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Emergency Room Evaluation of Cocaine-Associated Neuropsychiatric Disorders

  • Ricardo Mendoza
  • Bruce L. Miller
  • Ismael Mena
Part of the Recent Developments in Alcoholism book series (RDIA, volume 10)

Abstract

The widespread abuse of cocaine has produced an alarming number of cocaine-related emergency room visits in the last several years. The authors discuss the various issues involved in emergency rom evaluation of patients who abuse cocaine and manifest signs and symptoms suggesting neuropsychiatric disease. Appropriate triage is emphasized, and a discussion of impediments to the accurate assessment of these patients ensues. The unique features of cocaine-induced mood, psychotic, and organic disorders are then detailed and contrasted with other functional and organic disorders. Strategies for the emergency room treatment of patients exhibiting symptomatology consistent with cocaine intoxication and withdrawal are outlined. The issues of psychiatric comorbidity and dual diagnosis in the cocaine-abusing population are examined. In addition, the neurological complications associated with the use of cocaine are reviewed. Finally, emerging data from single photon emission computerized tomography (SPECT) analysis of cocaine abusers is reported.

Keywords

Single Photon Emission Computerize Tomography Cocaine Abuse Delusional Disorder Cocaine Craving Intravenous Cocaine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    US Department of Health and Human Services news release, Aug 31, 1990.Google Scholar
  2. 2.
    Johanson CE, Fischman M: The pharmacology of cocaine related to its abuse. Pharmacol Rev 41:1:3–52, 1989.PubMedGoogle Scholar
  3. 3.
    Pitts DK, Marwah J: Cocaine and central monoaminergic neurotransmission: a review of electro-physiological studies and comparison to amphetamine and antidepressants. Life Sci 42:949–968, 1988.PubMedCrossRefGoogle Scholar
  4. 4.
    Pitts DK, Marwah J: Autonomic effects of cocaine. Can J Physiol Pharmacol 67:1167–1176, 1989.CrossRefGoogle Scholar
  5. 5.
    Bozarth M: New perspectives on cocaine addiction: recent findings from animal research. Can J Physiol Pharmacol 67:1158–1167, 1988.CrossRefGoogle Scholar
  6. 6.
    Verebey K, Gold MS: From coca leaves to crack: the effects of dose and routes of administration in abuse liability. Psychiatry Ann 18:9:513–520, 1988.Google Scholar
  7. 7.
    Sherer M: Intravenous cocaine: psychiatric effects, biological mechanisms. Biol Psychiatry 24:865–885, 1988.PubMedCrossRefGoogle Scholar
  8. 8.
    Post RM: Cocaine psychoses: a continuum model. Am J Psychiatry 132:3:225–231, 1975.PubMedGoogle Scholar
  9. 9.
    Foltz RL, Fentiman AF Jr, Foltz RB: Cocaine and its major metabolite, benzoylecgonine, in Foltz RL, Fentiman, AF, Foltz RB (eds): GC/MS Assays for Abused Drugs and Body Fluids. NIDA Research Monograph Series, Vol 32. NIDA. Rockville, Maryland, 1980, pp 90-109.Google Scholar
  10. 10.
    Hamilton HE, Wallace JE, Shimek EL, et al.: Cocaine and benzoylecgonine excretion in humans. J Forensic Sci 22:4:697–706, 1977.PubMedGoogle Scholar
  11. 11.
    Sherer MA, Kumor KM, Cone EJ, et al.: Suspiciousness induced by four-hour intravenous infusions of cocaine. Arch Gen Psychiatry 45:673–677, 1988.PubMedCrossRefGoogle Scholar
  12. 12.
    Gawin FH, Ellinwood EH Jr: Cocaine and other stimulants: actions, abuse and treatment. N Engl J Med 318:18:1173–1182, 1988.PubMedCrossRefGoogle Scholar
  13. 13.
    Gawin FH, Kleber HD: Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Arch Gen Psychiatry 43:107–113, 1986.PubMedCrossRefGoogle Scholar
  14. 14.
    Post RM, Kopanda RT: Cocaine, kindling, and psychosis. Am J Psychiatry 133:6:627–634, 1976.PubMedGoogle Scholar
  15. 15.
    Post RM, Weiss SRB: Psychomotor stimulant vs. local anesthetic effects of cocaine: role of behavioral sensitization and kindling, in Clouet D, Asghar K, Brown R (eds): Mechanisms of Cocaine Abuse and Toxicity. NIDA Research Monograph Series, Vol 88. NIDA. Rockville, Maryland, 1988, pp 217–238.Google Scholar
  16. 16.
    Cummings JL: Epilepsy: Ictal and interictal behavioral alterations, in Clinical Neuropsychiatry. Orlando, FL, Grime & Stratton, 1985, pp 95-116.Google Scholar
  17. 17.
    Siegel RK: Cocaine hallucinations. Am J Psychiatry 135:3:309–314, 1978.PubMedGoogle Scholar
  18. 18.
    Johnson GC, Anton RF: Delusions of parasitosis: diagnosis and treatment. South Med J 78:8:914–918, 1985.PubMedCrossRefGoogle Scholar
  19. 19.
    Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised. Washington, DC, American Psychiatric Association, 1987.Google Scholar
  20. 20.
    Mody C, Miller B, Mclntyre, H, et al.: Neurologic complications of cocaine abuse. Neurology 37(Suppl):1:193,1987.Google Scholar
  21. 21.
    Weiss RD, Mirin SM, Griffin ML, et al.: Psychopathology in cocaine abusers changing trends. J Nerv Ment Dis 176:12:719–725, 1988.PubMedCrossRefGoogle Scholar
  22. 22.
    Rounsaville BJ, Anton SF, Carroll K, et al.: Psychiatric diagnoses of treatment-seeking cocaine abusers. Arch Gen Psychiatry 48:43–51, 1991.PubMedCrossRefGoogle Scholar
  23. 23.
    Brady K, Anton R, Ballenger JC, et al.: Cocaine abuse among schizophrenic patients. Am J Psychiatry 147(9):1164-U67,1990.Google Scholar
  24. 24.
    Caton CL, Gralnick A, Bender S, et al.: Young chronic patients and substance abuse. Hosp Community Psychiatry 40(10):1037–1040, 1989.PubMedGoogle Scholar
  25. 25.
    Drake RE, Wallach MA: Substance abuse among the chronic mentally ill. Hosp Community Psychiatry 40(10):1041–1046, 1989.PubMedGoogle Scholar
  26. 26.
    Khantzian EJ, Mckenna GJ: Acute toxic and withdrawal reactions associated with drug use and abuse. Ann Intern Med 90:361–372, 1979.PubMedCrossRefGoogle Scholar
  27. 27.
    Francis AJ, Hales RE: Drub abuse and drug dependence, in APA Annual Review, Vol 5, Section II. Washington DC, APA Press, 1986.Google Scholar
  28. 28.
    Pradhan SC, Dutta SN: Drug Abuse: Clinical and Basic Aspects. St. Louis, CV Mosby, 1977.Google Scholar
  29. 29.
    Wetli CV, Fishbain DA: Cocaine-induced psychosis and sudden death in recreational cocaine users. J Forensic Sci 30(3):873–879, 1985.PubMedGoogle Scholar
  30. 30.
    Gay GR: Clinical management of acute and chronic cocaine poisoning. Ann Emerg Med 11(10):76–86,1982.CrossRefGoogle Scholar
  31. 31.
    Witkin JM, Goldberg SR, Katz JL, et al.: Modulation of the lethal effects of cocaine by cholinomimetics. Life Sci 45:2295–2301, 1989.PubMedCrossRefGoogle Scholar
  32. 32.
    McCarron MM, Schulze BW, Thompson GA, et al.: Acute phencyclidine intoxication: clinical patterns, complications, and treatment. Ann Emerg Med 10:6:290–297, 1981.PubMedCrossRefGoogle Scholar
  33. 33.
    Dubin WR: Rapid tranquilization: antipsychotics or benzodiazepines? J Clin Psychiatry 49(Suppl):5–11, 1988.PubMedGoogle Scholar
  34. 34.
    Mendoza R, Djenderedjian AH, Adams J, et al.: Midazolam acute psychotic patients with hyperarousal. J Clin Psychiatry 48:291–292, 1987.PubMedGoogle Scholar
  35. 35.
    Kosten TR, Kleber HD: Sudden death in cocaine abusers: relation to neuroleptic malignant syndrome. Lancet 1:1198–1199, 1987.PubMedCrossRefGoogle Scholar
  36. 36.
    Vaughan AD: Frontiers in pharmacologie treatment of alcohol, cocaine, and nicotine dependence. Psychiatr Ann 20(12):695–710, 1990.Google Scholar
  37. 37.
    Gawin FH, Kleber HD, Byck R, et al.: Desipramine facilitation of initial cocaine abstinence. Arch Gen Psychiatry 46:117–121, 1989.PubMedCrossRefGoogle Scholar
  38. 38.
    Levine SR, Brust JCM, Futtrell N, et al.: Cerebrovascular complications of the use of the “crack” form of alkaloidal cocaine. N Engl J Med 323:1699–1704, 1990.Google Scholar
  39. 39.
    Mody CK, Miller BL, Mclntyre HB, et al.: Neurological complications of cocaine abuse. Neurology 38:1189–1193, 1988.PubMedCrossRefGoogle Scholar
  40. 40.
    Catravas JD, Waters IW: Acute cocaine intoxication in the conscious dog: studies on the mechanisms of lethality. J Pharmacol Exp Ther 217:350–356, 1981.PubMedGoogle Scholar
  41. 41.
    Root RK, Rowbotham M: Neurologic aspects of cocaine abuse. West J Med 149:442–448, 1988.Google Scholar
  42. 42.
    Jacobs IG, Roszler MH, Kelly JK, et al.: Cocaine abuse: neurovascular complications. Radiology 170:223–227, 1989.PubMedGoogle Scholar
  43. 43.
    Grewal RJ, Mody CK, Mclntyre HB, Daly J: Mixed apnea as a long-term complication of lateral medullary syndrome. Bull Clin Neurosci 53:148–152, 1988.Google Scholar
  44. 44.
    Krendel DA, Ditter SM, Frankel MR, et al.: Biopsy-proven cerebral vasculitis associated with cocaine abuse. Neurology 40:1092–1094, 1990.PubMedCrossRefGoogle Scholar
  45. 45.
    Johnson RT, Richardson EP: The neurological manifestations of systemic lupus erythematosus. Medicine 47:337, 1968.PubMedCrossRefGoogle Scholar
  46. 46.
    Mena I, Giombetti R, Mody CK, et al.: Acute cerebral blood flow changes with cocaine intoxication. Neurology 40(Suppl 1):15, 1990.Google Scholar
  47. 47.
    Miller BL, Garrett K, Leedom L, et al.: Neurospect in cocaine abuse: rCBF and HMPAO findings. Clin Nucl Med 14:12, 1989.Google Scholar
  48. 48.
    Tumeh SS, Nagel JS, et al.: Cerebral abnormalities in cocaine abusers: demonstration by SPECT perfusion brain scintigraphy. Radiology 9:821–824, 1990.Google Scholar
  49. 49.
    Neirinckx RD, Canning LR, Piper IM, et al.: Technetium-99md, 1 HMPAO: A new radiophar-maceutical for SPECT imaging of regional cerebral perfusion. J Nuc Med 28:191–202, 1987.Google Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Ricardo Mendoza
    • 1
  • Bruce L. Miller
    • 1
  • Ismael Mena
    • 1
  1. 1.Department of PsychiatryUCLA School of Medicine, Harbor-UCLA Medical CenterTorranceUSA

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