA, Sheridan, JL. Highs and lows: patterns of use, positive and negative effects of benzylpiperazine-containing party pills (BZP-party pills) amongst young people in New Zealand. Harm Reduct J. 2007; 19: 4–18.Google Scholar
7.De Boer, D, Bosman, I, Hidvégi, Eet al.Piperazine-like compounds: a new group of designer drugs-of-abuse on the European market. Forensic Sci Int 2001; 121: 47–56.CrossRefGoogle ScholarPubMed
8.Downes, J. Tighter control of pills sought by FG. The Irish Times; October 10, 2006.Google Scholar
9.Council of the European Union. Council decision on defining 1-benzylpiperazine (BZP) as a new psychoactive substance which is to be made subject to control measures and criminal provisions. February 29, 2008.Google Scholar
10. In short. Ecstasy-type drug criminalised. The Irish Times. April 1, 2009.Google Scholar
11.Vorce, SP, Holler, JM, Levine, B, Past, MR. Detection of 1-benzylpiperazine and 1-(3-trifluoromethylphenyl)-piperazine in urine analysis specimens using GC-MS and LC-ESI-MS. J Anal Toxicol 2008; 32: 444–50CrossRefGoogle ScholarPubMed
12.Yarosh, HL, Katz, EB, Coop, A, Fantegrossi, WE. MDMA-like behavioral effects of N-substituted piperazines in the mouse. Pharmacol Biochem Behav. 2007; 88: 18–27.CrossRefGoogle ScholarPubMed
13.Fantegrossi, WE, Winger, G, Woods, JH, Woolverton, WL, Coop, A. Reinforcing and discriminative stimulus effects of 1-benzylpiperazine and trifluoromethylphenylpiperazine in rhesus monkeys. Drug Alcohol Depend. 2005; 77: 161–8.CrossRefGoogle ScholarPubMed
14.Alciati, Aet al.Three cases of delirium after “ecstasy” ingestion. J Psychoactive Drugs. 1999; 31(2):167–70.CrossRefGoogle ScholarPubMed
15.Nakatani, Y, Hara, T. Disturbance of consciousness due to methamphetamine abuse. A study of 2 patients. Psychopathology. 1998; 31(3):131–7.CrossRefGoogle ScholarPubMed
16.Lan, KC, Lin, YF, Yu, FC, Lin, CS, Chu, P. Clinical manifestations and prognostic features of acute methamphetamine intoxication. J Formos Med Assoc. 1998; 97: 528–533.Google ScholarPubMed
17.Brennan, K, Johnstone, A, Fitzmaurice, P, Lea, R, Schenk, S. Chronic benzylpiperazine (BZP) exposure produ ces behavioral sensitization and cross-sensitization to methamphetamine (MA). Drug Alcohol Depend. 2007; 88: 204–13.CrossRefGoogle Scholar
18.Meririnne, E, Kajos, M, Kankaanpää, A, Seppälä, T. Rewarding properties of 1-benzylpiperazine, a new drug of abuse, in rats. Basic Clin Pharmacol Toxicol. 2006; 98: 346–50.CrossRefGoogle ScholarPubMed
19.Johnstone, AC, Lea, RA, Brennan, KA, Schenk, S, Kennedy, MA, Fitzmaurice, PS. Benzylpiperazine: a drug of abuse? J Psychopharmacol. 2007; 21: 888–94.CrossRefGoogle ScholarPubMed
20.Tekes, K, Tóthfalusi, L, Malomvölgyi, B, Hermán, F, Magyar, K. Studies on the biochemical mode of action of EGYT-475, a new antidepressant. Pol J Pharmacol Pharm. 1987; 39(2): 203–11.Google ScholarPubMed
21.Lyon, R, Titeler, M, McKenney, J, Magee, P, Glennon, R. Synthesis and evaluation of phenyl- and benzylpiperazines as potential serotonergic agents. J Med Chem. 1986; 29: 630–4.CrossRefGoogle ScholarPubMed
22.Magyar, K, Fekete, M, Tekes, K, Török, T. The action of trelibet, a new antidepressive agent on noradrenaline release from rabbit pulmonary artery. Eur J Pharmacol. 1986; 130: 219–27.CrossRefGoogle ScholarPubMed
23.González-Maeso, J, Weisstaub, NV, Zhou, M, Chan, P, Ivic, L, Ang, Ret al.Hallucinogens Recruit Specific Cortical 5-HT2A Receptor-Mediated Signaling Pathways to Affect Behavior. Neuron. 2007; 53: 439–452.CrossRefGoogle ScholarPubMed
24.Borman, RA, Tilford, NS, Harmer, DW, Day, N, Ellis, ES, Sheldrick, RLGet al.5-HT2B receptors play a key role in mediating the excitatory effects of 5-HT in human colon in vitro. Br J Clin Pharmacol. 2002 135: 1144–1151CrossRefGoogle ScholarPubMed
25.Centorrino, F, Albert, MJ, Drago-Ferrante, G, Koukopoulos, AE, Berry, JM, Baldessarini, RJ. Delirium during clozapine treatment: incidence and associated risk factors. Pharmacopsychiatry. 2003; 36(4): 156–60.Google ScholarPubMed
26.Taylor, D, Paton, C, Kerwin, R. Maudsley prescribing guidelines. 9th Edition. London: Informa Healthcare; 2007.CrossRefGoogle Scholar
27.Trzepacz, PT, Meagher, DJ. Neuropsychiatric Aspects of Delirium. In: Yudofsky, SC, Hales, RE, ediors. The American psychiatric publishing textbook of neuropsychiatry and behavioral neurosciences. 5th ed. Arlington: American Psychiatric Publishing. P. 582–3.Google Scholar
28.Trzepacz, PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry. 2000; 5:132–148.Google Scholar
29.Antia, U, Lee, HS, Kydd, RR, Tingle, MD, Russell, BR. Pharmacokinetics of ‘party pill’ drug N-benzylpiperazine (BZP) in healthy human participants. Forensic Sci Int. 2009; 186: 63–7.CrossRefGoogle ScholarPubMed
30.Gee, P, Richardson, S, Woltersdorf, W, Moore, G. Toxic effects of BZP-based herbal party pills in humans: a prospective study in Christchurch, New Zealand. N Z Med J. 2005; 118: U1784.Google ScholarPubMed
31.Gee, P, Gilbert, M, Richardson, S, Moore, G, Paterson, S, Graham, P. Toxicity from the recreational use of 1-benzylpiperazine. Clin Toxicol (Phila). 2008; 46: 802–7.CrossRefGoogle ScholarPubMed
32.Baumann, MH, Clark, RD, Budzynski, AG, Partilla, JS, Blough, BE, Rothman, RB. N-substituted piperazines abused by humans mimic the molecular mechanism of 3,4-methylenedioxymethamphetamine (MDMA, or ‘Ecstasy’). Neuropsychopharmacology. 2005; 30: 550–60.CrossRefGoogle ScholarPubMed
33.Elliott, S, Smith, C. Investigation of the first deaths in the United Kingdom involving the detection and quantitation of the piperazines BZP and 3-TFMPP. J Anal Toxicol. 2008; 32: 172–7.CrossRefGoogle ScholarPubMed
34.Cunningham Owens, DG, Johnstone, EC, Bydder, GM, Kreel, L. Unsuspected organic disease in chronic schizophrenia demonstrated by computed tomography. J Neurol Neurosurg Psychiatry. 1980; 43: 1065–1069.CrossRefGoogle ScholarPubMed
35.Fahy, ST, Carey, TG, Owens, JM, Owens, AP. Psychiatric Presentation of Frontal Meningiomas. Ir J Psych Med 1995: 12 (2): 61–63.CrossRefGoogle Scholar
36.Nakamura, M, Roser, F, Michel, J, Jacobs, C, Samii, M. The natural history of incidental meningiomas. Neurosurgery 2003; 53: 62–71CrossRefGoogle ScholarPubMed
37.Lieu, AS, Howng, SL. Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res 2000; 38: 45–52.CrossRefGoogle ScholarPubMed