STIMULANTS

Vasoconstrictor REF: KDT ^4th e p. 166

Effect of local anesthetic on blood vessels is:

The occurrence of the psychotic symptoms depends on the dose, the duration of use, and the individual user’s sensitivity to the substance. Paranoid delusions are the most frequent psychotic symptoms.

Paranoid delusions and hallucinations can occur in up to 50 percent of all persons who use cocaine.

Ref: Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical … By Benjamin J. Sadock, Virginia A. Sadock, 2007, Page 426

Formication is a form of haptic hallucinations, associated with the sensation of touch. It is commonly seen in delirium tremens, amphetamine psychosis, and cocaine intoxication.

Depersonalization  is a term that describes the feeling of being different, strange, or unreal. The person feels a loss of identity. This phenomenon is seen in dissociative disorders.

Dyskinesia is a term describing any movement disorder.

Illusion is an erroneous perception, or a false response to sensory stimulus. It is commonly seen in toxic states as well as in schizophrenia and severe anxiety disorders.

Ref: Nurcombe B., Ebert M.H. (2008). Chapter 4. The Psychiatric Interview. In M.H. Ebert, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

Cocaine act as a vasoconstrictor by blocking re uptake of norepinephrine at sympathetic nerve endings.

Coronary artery constriction causes myocardial infarction and with it the risk of cardioembolic stroke.

Systemic artery constriction causes acute hypertension, predisposing to rupture of underlying vascular malformations or aneurysms.

Cerebral artery constriction causes cerbral ischemia. 

Usual symptoms of cocaine poisoning are anorexia, pale face, sunken eyes, insomnia, digestive disturbances, impotence, Defective memory, physical and mental degeneration, mydriasis, tachycardia hypertension and tachypnoea. Mental changes include hallucination, delusion of persecution, depression and derangement of special senses.

Tactile hallucinations are common. Feeling of crawling of insects on skin as sand bags lying under the skin are reported (cocaine bugs).

Magnan’s or cocaine bugs is characteristic of cocaine poisoning, in which there is a feeling as if grains of sand are lying under the skin or some small insects are creeping on the skin giving rise to itching sensation with resultant excoriation, leading to irregular scratches and ulcers.

One of the consequence of maternal use of cocaine is cerebral infarction.

C i.e. Reverse tolerance

D i.e. Cocaine abuse

A. i.e. Freud

A i.e. Cocaine poisoning

Ans. Epithelial erosions

Ans. C: Hypothermia

Cocaine when ingested results in hyperthermia, hallucinations, euphoria and stimulation of libido Cocaine intoxication

• With excessive or prolonged use, the drug can cause itching, tachcardia, hallucinations and paranoid delusions.
• Overdoses cause tachyarrythmias and a marked elevation of blood pressure, which can be life-threatening.
• Toxicity results in seizures, followed by respiratory and circulatory depression of medullar origin.
• This may lead to death from respiratory failure, stroke, or heart-failure.
• Cocaine is also highly pyrogenic, because the stimulation and increased muscular activity cause greater heat production.
• Heat loss is inhibited by the intense vasoconstriction.
• Cocaine-induced hyperthermia may cause muscle cell destruction and myoglobinuria resulting in renal failure.
• Emergency treatment often consists of administering a benzodiazepine sedation agent, such as diazepam to decrease the elevated heart rate and blood pressure.
• Physical cooling (ice, cold blankets, etc.) and paracetamol (acetaminophen) may be used to treat hyperthermia
• There is no officially approved specific antodote for cocaine overdose
• Cocaine’s primary acute effect on brain chemistry is to raise the amount of dopamine and serotonin in the nucleus accumbens (the pleasure center in the brain); this effect ceases, due to metabolism of cocaine to inactive compounds and particularly due to the depletion of the transmitter resources (tachyplaxis).
• This can be experienced acutely as feelings of depression, as a “crash” after the initial high.

Ans. Half life is 3 h

Ans. Cocaine poisoning

Ans. Heroin

Ans. Amphetamine

Ans. is ‘d’ i.e., Creeping bugs

Patients withdrawing from cocaine typically experience fatigue, dysphoria, dirturbed sleep, and some craving; some may experience depression”.___________ Kaplan & Saddock.

o Creeping bugs are seen in chronic cocaine abuse (not due to withdrawal).

Cocaine

• Cocaine is an alkaloid derived from the Coca bush, Erythrexylum CoCa. It was the first local anaesthetic which was used clinically. Toxicity of cocaine may be : ‑

A. Acute toxicity : – Acute cocaine intoxication is characterized by : ‑

1. Sympathetic hyperactivity : – Tachycardia, hypertension, mydriasis, sweating, nausea & vomiting.
2. Hypoinanic state : – Increased psychomotor activity, grandiosity, elation, hypervigilance, Increased speech output.

B. Chronic overuse : – Chronic overuse can cause : ‑

1. Psychotic episodes (Cocaine psychosis) : Persecutory delusions with tactile hallucinations (formination). Tactile hallucinations are manifested as bugs crawling under the skin —) Cocaine bugs or magnan’s symptoms.
2. Other : – Anxiety reaction, compulsive behavior, delirium and delusional disorders.
3. Black pigmentation of tongue and teeth.

Ans. is ‘d’ i.e., No drug

• “Tolerance develops swiftly but there are no withdrawal symptoms. Treament, if needed, is symptomatic. Often no medicines are needed and the user can stop its use by himself when he is coerced to do so by the court or the employer”  – Namboodiri
• “No pharmacological agents reliably reduce the intensity of withdrawal, but recovery over a weak or two is generally uneventful”   – Kaplan & Saddock