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Phencyclidine (PCP)-Related Psychiatric Disorders: Differential Diagnoses & Workup

Author: Alan D Schmetzer, MD, Professor, Vice-Chair for Education, and Director of Residency Training in General and Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine
Coauthor(s): Roland McGrath, MD, Chairman, Professor, Department of Emergency Medicine, Indiana University School of Medicine; David R Diaz, MD, Assistant Professor of Clinical Psychiatry, Indiana University School of Medicine; Attending Psychiatrist, Adult Service, Larue D Carter Memorial Hospital; Medical Staff Member, Clarian Health Partners
Contributor Information and Disclosures

Updated: May 31, 2009

Differential Diagnoses

Amphetamine-Related Psychiatric Disorders
Hypertension
Bipolar Affective Disorder
Hypertension, Malignant
Cocaine-Related Psychiatric Disorders
Hyperthyroidism
Delirium
Neuroleptic Malignant Syndrome
Delirium Tremens
Schizophrenia
Depression
Stimulants

Other Problems to Be Considered

It is not uncommon today for people to abuse multiple different substances, which can alter the classical presentation of intoxication and/or withdrawal dramatically. Urine drug screens, while quite useful, may not capture metabolites from all of the ingested substances.

Workup

Laboratory Studies

  • Ordering a urine drug screen is always important for a person with agitation or psychosis, unless the patient is so well known to the treating physician and staff that there is no question at all regarding the cause of the abnormalities observed. Even then, if the clinical picture seems at all different from the usual presentation, a drug screen may be useful. Serum levels of specific drugs may also be available in some emergency departments. However, be aware that specific urine or serum levels may have little correlation with clinical manifestations.
  • Phencyclidine is excreted in the urine, both in unchanged form and as conjugated metabolites. The usual laboratory test for PCP is an enzyme immunoassay technique that detects both PCP and its analog, 1-[1-(2-thienyl)-cyclohexyl]-piperidine (TCP). This is a qualitative screening test; that is, it tells whether the drug is present or absent. Gas chromatography/mass spectometry (GC/MS), as with other drugs, is the confirmatory test providing the highest confidence level for PCP.
  • Because rhabdomyolysis9 is a potential complication of PCP intoxication, serum enzyme levels may be useful, particularly skeletal muscle creatine phosphokinase (CPK).

Imaging Studies

Imaging studies have not yet proven clinically useful in delineating PCP-induced psychosis. Brain imaging studies in small numbers of adult chronic PCP users suggest that they may have decreased right cerebral cortical blood flow and frontal glucose metabolism. Such abnormalities are similar to those found in patients diagnosed with schizophrenia. Eventually, diagnostic clues to PCP psychosis may be found from more complex imaging techniques than those currently available.

Other Tests

No other tests help identify PCP intoxication.

Staging

PCP use may begin as recreational and intermittent, but some evidence shows that people can progress to abuse and possibly to dependence. The DSM-IV-TR lists both PCP abuse and PCP dependence. Thus, determining just where the patient is on this continuum is important. In addition, assessing for stage of change, that is, is the patient in the precontemplation, contemplation, planning, action, or maintenance/relapse phase of decision making (as described by Prochaska and DiClemente) regarding their use of PCP.10

More on Phencyclidine (PCP)-Related Psychiatric Disorders

Overview: Phencyclidine (PCP)-Related Psychiatric Disorders
Differential Diagnoses & Workup: Phencyclidine (PCP)-Related Psychiatric Disorders
Treatment & Medication: Phencyclidine (PCP)-Related Psychiatric Disorders
Follow-up: Phencyclidine (PCP)-Related Psychiatric Disorders
Multimedia: Phencyclidine (PCP)-Related Psychiatric Disorders
References
Further Reading
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References

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Further Reading

Gorelick DA, Balster RL. Phencyclidine (PCP). Back to Psychopharmacology - The Fourth Generation of Progress

Pinchot JT, Schmetzer AD. Phencyclidine bibliography, for AAAP - Resource Site for the PGY-5 Curriculum Project, July 2001

Books and book chapters on PCP:

Hafen B, Frandsen K. Phencyclidine - Angel Dust: By any name not fit for human consumption. Hazelden Foundation, 1980.

Carroll M. The dangerous angel. In: Snyder SH, ed. The Encyclopedia of Psychoactive Drugs. Chelsea House Publishers, 1985, ISBN: 087754753X

Ogelsby EW, Faber S, Faber S. Angel Dust - What everyone should know about PCP. Charing Cross Publishing Company, 1982, ISBN: 0890740666

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Keywords

phencyclidine-related psychiatric disorders, PCP, angel dust, crystal, hog, krystal joint, KJ, mintweed, rocket fuel, delta-9-tetrahydrocannabinol, THC, N -methyl-D-aspartate, NMDA, lysergic acid diethylamide, LSD, substance-induced psychosis, 1-(phenylcyclidine) piperidine

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Contributor Information and Disclosures

Author

Alan D Schmetzer, MD, Professor, Vice-Chair for Education, and Director of Residency Training in General and Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine
Alan D Schmetzer, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy
Disclosure: Nothing to disclose.

Coauthor(s)

Roland McGrath, MD, Chairman, Professor, Department of Emergency Medicine, Indiana University School of Medicine
Roland McGrath, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

David R Diaz, MD, Assistant Professor of Clinical Psychiatry, Indiana University School of Medicine; Attending Psychiatrist, Adult Service, Larue D Carter Memorial Hospital; Medical Staff Member, Clarian Health Partners
David R Diaz, MD is a member of the following medical societies: American Psychiatric Association, Indiana Psychiatric Society, and Indiana State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Barry I Liskow, MD, Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center
Barry I Liskow, MD is a member of the following medical societies: American Academy of Clinical Psychiatrists, American Academy of Psychiatrists in Alcoholism and Addictions, American Medical Association, American Psychiatric Association, and Research Society on Alcoholism
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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