Intoxication phencyclidine

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Aronow, R. Micelli, J.N. and Done, A.K. Clinical observations during phencyclidine intoxication and treatment based on iontrapping. In Peterson, R.C. and Stillman, R.C., eds. 

Castel1ani, S. Adams, P.M. and Giannini, A.J. Physostigmine treatment of acute phencyclidine intoxication. J Clin Psychiatry 43 10-11, 1982. 

Baxley, R.C. Voluntary intoxication from phencyclidine Will it raise a reasonable doubt of the mental capacity of a person charged with a crime requiring specific intent or mental state il Psychedelic Drugs 12 (3-4) 330-335, 1980. 

McCarron, M.M. Schulze, B.W. Thompson, G.A. Conder, M.C. and Goetz, W.A. Acute phencyclidine intoxication Incidence of clinical findings in 1,000 cases. Ann Emerg Med 10 237-242, 1981a. 

Phencyclidine (PCP) abuse remains a serious public health problem in large urban areas of the United States, with recent trends suggesting increased use after a period of decline (Crider, this volume). Most clinical and research attention has focused on the psychiatric and medical manifestations of acute or subacute PCP intoxication, especially the organic mental disorders (toxic delirium, psychosis, or depression) that PCP can induce (McCarron et al. 1981 McCarron, this volume Sioris and Krenzelok 1978). 

Sioris, L.J.,and Krenzelok, E.P. Phencyclidine intoxication A literature review. Am J Hasp Pharm 35 1362-1367, 1978. 

It is not uncommon for individuals under the influence of phencyclidine to come to the attention of the criminal justice system. Increasingly, there is a need for forensic experts to advise and testify in cases involving PCP and other psychoactive drugs. With the publication of a paper on acute intoxication and fatalities from PCP use, we began to receive requests from attorneys to evaluate PCP-related cases (Burns et al. 1975). We have now consulted in over 400 civil and criminal cases and have testified in municipal, superior, and Federal courts from Hawaii to Washington, D.C. 

Bailey, D. N. (1979) Phencyclidine abuse. Clinical findings and concentrations in biological fluids after nonfatal intoxication. Am. J. Clin. Pathol., 72 795-799. 

Pearce, D. S. (1976) Detection and quantitation of phencyclidine in blood by use of [JH5] phencyclidine and select ion monitoring applied to non-fatal cases of phencyclidine intoxication. Clin. Chem., 22 1623-1626. 

Acute phencyclidine intoxication can proceed through stages from stupor to coma with unresponsiveness to pain. Delirium lasting several days is common during recovery from coma and may occur transiently as the final phase of an episode of intoxication (Gorelick Balster, 1995). Ketamine has similar effects when abused recreationally. When used as an anaesthetic in adults, it... 

Lerner, S.E., and Burns, R.S. Phencyclidine use among youth History, epidemiology, and acute and chronic intoxication. In Petersen, R.C., and Stillman, R.C., editors. Phencyclidine (PCP) Abuse An Appraisal. National Institute on Drug Abuse, Rockville, Md. NIDA Research Monograph 21, 1978, p. 66-118. 

Finally, some patients may die before hospitalization because the behavioral effects of the ingested drug may result in traumatic injury. Intoxication with alcohol and other sedative-hypnotic drugs is a common contributing factor to motor vehicle accidents. Patients under the influence of hallucinogens such as phencyclidine (PCP) or lysergic acid diethylamide (LSD) may suffer trauma when they become combative or fall from a height. 

Previously popular but of unproved value, forced diuresis may cause volume overload and electrolyte abnormalities and is not recommended. Renal elimination of a few toxins can be enhanced by alteration of urinary pH. For example, urinary alkalinization is useful in cases of salicylate overdose. Acidification may increase the urine concentration of drugs such as phencyclidine and amphetamines but is not advised because it may worsen renal complications from rhabdomyolysis, which often accompanies the intoxication. 

Both indoleamine (e.g., lysergic acid diethylamide, LSD psilocybin) and phenethylamine hallucinogens (e.g., mescaline) increased pupil diameter.26 There have been no systematic studies of the effects of these drugs on dynamic measures of the light reflex. Phencyclidine (PCP) does not cause marked changes in pupil size or light reflex. However, subjects intoxicated with PCP often show horizontal and vertical nystagmus.26... 

Perry, Paul. Phencyclidine Intoxication. Updated January 27, 2000. University of Iowa Health Care Virtual Hospital. [Cited February 27, 2002]. . 

Psychiatric uses of benzodiazepines other than treatment of anxiety states include the initial management of mania, the control of drug-induced hyperexcitability states (eg, phencyclidine intoxication), and possibly the treatment of major depressive disorders with alprazolam. Sedative-hypnotics are also used occasionally as diagnostic aids in neurology and psychiatry. 

For decades researchers have looked at whether intoxication with certain drugs could mimic the signs and symptoms of schizophrenia. Amphetamines increase dopamine release and can induce some positive symptoms like paranoia. Lysergic acid diethylamide (LSD) affects 5-HT receptors but tends to induce visual perception changes and not frank hallucinations. Phencyclidine (PCP), however, induces a state in healthy controls that seems very similar to schizophrenia. This includes thought disorder and negative symptoms... 

There have been two further reports of sudden death after the use of droperidol to sedate agitation secondary to cocaine and phencyclidine intoxication (26). Both patients were restrained by the police and were then given droperidol, either 5 mg (a 33-year-old obese man) or 10 mg (a 22-year-old man). The first patient stopped breathing 10-15 minutes later, while being transported to the emergency department he was pulseless and couldn t be resuscitated. The other patient was unresponsive on arrival at the emergency department, with agonal respirations and no detectable pulse after 30 minutes of resusci-tative efforts he was pronounced dead. 

Among 107 consecutive patients with phencyclidine intoxication, the diagnosis was confirmed by positive urine assay in 27 (6). The most common abnormalities were mental/behavioral (89%) and nystagmus (85%). There were also increases in blood pressure, temperature, and heart rate. The most common serious medical complication requiring hospitalization was rhabdomyolysis, which occurred in three patients, two of whom developed acute renal insufficiency. 

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