[Case report: the psychotic-mystical effects related to an unaware use of Salvia divinorum.] / Gli effetti psicotico-mistici di un'assunzione inconsapevole di Salvia divinorum: un caso clinico.

It's well known that exotoxicosis can originate various psychiatric clinical pictures. The psychic impact of "classic" substances of abuse is well known and easily detectable with the usual methods of examination. In the last years new psychoactive substances (NPS) are spreading worldwide, determining not easily recognizable situations, with a significant clinical and organizational impact on psychiatry. In this case report, we present a clinical picture treated in hospital and outpatient settings in Vigevano (Pavia - Italy) and characterized by a psychotic onset secondary to an unaware use of Salvia divinorum. After the failure of two psychopharmacological treatment, the patient showed an excellent response to brexiprazole, with substantial restitutio ad integrum in the absence of significant side effects.

Abuse and Effects of Salvia divinorum in a Sample of Patients Hospitalized for Substance Dependence.

The study goal is to document the prevalence of salvia use among patients admitted for detoxification of other illicit drug use and to determine its effect. This cross-sectional study included 47 heavy drug users who were admitted for detoxification of other illicit drug abuse at a psychiatric hospital in Lebanon. The prevalence of salvia use was 66%. The salvia effect started and dissipated rapidly (15 min). No significant difference was found between salvia and non-salvia users in terms of affect, cognition and somaesthesia subscales of the Hallucinogen Rating Scale. Ratings of intensity and volition subscales were higher in non-salvia users than salvia users, while perception score was higher in users. Salvia use was correlated with perceptual alteration and hallucinogenic effects.

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The Association of Salvia divinorum and Psychotic Disorders: A Review of the Literature and Case Series.

The association of substance abuse and psychotic disorders is of interest to clinicians, academics, and lawmakers. Commonly abused substances, such as cannabis, cocaine, amphetamines, and alcohol, have all been associated with substance-induced psychosis. Hallucinogens can induce desired psychedelic effects and undesirable psychomimetic reactions. These are usually transient and resolve once the duration of action is over. Sometimes, these effects persist, causing distress and requiring intervention. This article focuses on the hallucinogenic substance Salvia divinorum, the use of which has been observed, particularly among youth worldwide. We present background information based on a review of the literature and on our own clinical encounters, as highlighted by two original case reports. We hypothesize that consumption of Salvia divinorum could be associated with the development of psychotic disorders. We propose that clinicians routinely inquire about the use of Salvia in patients with substance use disorders or psychotic illnesses. More research is required to assess any relationship between Salvia divinorum and psychosis. Additionally, we advocate increased public and medical awareness of this substance and other emerging drugs of abuse.

From divination to madness: features of acute intoxication with Salvia use.

Salvia divinorum is a psychoactive botanical plant that is increasingly used for the 'legal' highs that it can produce. It is readily available for purchase on the Internet, and most abusers are unaware of the toxicity and abuse potential associated with its use. As the use of novel compounds among abusers is not uncommon, physicians need to increase their awareness and recognition of these new substances. Herein, we report a case of an acute presentation of Salvia intoxication.

Current "legal highs".

BACKGROUND: A growing number of novel substances have been abused as recreational drugs by young people in the United States (US), Europe, and Australia. Called "legal highs," these substances range from plant-based to completely synthetic compounds. Spice, Salvia, mephedrone, methylenedioxypyrovalerone (MDPV), and other cathinone derivatives have psychotropic effects and are marketed for recreational use through exploitation of inadequacies in existing controlled substance laws. OBJECTIVES: This article reviews available literature on the most common "legal highs" as well as discussing the scientific basis for the legal difficulties in controlling trafficking in these novel substances. CONCLUSIONS: "Legal highs" continue to increase in use in the US, Europe, and Australia. These substances are powerful, can mimic effects of more traditional drugs of abuse, and are intentionally manufactured to circumvent existing controlled substance laws. As controlled substance legislation may be inadequate in the face of the quickly evolving legal highs, physicians are likely to see an increase in the prevalence of legal highs.

Salvia divinorum: effects and use among YouTube users.

Salvia divinorum (salvia) is an intense, short-acting hallucinogenic plant gaining popularity among adolescents in the United States. There has been little scientific documentation of salvia's effects. The popular video-sharing website YouTube has received literally thousands of video-posts of people using salvia. The objective of this study was to assess the effects of salvia use through systematic observations of YouTube videos. A sample of salvia videos was obtained using the search term "salvia." The videos were further screened and only videos that captured the entire drug "trip" without video edits were included in the analyses described here (n=34). Three trained research assistants independently watched the videos and rated their observations on 42 effects in 30-s intervals. Onset of symptoms was quick (often less than 30s) and tended to dissipate within 8min. Further, there was a relationship between salvia dose and effect duration. Since salvia's effects on humans are largely undocumented, this study provides the look at users in a non-laboratory environment (e.g. self-taped videos) exhibiting impairments and behaviors consistent with this powerful hallucinogen. Also, this study demonstrates the feasibility and shortcomings of using YouTube videos to assess emerging drugs and drug effects.

Evaluación del extracto fluido de Pluchea carolinensis (Jacq) G Don. por el método de clases de toxicidad en ratas / Evaluation of fluid extract from Pluchea carolinensis (jacq) G Don by the toxicity class method in rats

Introducción: la salvia de playa, Pluchea carolinensis (Jacq) G Don., ha sido utilizada en la medicina tradicional para eliminar fiebres, digestiones lentas, dolores de riñones, de cabeza, ronqueras. Objetivos: clasificar al extracto fluido de salvia comenzando por el nivel de dosis 2 000 mg/kg, según el método de clase de toxicidad aguda. MÉTODOS: se evaluó el extracto fluido de hojas secas de salvia de playa mediante el ensayo de las clases de toxicidad, que permite clasificar la sustancia en un rango de toxicidad. Se utilizaron 6 hembras de la sublínea Cenp:SPRD, procedentes del CENPALAB. Se les administró una dosis única de 2 000 mg/kg de peso corporal del extracto fluido de salvia de playa por vía oral, previo ayuno. El período de observación fue de 14 d, en el cual se monitorearon las condiciones ambientales diariamente, la aparición de signos de toxicidad y muerte, así como el peso corporal en los días 0, 7 y 14 del ensayo. Resultados: los animales alcanzaron 100 por ciento de supervivencia. No se observaron signos de toxicidad, tras la administración de la sustancia ensayo en la dosis máxima de 2 000 mg/kg. En la evaluación anatomopatológica no se observaron alteraciones macroscópicas en la superficie externa de los animales y en ninguna de sus cavidades, órganos y tejidos. Conclusiones: de acuerdo con el método de toxicidad de clases la sustancia no es clasificada, DL50 es mayor que 2 000 mg/kg.

Introduction: beach salvia, Pluchea carolinensis (Jacq)G Don has been used for long in traditional medicines to abate fevers, slow digestion, kidney pains, headache, and hoarseness. Objectives: to classify fluid extract from beach salvia according to the acute toxicity class method, by starting with a 2000 mg/kg dose. Methods: the fluid extract from beach salvia dry leaves was evaluated through the toxicity class test that allows classifying the substance into a range of toxicity. Six Cenp:SPRD subline female rats from CENPALAB (Center of lab animal production) were used. They were orally administered a single dose of 2000 mg of beach salvia fluid extract per kg of body weight on fasting. The observation period was 14 days to monitor daily environmental conditions, the occurrence of toxicity signs and death as well as the body weight at 0th,7th and 14th day. Results: the six rats survived. No sign of toxicity was observed after the administration of the extract at 2000 mg/kg dose. In the anatomopathological assessment, no macroscopic alterations were seen in the external surface or in the cavities, organs and tissues of the animals. Conclusions: according to this toxicity class method, the substance is not classified since LD50 is higher than 2 000 mg/kg.

Evaluación del extracto fluido de Pluchea carolinensis (Jacq) G Don. por el método de clases de toxicidad en ratas / Evaluation of fluid extract from Pluchea carolinensis (jacq) G Don by the toxicity class method in rats

Introducción: la salvia de playa, Pluchea carolinensis (Jacq) G Don., ha sido utilizada en la medicina tradicional para eliminar fiebres, digestiones lentas, dolores de riñones, de cabeza, ronqueras. Objetivos: clasificar al extracto fluido de salvia comenzando por el nivel de dosis 2 000 mg/kg, según el método de clase de toxicidad aguda. MÉTODOS: se evaluó el extracto fluido de hojas secas de salvia de playa mediante el ensayo de las clases de toxicidad, que permite clasificar la sustancia en un rango de toxicidad. Se utilizaron 6 hembras de la sublínea Cenp:SPRD, procedentes del CENPALAB. Se les administró una dosis única de 2 000 mg/kg de peso corporal del extracto fluido de salvia de playa por vía oral, previo ayuno. El período de observación fue de 14 d, en el cual se monitorearon las condiciones ambientales diariamente, la aparición de signos de toxicidad y muerte, así como el peso corporal en los días 0, 7 y 14 del ensayo. Resultados: los animales alcanzaron 100 por ciento de supervivencia. No se observaron signos de toxicidad, tras la administración de la sustancia ensayo en la dosis máxima de 2 000 mg/kg. En la evaluación anatomopatológica no se observaron alteraciones macroscópicas en la superficie externa de los animales y en ninguna de sus cavidades, órganos y tejidos. Conclusiones: de acuerdo con el método de toxicidad de clases la sustancia no es clasificada, DL50 es mayor que 2 000 mg/kg(AU)

Introduction: beach salvia, Pluchea carolinensis (Jacq)G Don has been used for long in traditional medicines to abate fevers, slow digestion, kidney pains, headache, and hoarseness. Objectives: to classify fluid extract from beach salvia according to the acute toxicity class method, by starting with a 2000 mg/kg dose. Methods: the fluid extract from beach salvia dry leaves was evaluated through the toxicity class test that allows classifying the substance into a range of toxicity. Six Cenp:SPRD subline female rats from CENPALAB (Center of lab animal production) were used. They were orally administered a single dose of 2000 mg of beach salvia fluid extract per kg of body weight on fasting. The observation period was 14 days to monitor daily environmental conditions, the occurrence of toxicity signs and death as well as the body weight at 0th,7th and 14th day. Results: the six rats survived. No sign of toxicity was observed after the administration of the extract at 2000 mg/kg dose. In the anatomopathological assessment, no macroscopic alterations were seen in the external surface or in the cavities, organs and tissues of the animals. Conclusions: according to this toxicity class method, the substance is not classified since LD50 is higher than 2 000 mg/kg(AU)

Compound Salvia droplet pill, a traditional Chinese medicine, for the treatment of unstable angina pectoris: a systematic review.

Compound Salvia droplet pill (CSDP) has been frequently used for patients with angina pectoris in China. However, the efficacy and safety of CSDP for unstable angina pectoris (UA) have not been systematically evaluated. The aim was to assess the efficacy and safety of CSDP for UA and provide information for current practice or future research. An extensive search was performed in Jan 2007 which included MEDLINE, EMBASE, Chinese Biomedical Database (CBM), and the Cochrane Center Controlled Trials Register. Randomized controlled trials (RCTs) about CSDP for UA were included irrespective of language. The main comparisons was CSDP plus current western drugs compared with western drugs alone. The quality of each trial was assessed according to criteria from the Cochrane Reviewers' Handbook. Statistical software (RevMan 4.2) provided by the Cochrane Collaboration was applied. Seventeen RCTs were included in this review. The quality of the trials was low. Statistical analysis of the results showed that CSDP plus western routine drugs compared with routine drugs alone had significant effect on relieving angina symptoms (P<0.00001, pooled RR=1.23, 95%CI: 1.16-1.30) and improving ECG (P<0.00001, pooled RR=1.34, 95%CI: 1.23-1.46). Some trials' data suggest that CSDP can also improve hemorheology and blood lipid level. CSDP had a significant effect for treatment of UA with few adverse events. However, the evidence is not reliable enough because of the low quality of the methodology of the included trials. To produce good evidence, high-quality clinical trials are needed.

Adolescent salvia substance abuse.

BACKGROUND: Salvia divinorum is a non-water-soluble hallucinogen that is becoming increasingly popular among adolescents. Salvia is a highly selective full agonist of primate and cloned human cerebral kappa-opioid receptors, although its psychotomimetic effects are similar to serotonergic agonists and NMDA glutamate antagonists. Salvia has been associated with depersonalization, laughter, feelings of levitation and self-consciousness. These effects resolve within 30 minutes following use. Salvia has been banned in many countries, although it remains legal and easily assessable over the internet in the United States. CASE DESCRIPTION: A 15-year-old man with a history of salvia and marijuana use presented to psychiatric emergency services with acute onset of mental status changes characterized by paranoia, déjà vu, blunted affect, thought blocking and slow speech of 3 days' duration. CONCLUSION: There is limited literature discussing the clinical effects of salvia use. Based on this case presentation, salvia use may be associated with many undocumented long-term effects such as déjà vu. The ease of use and increasing popularity of salvia requires further investigation into the clinical effects of salvia use.

Psychopharmacology of the hallucinogenic sage Salvia divinorum.

At present, the Mexican mint Salvia divinorum is an unregulated hallucinogen. This has resulted in various on-line botanical companies advertising and selling S. divinorum as a legal alternative to other regulated plant hallucinogens. It is predictable that its misuse will increase rapidly. The active ingredient in S. divinorum is the neoclerodane diterpene, salvinorin A (1a), which has been shown to be a kappa agonist both in vitro and in vivo. This review will cover the current state of research into the psychopharmacology of S. divinorum.

Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial.

S. lavandulaefolia Vahl. (Spanish sage) extracts and constituents have demonstrated anticholinesterase, antioxidant, anti-inflammatory, oestrogenic and CNS depressant (sedative) effects all of which are currently relevant to the treatment of Alzheimer's disease (AD). The essential oil inhibits the enzyme acetylcholinesterase (AChE) from human brain tissue and bovine erythrocyte and individual monoterpenoid constituents inhibit AChE with varying degrees of potency. In vivo AChE inhibition of select brain (striatal and hippocampal over cortical) AChE was obtained following oral administration of the essential oil to rats. In a study in healthy volunteers essential oil administration produced significant effects on cognition. In a pilot open-label study involving oral administration of the essential oil to patients with AD, a significant increase in diastolic and systolic blood pressure was observed in two patients, however this may have been due primarily to preexisting hypertension and there were no abnormalities in other vital signs or blood samples during the trial period. Although an open label trial is not free from practice effects or rater-caregiver expectations, statistically significant differences between baseline and 6 weeks treatment were a reduction in neuropsychiatric symptoms and an improvement in attention.