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Paper text:
the aim of this study is to describe the use of electroconvulsive therapy ( ect ) in the treatment of methamphetamine - induced withdrawal delirium and craving in a single case .
a 44-year - old male presented to the hospital in fars province , iran , with methamphetamine - induced withdrawal delirium who responded to ect .
the electroconvulsive therapy can be a suitable option for the treatment of methamphetamine withdrawal delirium and craving .
also , it can be usefully employed in these very serious conditions which may represent a risk to life .
we describe a patient with methamphetamine - induced delirium and craving which responded to electroconvulsive therapy ( ect ) .
methamphetamine abuse was a minor problem in iran ( 1 , 2 ) until the last couple of years .
recently , there has been a marked increase in the use of methamphetamine , especially among the young , with an increase in methamphetamine related psychiatric presentations to hospitals .
formerly , methamphetamine was illegally smuggled in from the abroad , but it is now synthesized in iran in  underground laboratories .
the methamphetamine synthesized in iran is of higher potency and is commonly associated with psychosis .
a 44-year - old male employee presented to the hospital in fars province , iran , with decreased level of consciousness .
the patient had no personal or family history of medical problems , and no history of head trauma .
the patient began occasional smoking of opium 14 years prior to admission , which increased to daily smoking for the decade leading up to admission .
he had a distant history of occasional use of alcohol ; however , he stopped using it eight years prior to admission .
moreover , the patient had smoked heroine for six years prior to admission ; however , there was no history of cannabis or cocaine use in the past .
eight months prior to admission , the patient commenced smoking methamphetamine , twice weekly , which then increased to daily use in the two months leading up to admission . from the time he commenced daily smoking of methamphetamine , the patient developed persecutory delusions , believing he was being followed by an agent from .
he also experienced persecutory delusions regarding his neighbors and had a visual hallucination of a man on his roof .
in short , when he was brought to hospital by his wife , he had been smoking heroine for six years and methamphetamine daily for two months .
drug screening was positive for methamphetamine and morphine ( consistent with opium and heroin use ) and negative for cannabis , ecstasy , methadone , buprenorphine , benzodiazepine and alcohol .
the patient had taken methamphetamine on the morning of admission . by that evening his level of consciousness was reduced and he was drowsy .
he was given buprenorphine 2 mg sublingually twice daily , to reduce opioid withdrawal , and closely monitored .
on the second day of admission his drowsiness had increased and it was difficult to arouse him to answer questions .
his condition was further deteriorated and could not speak or take food . on the fourth day of admission ,
the patient was considered to be in mortal danger and he was given emergency ect using a thymatron tm ( system iv , company ind , usa ) .
the electrodes were applied bilaterally , he was administered two seizures during the same anesthetic multiple monitored ect .
fourteen hours later he was alert and orientated , although still with some psychotic thinking and hallucinations .
five hours later the patient was alert and orientated in time , place and person , and free of psychotic features .
single ect was administered on 9th , 11th and 13th days and he was discharged on the 14th day .
he received further single ect on the 16th and 18th days ( as an out - patient ) and remained well . within a week or so
, however , he again began to smoke amphetamine and was soon psychotic as before , with hallucinations and delusions .
multiple monitored ect was again administered , and some hours later , he showed partial improvement .
he was administered double ect on two further occasions over the next 5 days and was discharged free of psychiatric symptoms .
this case illustrates that ect may be beneficial in treating methamphetamine - induced psychosis and methamphetamine withdrawal delirium . its use in these conditions
, a systematic prospective trial of ect in delirium is yet to be published , and this report is an important addition to the literature .
it is of interest that mmect continues to be used with good effect in leading centers in iran .
introduction : the aim of this study is to describe the use of electroconvulsive therapy ( ect ) in the treatment of methamphetamine - induced withdrawal delirium and craving in a single case.case presentation : a 44-year - old male presented to the hospital in fars province , iran , with methamphetamine - induced withdrawal delirium who responded to ect.conclusions:the electroconvulsive therapy can be a suitable option for the treatment of methamphetamine withdrawal delirium and craving . 
 also , it can be usefully employed in these very serious conditions which may represent a risk to life .