The phenomenon of acute behavioural disturbance (ABD) (also known as acute behavioural disorder or excited delirium) is an underrecognised and potentially life-threatening syndrome, and an emergency in psychiatric settings. Causes are discussed and the pathophysiology explained. The challenges faced by practitioners are highlighted, including how ‘standard’ control and restraint can exacerbate symptoms. Initial treatment strategies are suggested.

New psychoactive substances (NPS) or ‘legal highs’ are defined as unregulated psychoactive substances including synthetic and/or plant derived substances (marketed as research chemicals, party pills and herbal highs) that are intended to mimic the effects of controlled drugs. Psychiatric services around the country are seeing a rise in the use of NPS complicating mental health presentations. The challenge surrounding these substances is the fact that they are not under the international drug control system and are proving to have a detrimental health effect on users. This article reviews the current literature on this subject and discusses some of the most common examples of NPS and their potential effects on mental health.

‘Whack’ is a new psychoactive substance available until recently in ‘head shops’. It contains two active constituents, 4-fluorotropacocaine and desoxypipradrol. We present two case reports of subjects who developed acute psychotic states after using Whack. Both individuals displayed similar affective and anxiety symptoms in the presence of significant psychotic symptoms. Both required inpatient treatment but displayed a good treatment response to atypical antipsychotic agents. To our knowledge, this is the first published case series relating to this psychoactive substance.