0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

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TABLE 16.4. Characteristics of Hallucinogens

DURATION OF

DRUG ACTION(HOURS)CLINICALFEATURES COMPLICATIONS TREATMENT

MDMA(3,4-methylenedioxy- 8-24 Mydriasis, sympathomimetic Hypertension, hyper- IV fluids, cooling,

N-methylamphetamine symptoms, euphoria, thermia, rhabdomyolysis, supportive care,

nausea, dry mouth, ataxia, dehydration benzodiazepines

musclespasm Excessive water drinking

and hyponatremia

Seizures

LSD (derived from 8–12 Mydriasis, sympathomimetic Persistent psychosis, Supportive care,

fungusClaviceps symptoms, muscle spasm “flashbacks” or benzodiazepines

purpurea) hallucinogen

persisting perception

disorder

Psilocybin(derived 4–6 Mydriasis, sympathomimetic Seizures (rare), Supportive care,

from mushrooms of symptoms, nausea hyperthermia (rare) benzodiazepines

Psilocybegenus)

Mescaline(a phenyl- 6–12 Mydriasis, sympathomimetic Rare Supportive care,

ethylamine found in symptoms, abdominal benzodiazepines

Mexican peyote cactus) pain, vomiting, dizziness

Marijuana 2–4 Tachycardia, conjunctival Rare Supportive care,

injection, impaired motor benzodiazepines

coordination

(Adapted, with permission, from Tintinalli JE, Kelen, GD, Stapczynski SJ. Emergency Medicine: A Comprehensive Study Guide, 6th ed.

New York: McGraw-Hill, 2004:1080.)

Sedative/Hypnotics/Anxiolytics

Includes benzodiazepines, benzodiazepine-like drugs, barbiturates, and

barbiturate-like drugs, carbamates

SYMPTOMS/EXAM

Inappropriate behavior, mood lability, slow, slurred speech, unsteady gait,

incoordination, nystagmus, impairment in attention/memory, stupor, coma;

can also see bradycardia, bradypnea, hypotension

DIFFERENTIAL

Alcohol intoxication, CVA, head trauma, opioid intoxication, hypoglycemia,

hypoxia

DIAGNOSIS

Clinical diagnosis; urine and blood toxicology can be positive for up to a week

with long-acting substances and chronic use

TREATMENT

■ Supportive care

■ ABCs; consider need for airway protection.