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570 sEctiON iii Psychiatry ` Psychiatry—Pathology Psychiatry ` Psychiatry—Pathology

Psychoactive drug intoxication and withdrawal
DrUg iNtoXicatioN WithDraWal
Depressants
Nonspecific: mood elevation,  anxiety, sedation, Nonspecific: anxiety, tremor, seizures,
behavioral disinhibition, respiratory depression. insomnia.
Alcohol Emotional lability, slurred speech, ataxia, Alcoholic hallucinosis
coma, blackouts. Serum γ-glutamyltransferase (usually visual)
(GGT)—sensitive indicator of alcohol use. AST Withdrawal seizures
value is 2× ALT value (“ToAST 2 ALcohol”). Tremors, insomnia, diaphoresis, Delirium tremens
Treatment: benzodiazepines. agitation, GI upset

0 3 6 12 24 36 48 96
Time from last drink (hours)
Barbiturates Low safety margin, marked respiratory Delirium, life-threatening cardiovascular
depression. Treatment: symptom management collapse.
(eg, assist respiration,  BP).

Benzodiazepines Greater safety margin. Ataxia, minor Sleep disturbance, depression.
respiratory depression. Treatment: flumazenil
(benzodiazepine receptor antagonist, but
rarely used as it can precipitate seizures).
Opioids Euphoria, respiratory and CNS depression, Sweating, dilated pupils, piloerection (“cold
 gag reflex, pupillary constriction (pinpoint turkey”), rhinorrhea, lacrimation, yawning,
pupils), seizures. Most common cause of drug nausea, stomach cramps, diarrhea (“flu-like”
overdose death. Treatment: naloxone. symptoms). Treatment: symptom management,
methadone, buprenorphine.
Inhalants Disinhibition, euphoria, slurred speech, Irritability, dysphoria, sleep disturbance,
disturbed gait, disorientation, drowsiness. headache.
Stimulants
Nonspecific: mood elevation,  appetite, Nonspecific: post-use “crash,” including
psychomotor agitation, insomnia, cardiac depression, lethargy,  appetite, sleep
arrhythmias, tachycardia, anxiety. disturbance, vivid nightmares.
Amphetamines Euphoria, grandiosity, pupillary dilation,
prolonged wakefulness, hyperalertness,
hypertension, paranoia, fever, fractured teeth.
Skin excoriations with methamphetamine use.
Severe: cardiac arrest, seizures. Treatment:
benzodiazepines for agitation and seizures.
Caffeine Palpitation, agitation, tremor, insomnia. Headache, difficulty concentrating, flu-like
symptoms.

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