Overview
Stimulant Intoxication is a type of stimulant-related disorder, characterized by significant behavioral and psychological changes following the ingestion of a stimulant substance, such as amphetamine-type substances, cocaine, or other stimulants. Individuals are likely to experience an initial “high” illustrated by feelings of euphoria, hyperactivity, restlessness, talkativeness, anxiety, and more.
Physical changes such as abnormal heart rate, dilated pupils, and abnormal blood pressure are also likely to exist. Individuals may also experience auditory hallucinations (hearing things when no sounds have been made) as well as paranoia. In severe cases, intoxication can cause seizures, cardiac problems, excessively high fevers (106°C and above) as well as death.
A varying demographic is associated with stimulant intoxication. Patients are typically treated in emergency settings, and the means of management, including medication, is dependent greatly on the exhibited symptomatology and underlying comorbidities. Long-term treatment after acute intoxication is usually required.
Signs and Symptoms
The signs and symptoms of stimulant intoxication follow the use of a type of stimulant, and may include:
- Behavioral changes such as hyper-vigilance, restlessness, talkativeness, and stereotyped behaviors
- Psychological changes such as euphoria, sensitivity, anxiety, tension, anger, and impaired judgment
- Abnormally slow or fast heart rate (bradycardia or tachycardia)
- Dilated pupils
- Elevated or lowered blood pressure
- Chills or sweating
- Nausea or vomiting
- Weight loss
- Slowed down or agitated movement
- Muscle weakness
- Shallow breath
- Chest pain
- Confusion
- Seizures
- Involuntary or uncontrollable muscle movements
- Abnormal posture
- Coma
Risk Factors
Stimulant use largely occurs illicitly, with a wide range of stimulant drugs being used for purposes other than pharmaceutical ones. Stimulants may be prescribed as pharmaceutical treatment for various psychiatric or physical disorders, such as Ritalin and Adderall for ADHD.
However, the use of stimulants including cocaine, methamphetamines, synthetic cathinones, and 3, 4-Methylenedioxymethamphetamine (MDMA, also known commonly as ecstasy) is rampant among various demographics. The specific stimulant used, its quantity, quality, and the duration of its use have a direct impact on intoxication.
Individuals may engage in stimulant use in order to experience the “high” that comes with intoxication, as well as other properties that may seem appealing, such as appetite suppression. It is possible for commercially sold weight loss products to contain stimulants, thus leading to consumers ingesting stimulants without awareness.
Alternatively, individuals may engage in stimulant use in order to improve sexual desire and performance, though long-term stimulant use has been associated with sexual dysfunction, particularly in men. Further, stimulants may also be used in an attempt to enhance cognitive capacities in order to improve academic performance: however, there is no evidence of stimulants increasing academic achievement, and their effects have instead been linked to worsening of anxiety and insomnia. Stimulant intoxication has also been associated with excess alcohol consumption.
In cases where children have parents or caregivers that use stimulant substances, there is a higher likelihood of them accidentally ingesting the stimulants. Individuals may also manufacture methamphetamines in their house, and children living in these houses are at high risk for poisoning, burn, and inhalation injury. In case of accidental intoxication, children may present with symptoms such as crying, increased heart rate, and restlessness, which may make it difficult for the clinician to detect stimulant intoxication.
Diagnosis
Emergency rooms in hospitals are likely to receive patients with acute intoxication. These individuals may exhibit symptoms mentioned above, and also have a higher likelihood of being violent. Determining the exact cause of symptoms can be particularly challenging as similar symptoms may be observed across intoxication due to various stimulants, as well as due to alcohol withdrawal, infection, seizures, brain injury, and more. Individuals themselves may not be in a state to corroborate a history that can lead to better diagnosis.
Various tests including toxicology screens, gas chromatography and mass spectrometry testing may be carried out, though there are chances of receiving false positives on these tests. Vital signs and glucose tests are considered to be first priority, and then a range of labs including liver function, pregnancy, urine, and serum toxicology tests may be carried out. Electrocardiograms are recommended when stimulant use is suspected.
The DSM-5 provides the following criteria for the diagnosis of Stimulant Intoxication:
- Recent use of an amphetamine-type substance, cocaine, or other stimulant.
- Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting: changes in sociability: hyper-vigilance: interpersonal sensitivity: anxiety, tension, or anger; stereotyped behaviors: impaired judgment) that developed during, or shortly after, use of a stimulant.
- Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use:
- Tachycardia or bradycardia.
- Pupillary dilation.
- Elevated or lowered blood pressure.
- Perspiration or chills.
- Nausea or vomiting.
- Evidence of weight loss.
- Psychomotor agitation or retardation.
- Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias.
- Confusion, seizures, dyskinesias, dystonias, or coma.
The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.
Within the diagnosis, the specific intoxicant as well as whether or not the individual experienced perceptual disturbances is specified.
Treatment
The management of Stimulant Intoxication is dependent on many factors, which may be assessed initially in emergency settings. Observing exhibited symptoms as well, conducting physiological tests and running laboratory tests can help determine emergency treatment. Stimulant intoxication can have a significant impact on heart, kidney and brain organ systems, and thus the examination and stabilization of these systems may be prioritized first.
The use of medication in emergency treatment is determined largely by the experienced symptoms. Benzodiazepines may be used for complaints of chest pain. The use of cocaine may increase risk of cardiac issues as well as neurological abnormalities, including stroke. The use of ethanol has been reported to increase the absorption of cocaine, and must be avoided.
In cases where patients experience increasingly high body temperature, there may be a necessity of external cooling combined with calming physical activity of the patient. In cases of methamphetamine and synthetic cathinone use, patients may exhibit high levels of paranoia and be agitated, which can be challenging for clinicians.
In such cases, along with providing external support, higher doses of benzodiazepines may be administered to control agitation. Haloperidol may be used if the patient has normal body temperature and normal vitals.
While emergency response is the most important in terms of Stimulant Intoxication, management of the disorder does not end with acute treatment. Patients must be referred to appropriate specialists who can assess their condition, and further provide adequate intervention strategies. Individuals who have been indulging in chronic stimulant use may be diagnosed with Stimulant Use Disorder.
Other comorbidities must be assessed as well. Various intervention modalities, including behavioral intervention such as Contingency Programs, Cognitive Behavioral Therapy, and Community Reinforcement may be recommended. Pharmacotherapy may be provided in case symptoms are severe, with help of medication such as antidepressants and anticonvulsants.
Specialist
Emergency medicine doctors are involved in the initial examination and stabilization of individuals exhibiting symptoms of intoxication due to stimulant use. Upon dealing with the initial threat posed by the use of these substances, patients may be referred to psychiatrists, or clinical psychologists for further treatment.
In Conclusion
There are physical, psychological, and social implications of Stimulant Intoxication. People who use stimulants experience rapid weight loss, cardiovascular effects like an increase in heart rate, respiration, and blood pressure, emotional or mental side effects like paranoia, anxiety, and aggression, as well as a change in the survival pathway in our brains known as the reward/reinforcement pathway.
Thus, it is important for family, friends, and relatives to consult an expert and start counseling to help the patient get over this addiction.
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