5-151
Similarly, indigenous people and host nation personnel may present for care with signs and symptoms of
withdrawal or intoxication.
Procedures
Essential: Supportive measures, IV hydration
Recommended: Monitoring (Vitals at a minimum) (see Table 5-9)
Mood Disorders: See Symptom: Depression
Mental Health: Psychosis versus Delirium
MAJ Michael Doyle, MC, USAIntroduction: Delirium represents a disturbance in consciousness accompanied by a change in cognitive
function that develops acutely. Someone who is delirious has impairments in awareness, alertness, memory
and executive functioning (i.e., difficulty buttoning a shirt) and may be hallucinating. Psychosis is not a specific
disorder, but rather describes a degree of severity in certain mental disorders. Someone with psychosis or a
psychotic disorder has gross or obvious impairment in perceiving reality. The individual misperceives external
cues and responds often to internal stimuli. He appears cognitively impaired, behaviorally disturbed, or
both. Psychotic disorders are generally not amenable to treatment in a theater of operations. The most
important consideration here is distinguishing psychosis (which is largely idiopathic) from delirium (which is a
manifestation of a life-threatening medical condition that may be reversible). Always maintain a high index
of suspicion for a physical or CNS injury!
Intoxication T P R BP Motor Eyes Complaints Mental Status
↑ ↑↑ ↑ ↑↑ fine tremor, ↓visual N/V, fatigue, agitated, irritable,
restless, acuity anxiety, insomnia hallucinations and
Benzo- seizure delusions, illusions,
diazepine confusion, seizures
24-48 hours Rx: Treat those with autonomic evidence of withdrawal (↑ pulse, temp, BP or visible tremors) with Valium
after last 5-10 mg po 3-4 times a day on the first day of withdrawal. Do not give a dose once the patient begins
dose to feel groggy or sleepy. Continue to assess and monitor vitals and treat on days 2 and 3 if T, P,
BP are still elevated.
↑ ↑↑ ↑ ↑↑ fine tremor, ↓visual N/V, fatigue, agitated, irritable,
Barbiturate restless, acuity anxiety, insomnia hallucinations and
onset at 24 delusions, illusions,
hours, may confusion, seizures
last up to 14 Rx: Give phenobarbital 120 mg po every 1 to 2 hours until 3 of the following 5 signs are present:
daus 1) nystagmus, 2) drowsiness, 3) ataxia, 4) slurred speech, and 5) emotional lability. Then give no more.
Phenobarbital has a long half-life and will self-taper.
↑ ↑↑ ↑ ↑↑ restless mydriasis, drug craving, anxious, sad, irritable,
twitching and bone, back & muscle with yawning,
Opiates kicking, pain, isnomnia, N/V rhinorrhea,
Symptoms the habit" and darrhea lacrimation,
peak at 48 "gooseflesh" ("cold
hours turkey")
Rx: Not life-threatening, only uncomfortable. Treat with Motrin 800 mg po tid and clonidine 0.1-0.3 mg po
tid or qid, not to exceed more than 1 mg total dose/day. Follow for signs of hypotension after each
dose/day.