UW MED psych drugs cases (Nr 5-8) - cocaine) Flashcards
(5) 32 years male + affect is irritable, tense, and labile; speech is pressured and difficult to interrupt; persecutory delusion that his boss, coworkers, and wife are working together to get him fired; no suicidal or homicidal ideation + BP 160/100 + HR 102 + RR 16 + drinks 5-6 beers a week + on probation at work. Appearance: restless and shifting in seat; diaphoretic; mildly tremulous. Neurologic: alert and fully oriented; pupils dilated and reactive to light; steady gait
The patient accused the company of hacking his personal computer; he had to be restrained from hitting a coworker. His mood has been “up and down every few days” for a few months, switching from irritable and paranoid to quiet and withdrawn. pPatient states that he created “a genius business plan” and is being punished for not letting others take credit for it.
Dx?
COCAINE USE DISORDER
(5) COCAINE USE DISORDER. This patient’s history of mood swings and erratic behavior and his physical findings consistent with sympathetic nervous system stimulation? CP
(ie, tachycardia, pupil dilation, diaphoresis, tremors) are most likely due to cocaine use disorder.
(5) COCAINE USE DISORDER. Psychiatric effects of cocaine include ?
anxiety, irritability, mood swings, panic attacks, grandiosity, impaired judgment, and psychotic symptoms (eg, paranoia, hallucinations).
(5) cocaine. When intoxicated, patients using cocaine are frequently energetic, restless, and hypervigilant and may exhibit euphoria and grandiosity that resemble an acute manic episode. Paranoid and grandiose delusions and auditory, visual, or tactile hallucinations may occur. Cocaine withdrawal frequently presents with depression and lethargy, which resolve spontaneously after a period of abstinence.
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(5) COCAINE USE DISORDER. VS PCP?? especially eyes!!
PCP intoxication can present with severe combativeness, sympathetic overactivity, and psychosis;
-> however, confusion, disorganized behavior, ataxia, dissociation, and increased pain tolerance are expected. In addition, mydriasis is better explained by cocaine (ie, sympathomimetic) use, whereas nystagmus (horizontal, vertical, rotary) is expected in PCP use.
(5) cocaine. kitas ats. Why used PCP?
Phencyclidine (PCP) is an NMDA antagonist classified as a dissociative anesthetic; it is abused for its hallucinogenic properties.
(5) cocaine. kiti ats. Psichiatrines diagnozes - reikia is pradziu rule out intoxication with substances. + yra durations.
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(5) cocaine. kiti ats. Delusional disorder is characterized by persistent delusions and no other psychotic symptoms. Paranoid personality disorder involves a lifelong pattern of distrust and suspiciousness.
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(6) A 17-year-old girl is brought to the office by her mother, who is concerned about her daughter’s weight loss and mood changes. The girl has lost 4.5 kg (10 lb) in the last 2 months and has been uncharacteristically irritable. The mother says that she has suddenly become a “picky eater” and that she now often refuses to eat, insisting that she is “just not hungry.” She also worries that her daughter is not sleeping enough. When questioned about these concerns, the patient denies having any problems and says that she feels “fine” and just has lots of energy. She adds, “Isn’t it healthy to be thin and fit? I don’t understand what my mother is worried about.” The patient’s height is 157.5 cm (5 ft 2 in) and weight is 47.6 kg (105 lb). Physical examination shows a thin body habitus, erythema of the nasal mucosa, and mild facial acne. Which of the following is the most likely diagnosis?
COCAINE USE DISORDER
In addition to mood disturbance, other psychiatric complications of cocaine use include anxiety, panic attacks, grandiosity, and psychosis (ie, delusions and hallucinations).
(6) COCAINE USE DISORDER - hallmark?
The diagnostic hallmark in this scenario is erythema of the nasal mucosa, which is a common finding in individuals who snort cocaine. In severe cases, perforation of the nasal septum can occur.
(6) COCAINE USE DISORDER. In addition to mood disturbance, other psychiatric complications of cocaine use include anxiety, panic attacks, grandiosity, and psychosis (ie, delusions and hallucinations).
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(6) COCAINE USE DISORDER.
Cocaine is a stimulant that produces increased energy, decreased appetite, and reduced need for sleep. Individuals who abuse cocaine often have mood changes (eg, euphoria, irritability) and weight loss secondary to decreased appetite.
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(6) COCAINE USE DISORDER. kiti ats.
(Choices A, B, and C) The physical finding of erythema of the nasal mucosa, normal weight (BMI of 19.2 kg/m2), and lack of other characteristic features of eating disorders (eg, discrepancy between desired and perceived body image) make these diagnoses less likely.
Anorexia nervosa is associated with intense fear of gaining weight and distorted body image despite a significantly low weight (BMI <18.5 kg/m2).
Avoidant/restrictive food intake disorder involves lack of interest and avoidance of eating based on the sensory characteristics of food, with typical onset in infancy or early childhood.
Diagnosis of bulimia nervosa requires evidence of binge eating and compensatory behaviors.
Sitam case BMI paciam reikejo apsiskaicuoti :)
(6) COCAINE USE DISORDER. kiti ats. Canabinoids?
Synthetic cannabinoid use may produce a variety of effects depending on the exact chemical constituents of the synthetic; however, at low doses these agents typically mimic the effects of cannabis (eg, euphoria, paranoia). Synthetic cannabinoid agents are most commonly smoked and are not associated with erythema of the nasal mucosa or weight loss.
(7) A 32-year-old woman is brought to the emergency department by police for agitated behavior at work. The patient, who works as an assistant editor at a publishing company, did not show up to work for the previous 2 days. This morning, on arrival in the office, she yelled, “I’ve written the next bestselling novel!” She then demanded a meeting with the company president to present her plan to launch a nationwide tour for the book. Her coworkers attempted to usher her into the conference room to talk, but she became angry, kicked over a trash can, and threw multiple vases against the wall. The patient has no psychiatric history. Throughout the evaluation, she is hypervigilant and restless. Temperature is 37 C (98.6 F), blood pressure is 158/92 mm Hg, pulse is 102/min, and respirations are 16/min. She appears diaphoretic; pupils are dilated. The patient speaks rapidly and loudly. She says, “They don’t appreciate my genius. I’m too good for them.” Which of the following is the most likely diagnosis?
COCAINE INTOXICATION
(7). COCAINE INTOXICATION. Manic behaviour + sympathetic CP.
This patient’s manic behavior (eg, agitation; grandiosity; loud, pressured speech) and signs of sympathetic stimulation (eg, diaphoresis, tachycardia, hypertension, mydriasis) are most consistent with cocaine intoxication.
Patients under the influence of cocaine or other stimulants may exhibit elevated or irritable mood, hyperactivity, agitation, and grandiosity that are indistinguishable from an acute manic episode of bipolar disorder.
Other manic symptoms, such as decreased need for sleep, racing thoughts, and distractibility, can also be seen in cocaine intoxication. Bipolar disorder is not diagnosed when there is evidence that symptoms are caused by substance use or withdrawal (Choice A).
(7). COCAINE INTOXICATION. kiti ats. Hallucinogen intoxication (eg, LSD) is characterized by ?
perceptual distortions.
It does not typically cause manic behavior or severe agitation.
(7). COCAINE INTOXICATION. kiti ats.
Phencyclidine (ie, PCP) intoxication may cause?
Agitated and violent behavior. However, it typically presents with prominent nystagmus.
(7). COCAINE INTOXICATION. kiti ats. opioid withdrawal? maniac symptoms?
Opioid withdrawal presents with gastrointestinal distress (eg, nausea, diarrhea, abdominal cramping), myalgias, mydriasis, piloerection, and lacrimation.
It would not explain this patient’s manic symptoms.
(8). A 24-year-old woman is brought to the emergency department by her roommate due to depression and suicidal thoughts. The roommate became alarmed when the patient did not get up for work as usual and reported feeling “so depressed I want to die.” She currently has no suicidal ideation but describes feeling depressed, exhausted, and unable to concentrate. The patient appears distracted and speaks slowly. The roommate says, “We were up for the last 3 nights at parties where there was alcohol and other stuff,” but reports that her friend was energetic and talkative and appeared to be in a great mood. However, the patient subsequently slept for 18 hours, had difficulty getting out of bed, and missed work. She has no medical or psychiatric history but describes brief periods of acute depression over the past several months. These lasted a few days and were characterized by low energy; hypersomnia; vivid, unpleasant dreams; and increased appetite. Temperature is 36.7 C (98.1 F), blood pressure is 110/70 mm Hg, pulse is 70/min, and respirations are 12/min. Physical examination is normal. Which of the following is the most likely diagnosis for this patient?
COCAINE WITHDRAWAL
This patient’s acute onset of depression with pronounced fatigue following a period of increased energy is suggestive of cocaine withdrawal.
(8) COCAINE WITHDRAWAL. Cocaine withdrawal involves predominantly psychological features. What features?
Common symptoms include depression, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration, and intense drug craving. Physical symptoms are minor and rarely require treatment.
(8) COCAINE WITHDRAWAL. Individuals often use cocaine in binges, taking the drug repeatedly over a short period to maintain their “high.” Abrupt cessation is typically followed by a “crash,” which can include severe depression with suicidal ideation and psychomotor slowing with milder symptoms that resolve within 1-2 weeks.
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(8) COCAINE WITHDRAWAL. vs Alcohol withdrawal?
This patient’s normal physical examination and vital signs make alcohol and opiate withdrawal syndromes unlikely. Alcohol withdrawal is characterized by CNS hyperactivity, and its symptoms include anxiety, insomnia, tremulousness, tachycardia, and hypertension.
(8) COCAINE WITHDRAWAL. vs opiate withdrawal?
Opiate withdrawal typically presents with dysphoria and is accompanied by myalgia, yawning, and abdominal cramping. Physical findings include mydriasis, lacrimation, increased bowel sounds, and piloerection.
cia kito klausimo ats buvo. cocaine intox.
Cocaine intoxication can also cause anxiety, paranoia, and tachycardia, but it is associated with pupillary dilation, not conjunctival injection, as well as diaphoresis.
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cia kito klausimo ats buvo. cocaine withdrawal.
Cocaine withdrawal typically presents with dysphoria, difficulty concentrating, and increased sleep and appetite, as well as depression and possible suicidality. It does not cause the dry mouth and conjunctival injection seen with cannabis use.
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