Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review

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A 24-year old man is brought to the emergency department by the police after being found wandering the streets screaming at bystanders. He resisted arrest and became physically aggressive. While a nurse attempts to place an IV, the patient screams and attempts to hit her. His temperature is 37.1°C (98.6°F), respirations are 20/minute, heart rate is 120/minute, and blood pressure is 155/95 mmHg. The patient is subsequently provided with intramuscular haloperidol. Urine toxicology confirms the use of a drug that exerts its effects by binding to and activating N-methyl-D-aspartate (NMDA) receptors. Which of the following physical exam findings is highly associated with this drug?

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In the middle of the night, two people are brought to the clinic. First comes 18 year old Kyle and his mother, who's noticed that lately, Kyle seems to have an increased appetite, and won’t stop laughing or giggling. Kyle adds that he feels like time has stopped and that’s making him a bit anxious. Upon physical examination, Kyle’s eyes are extremely red, he has a heart rate of 105 beats per minute, and a blood pressure of 130 over 90 millimeters of mercury. Next comes 25 year old Matt and his girlfriend Allison, who is very concerned for him. She says that in the past few months, Matt has been very aggressive and violent, and has been frequently getting into fights with strangers for no good reason. Matt interrupts Allyson and tells you that the reason he gets into fights is because some voices in his head tell him so. Upon physical examination, you notice that Matt keeps tapping his feet, and his eyes keep moving from side to side and up and down. In addition, he has a heart rate of 110 beats per minute, and a blood pressure or 135 over 95 millimeters of mercury.

Based on the initial presentation, both Kyle and Matt seem to have some form of hallucinogen intoxication. Hallucinogens are a class of psychoactive drugs that cause hallucinations, which are distortions of a person’s sensory perception, mood, and thought, as well as enhancement of feelings and introspection. The way they do this isn’t clearly understood, but it involves the interaction of numerous neurotransmitters, including serotonin, dopamine, and glutamate. Now, some high yield hallucinogens include lysergic acid diethylamide or LSD, cannabis or marijuana, MDMA or ecstasy, and phencyclidine or PCP. And in addition to causing hallucinations, they can all cause their own set of unique symptoms that you need to be able to recognize for your exams. In addition to these, they can all cause their own set of unique symptoms that you need to be able to recognize for your exams.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future" Neuropsychopharmacology (2017)
  6. "The Psychopharmacology of Hallucinogenic Agents" Annual Review of Medicine (1969)
  7. "The Psychopharmacology of Hallucinogenic Agents" Annual Review of Medicine (1969)
  8. "Receptor mechanisms and circuitry underlying NMDA antagonist neurotoxicity" Molecular Psychiatry (2002)
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