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A middle-aged male is found on the streets after having attended a party where illicit drugs and alcohol were being used. He is behaving wildly and complains of hearing voices. He is confused, delirious, and appears paranoid. A friend tells you that he saw him taking numerous pills from a prescription bottle. Which of the following is the treatment of choice?
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Teaching Points
- A urinalysis can reveal the type of drug ingested, but treatment should be started empirically. Amphetamine overdose can produce a psychotic state where the individual will present with confusion, delirium, paranoia, and hallucinations.
- Amphetamine psychosis is effectively treated with the butyrophenone haloperidol, which can mitigate the central nervous system (CNS) symptoms from antagonism of excess dopamine.
- Benzodiazepines also are used as first-line treatment of undifferentiated agitated delirium, with ketamine as an option for adjunctive therapy. Particularly, if benzodiazepines appear to be failing and the patient is not hypertensive. Lipid-soluble beta-blockers such as metoprolol and labetalol may also help mitigate agitation as these drugs penetrate the CNS and antagonize excess monoamines.
- Agitation and paranoia secondary to primary mental illness and ingestant-related agitated delirium usually can be eased with antipsychotic medications. Butyrophenones such as haloperidol are preferred to older antipsychotics such as chlorpromazine as there are fewer anticholinergic side effects. This is important especially in patients who are or may become hyperthermic.
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PubMed References
| Clinical and Autopsy Characteristics of Fatal Methamphetamine Toxicity in Australia., Darke S,Duflou J,Lappin J,Kaye S,, Journal of forensic sciences, 2017 Nov 29 [PubMed PMID: 29193063] | |
| Cardiac pathologic findings in three unusual cases of sudden cardiac death related to anorexiant drugs., Leone O,Agostini V,Foà A,Cerbelli B,di Gioia CRT,Aromatario M,Ciallella C,Lucena J,d'Amati G,, Human pathology, 2017 Oct 9 [PubMed PMID: 29024685] | |
| A fatal case of amphetamine induced ischaemic colitis., Green PA,Battersby C,Heath RM,McCrossan L,, Annals of the Royal College of Surgeons of England, 2017 Sep [PubMed PMID: 28853604] | |
| Corticosterone and exogenous glucose alter blood glucose levels, neurotoxicity, and vascular toxicity produced by methamphetamine., Bowyer JF,Tranter KM,Sarkar S,George NI,Hanig JP,Kelly KA,Michalovicz LT,Miller DB,O'Callaghan JP,, Journal of neurochemistry, 2017 Oct [PubMed PMID: 28792619] | |
| Isolated non-cardiogenic pulmonary edema - A rare complication of MDMA toxicity., Haaland A,Warman E,Pushkar I,Likourezos A,Friedman MS,, The American journal of emergency medicine, 2017 Sep [PubMed PMID: 28733094] | |
| Toxicity, Methamphetamine, Richards JR,Laurin EG,,, 2017 Jun [PubMed PMID: 28613645] | |
| Role of Mitochondria in Methamphetamine-Induced Dopaminergic Neurotoxicity: Involvement in Oxidative Stress, Neuroinflammation, and Pro-apoptosis-A Review., Shin EJ,Tran HQ,Nguyen PT,Jeong JH,Nah SY,Jang CG,Nabeshima T,Kim HC,, Neurochemical research, 2017 Jun 7 [PubMed PMID: 28589520] |
