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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.
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