Hyperbaric oxygen therapy to improve cognitive dysfunction and encephalatrophy induced by&amp;nbsp;N&lt;sub&gt;2&lt;/sub&gt;O for recreational use: a case report

Luo, Dan; Xu, Jiajun; Hu, Li; Yu, Liangming; Xie, Leling; Li, Jing

doi:10.2147/ndt.s170037

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…Six patients were not staying in their country of origin at the time of use and hospitalization, e.g., immigrants and exchange students. One patient [32] was staying abroad during the period of abuse but returned home prior to hospitalization. Of the 31 cases, 15 were female and 16 were male (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…This results in a discordance between the treatment of patients with and without neurological symptoms, likely explained by the difference in physicians' awareness of a possible association between psychiatric symptoms and vitamin B12. One of the case reports [32] described a treatment regimen involving hyperbaric oxygen therapy (HBOT), based on the seeming effectiveness of HBOT in cases of delayed encephalopathy after acute carbon monoxide poisoning [63]. The patient in this article presented with various symptoms, including tetraparesis, disturbance of orientation and memory, and irritability.…”

Section: Discussionmentioning

confidence: 99%

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Does vitamin B12 deficiency explain psychiatric symptoms in recreational nitrous oxide users? A narrative review

Paulus

Wijnhoven

Maessen

et al. 2021

Clinical Toxicology

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Background Recreational use of nitrous oxide (N 2 O) is associated with many side effects, of which neurological complications are most common. Nitrous oxide abuse is also associated with psychiatric symptoms, but these have received less attention so far. Vitamin B12 deficiency may play a role in the development of these psychiatric symptoms. Aims To explore the relationship among the occurrence of recreational nitrous oxide-induced psychiatric symptoms, accompanying neurological symptoms, vitamin B12 status and choice of treatment. Methods A retrospective search for case reports was conducted across multiple databases (Pubmed, Embase, Web of Science, PsycINFO and CINAHL). Keywords included variants of "nitrous oxide", "case report" and "abuse". No restrictions to language or publication date were applied. Results The search retrieved 372 articles. A total of 25 case reports were included, representing 31 patients with psychiatric complications following nitrous oxide abuse. The most often reported symptoms were: hallucinations (n ¼ 16), delusions (n ¼ 11), and paranoia (n ¼ 11). When neurological symptoms were present, patients were treated more frequently with vitamin B12 supplementation. Conclusions This review highlights the need to recognize that psychiatric symptoms may appear in association with nitrous oxide use. Approximately half of the cases that presented with nitrous oxideinduced psychiatric complaints did not show neurological symptoms, and their vitamin B12 concentration was often within the hospital's reference range. Psychiatrists and emergency physicians should be aware of isolated psychiatric symptoms caused by recreational nitrous oxide abuse. We suggest asking all patients with new psychiatric symptoms about nitrous oxide use and protocolizing the management of nitrous oxide-induced psychiatric symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does vitamin B12 deficiency explain psychiatric symptoms in recreational nitrous oxide users? A narrative review

Paulus

Wijnhoven

Maessen

et al. 2021

Clinical Toxicology

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“…However, the effect of HBOT on the cognitive dysfunction induced by nitrous oxide abuse is unknown. We previously reported the improvement of cognitive function with HBOT in a patient who abused nitrous oxide 11. Based on this finding and the literature regarding the improvement of cognitive function with HBOT, we plan to conduct a randomised, double-blinded, placebo-controlled trial to investigate the effect of HBOT on cognitive dysfunction in patients who abuse nitrous oxide.…”

Section: Introductionmentioning

confidence: 95%

“…They presented deficits in attention, executive functioning, short-term memory and visuospatial organisation, and the symptoms slowly improved after the cessation of occupational exposure and treatment with antidepressants and neuropsychology 10. In addition, recent cases also reported that nitrous oxide abuse may cause cognitive dysfunction;11 12 however, the characteristics of cognitive impairment due to nitrous oxide abuse are unknown.…”

Section: Introductionmentioning

confidence: 99%

Effect of hyperbaric oxygen therapy on cognitive dysfunction induced by nitrous oxide abuse: protocol of a randomised, double-blinded, placebo-controlled trial

et al. 2022

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IntroductionThe cognitive dysfunction associated with nitrous oxide abuse is gradually becoming a major global public health concern. Despite the increasing prevalence of nitrous oxide abuse, there are currently no authorised/approved treatment options. Hyperbaric oxygen therapy (HBOT) has been proven to be an efficient method to improve cognitive function. The current randomised, double-blinded, placebo-controlled trial will explore the effect of HBOT on cognitive dysfunction induced by nitrous oxide abuse.Methods and analysisEighty participants who abuse nitrous oxide and have cognitive dysfunction, including memory decline, disorientation, attention deficits, slower reactions and learning disabilities, will be included in the trial. They will be randomly assigned to receive either HBOT or sham-HBOT 90–120 min once daily for 5 days per week for 2 weeks. The primary outcome will be the improvement in the total score of the MATRICS Consensus Cognitive Battery, which will measure comprehensive cognitive function between the two groups. Additionally, attention will be measured by integrated visual and auditory continuous performance tests, executive function will be measured by the Wisconsin card sorting test, intelligence will be measured by Raven’s standard progressive matrices and cognitive control will be measured by the Stroop colour word interference test.Ethics and disseminationThis protocol was approved by the West China Hospital of Sichuan University Biomedical Research Ethics Committee. The report of the study will be disseminated via scientific forums including peer-reviewed publications and presentations at national and international conferences.Trial registration numberChinese Clinical Trial Registry (ChiCTR2100047111).

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Severe Encephalatrophy and Related Disorders From Long-Term Ketamine Abuse: A Case Report and Literature Review

Lin-ying

Huang

Li³

et al. 2021

Front. Psychiatry

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Ketamine is a glutamate N-methyl D-aspartate receptor antagonist and an anaesthetic agent that has been effectively used to treat depression. However, ketamine has also been increasingly used for recreational purposes. The dissociative side-effects of ketamine use, such as hallucinations, are the reason for abuse. Additionally, long-term ketamine abuse has been highly associated with liver-gallbladder and urinary symptoms. The present study reports the case of a 28-year-old young male adult with an 8-year history of daily inhalation of ketamine. We investigated the association between ketamine abuse and the mechanism of its adverse effects, particularly encephalatrophy, and attempted to find a link between these disorders. These results would help us to better understand ketamine usage, ketamine abuse effects and the addictive mechanism. To the best of our knowledge, the present case is the first report of severe brain atrophy related to ketamine abuse. Details of the patient are presented and the mechanism of the encephalatropy-associated ketamine abuse is discussed. Furthermore, organ dysfunction following chronic ketamine abuse may indicate that the side effects are the result of comprehensive action on multiple regions in the brain.

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Hyperbaric oxygen therapy to improve cognitive dysfunction and encephalatrophy induced by N<sub>2</sub>O for recreational use: a case report

Cited by 3 publications

References 26 publications

Does vitamin B12 deficiency explain psychiatric symptoms in recreational nitrous oxide users? A narrative review

Does vitamin B12 deficiency explain psychiatric symptoms in recreational nitrous oxide users? A narrative review

Effect of hyperbaric oxygen therapy on cognitive dysfunction induced by nitrous oxide abuse: protocol of a randomised, double-blinded, placebo-controlled trial

Severe Encephalatrophy and Related Disorders From Long-Term Ketamine Abuse: A Case Report and Literature Review

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