Acute confusional state after designer tryptamine abuse

Pharmaco-toxicological effects of the novel tryptamine hallucinogen 5-MeO-MiPT on motor, sensorimotor, physiological, and cardiorespiratory parameters in mice-from a human poisoning case to the preclinical evidence

RATIONALE

The 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT, known online as "Moxy") is a new psychedelic tryptamine first identified on Italian national territory in 2014. Its hallucinogen effects are broadly well-known; however, only few information is available regarding its pharmaco-toxicological effects.

OBJECTIVES

Following the seizure of this new psychoactive substances by the Arm of Carabinieri and the occurrence of a human intoxication case, in the current study we had the aim to characterize the in vivo acute effects of systemic administration of 5-MeO-MiPT (0.01-30 mg/kg i.p.) on sensorimotor (visual, acoustic, and overall tactile) responses, thermoregulation, and stimulated motor activity (drag and accelerod test) in CD-1 male mice. We also evaluated variation on sensory gating (PPI, prepulse inhibition; 0.01-10 mg/kg i.p.) and on cardiorespiratory parameters (MouseOx and BP-2000; 30 mg/kg i.p.). Lastly, we investigated the in silico ADMET (absorption, distribution, metabolism, excretion, toxicity) profile of 5-MeO-MiPT compared to 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT) and N,N-dimethyltryptamine (DMT).

RESULTS

This study demonstrates that 5-MeO-MiPT dose-dependently inhibits sensorimotor and PPI responses and, at high doses, induces impairment of the stimulated motor activity and cardiorespiratory changes in mice. In silico prediction shows that the 5-MeO-MiPT toxicokinetic profile shares similarities with 5-MeO-DIPT and DMT and highlights a cytochrome risk associated with this compound.

CONCLUSIONS

Consumption of 5-MeO-MiPT can affect the ability to perform activities and pose a risk to human health status, as the correspondence between the effects induced in mice and the symptoms occurred in the intoxication case suggests. However, our findings suggest that 5-MeO-MiPT should not be excluded from research in the psychiatric therapy field.

Molecular and clinical aspects of potential neurotoxicity induced by new psychoactive stimulants and psychedelics

New psychoactive stimulants and psychedelics continue to play an important role on the illicit new psychoactive substance (NPS) market. Designer stimulants and psychedelics both affect monoaminergic systems, although by different mechanisms. Stimulant NPS primarily interact with monoamine transporters, either as inhibitors or as substrates. Psychedelic NPS most potently interact with serotonergic receptors and mediate their mind-altering effects mainly through agonism at serotonin 5-hydroxytryptamine-2A (5-HT_2A) receptors. Rarely, designer stimulants and psychedelics are associated with potentially severe adverse effects. However, due to the high number of emerging NPS, it is not possible to investigate the toxicity of each individual substance in detail. The brain is an organ particularly sensitive to substance-induced toxicity due to its high metabolic activity. In fact, stimulant and psychedelic NPS have been linked to neurological and cognitive impairments. Furthermore, studies using in vitro cell models or rodents indicate a variety of mechanisms that could potentially lead to neurotoxic damage in NPS users. Cytotoxicity, mitochondrial dysfunction, and oxidative stress may potentially contribute to neurotoxicity of stimulant NPS in addition to altered neurochemistry. Serotonin 5-HT_2A receptor-mediated toxicity, oxidative stress, and activation of mitochondrial apoptosis pathways could contribute to neurotoxicity of some psychedelic NPS. However, it remains unclear how well the current preclinical data of NPS-induced neurotoxicity translate to humans.

Dual actions of 5-MeO-DIPT at the serotonin transporter and serotonin 5-HT1A receptor in the mouse striatum and prefrontal cortex

Aims

5‐Methoxy‐N,N‐diisopropyltryptamine (5‐MeO‐DIPT) is a synthetic orally active hallucinogenic tryptamine analogue. The present study examined whether the effects of 5‐MeO‐DIPT involve the serotonin transporter (SERT) and serotonin 5‐hydroxytryptamine‐1A (5‐HT_1A) receptor in the striatum and prefrontal cortex (PFC).

Methods

We investigated the effects of 5‐MeO‐DIPT on extracellular 5‐HT (5‐HT_ex) and dopamine (DA_ex) levels in the striatum and PFC in wildtype and SERT knockout (KO) mice using in vivo microdialysis, and for comparison the effects of the 5‐HT_1A receptor antagonist WAY100635 and the 5‐HT_1A receptor agonist 8‐OH‐DPAT on 5‐HT_ex.

Results

5‐MeO‐DIPT decreased 5‐HT_ex levels in the striatum, but not PFC. In SERT‐KO mice, 5‐MeO‐DIPT did not affect 5‐HT_ex levels in the striatum or PFC. In the presence of WAY100635, 5‐MeO‐DIPT substantially increased 5‐HT_ex levels, suggesting that 5‐MeO‐DIPT acts on SERT and these effects are masked by its 5‐HT_1A actions in the absence of WAY100635. 8‐OH‐DPAT decreased 5‐HT_ex levels in the striatum and PFC in wildtype mice. WAY100635 antagonized the 8‐OH‐DPAT‐induced decrease in 5‐HT_ex levels. In SERT‐KO mice, 8‐OH‐DPAT did not decrease 5‐HT_ex levels in the striatum and PFC. 5‐MeO‐DIPT dose‐dependently increased DA_ex levels in the PFC, but not striatum, in wildtype and SERT‐KO mice. The increase in DA_ex levels that was induced by 5‐MeO‐DIPT was not antagonized by WAY100635.

Conclusion

5‐MeO‐DIPT influences both 5‐HT_ex and DA_ex levels in the striatum and PFC. 5‐MeO‐DIPT dually acts on SERT and 5‐HT_1A receptors so that elevations in 5‐HT_ex levels produced by reuptake inhibition are limited by actions of the drug on 5‐HT_1A receptors.

5‐MeO‐DIPT influences both 5‐HT_ex and DA_ex levels in the striatum and PFC. 5‐MeO‐DIPT dually acts on SERT and 5‐HT1A receptors so that elevations in 5‐HT_ex levels produced by reuptake inhibition are limited by actions of the drug on 5‐HT_1A receptors.

Designer drugs: mechanism of action and adverse effects

Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at μ-opioid receptors and γ-aminobutyric acid-A (GABAA) or GABAB receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.

The spectrum of involuntary vocalizations in humans: A video atlas

In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video-documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic-like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep-related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

LC-MS/MS quantitative determination of Tetrapterys mucronata alkaloids, a plant occasionally used in ayahuasca preparation

INTRODUCTION

Tetrapterys mucronata Cav. (Malpighiaceae) is a plant used in some regions of Brazil in the preparation of ayahuasca.

OBJECTIVE

To determine the content of the main tryptamine alkaloids in the stem bark of T. mucronata Cav. and assess their possible toxic and hallucinogenic properties based on the doses found in a water decoction that mimics the ayahuasca preparation.

METHODS

Four alkaloids previously described for their toxic and hallucinogenic properties were quantitated by multiple reaction monitoring HPLC combined with electrospray ionisation and tandem MS (HPLC-ESI/MS/MS) in the water decoction and ethanolic extracts from the bark of T. mucronata.

RESULTS

Exhaustive extraction of the stem barks with ethanol revealed the following alkaloid levels: bufotenine (1) 3.26 ± 0.31 mg/g, 5-methoxy-N-methyltryptamine (2) 0.88 ± 0.08 mg/g, 5-methoxy-bufotenine (3) 3.07 ± 0.22 mg/g and 2-methyl-6-methoxy-1,2,3,4-tetrahydro-β-carboline (4) 0.14 ± 0.004 mg/g. The water decoction presented slightly lower levels, ranging between 2.32 ± 0.14, 0.50 ± 0.04, 1.53 ± 0.09 and 0.10 ± 0.01 mg/g for (1), (2), (3) and (4) respectively.

CONCLUSIONS

The HPLC-ESI/MS/MS quantitation revealed significant alkaloid levels, in particular for bufotenine and 5-methoxy-bufotenine. As such compounds are known for their toxic and hallucinogenic properties, these results indicate that the consumption of this plant as an ingredient in ayahuasca preparations may present a risk to consumers.

Prolonged delusional state triggered by repeated ingestion of aromatic liquid in a past 5-methoxy-N, N-diisopropyltryptamine abuser

A 30-year-old Japanese man with no previous psychiatric history presented to our facility with delusions, which had been ongoing for 2 months. Upon further interview, he confided that he had a past history of recurrent 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT or "Foxy") abuse, as well as a recent history of recurrent ingestion of a legal aromatic liquid used as a recreational drug. After this episode, his condition improved and he did not follow up at subsequent appointments. However, 6 months later, he suffered a relapse of prolonged delusions after again ingesting a recreational aromatic liquid. An evaluation of the chronological sequence of the patient's condition revealed that ingestion of these aromatic liquids, which can be purchased easily on the Internet, likely triggered the patient's delusional episodes. We speculate that the patient's recurrent abuse of 5-MeO-DIPT caused sensitization (or reverse tolerance), thus prolonging his delusions. Sensitization is the amplification of a response following repeated administrations of a stimulus. 5-MeO-DIPT is a popular drug of abuse, and it is highly probable that a large number of past 5-MeO-DIPT users are currently sensitized. This is an important latent factor underlying subsequent episode of drug-induced psychosis. Psychiatrists should consider the possibility of 5-MeO-DIPT sensitization when evaluating patients with acute psychoses.

Psychoactive properties of alpha-methyltryptamine: analysis from self reports of users

This is a retrospective examination of former users of alpha-methyltryptamine (AMT). A scale of questions was given to subjects who were familiar with the effects of AMT and the outcome was analyzed. Most subjects agreed that AMT had strong hallucinogenic qualities. The most common unwanted effects included anxiety, nausea and moderately severe dysphoria. Several subjects reported significant depression associated with use of AMT. Use of alpha-methyltryptamine could be dangerous in individuals prone to depression.