Phencyclidine (PCP)-Related Psychiatric Disorders Workup

  • Author: Alan D Schmetzer, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Aug 23, 2011
 

Laboratory Studies

  • Always obtain a urine drug screen 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 also may be available in some emergency departments. However, be aware that specific urine or serum levels may have little correlation with clinical manifestations, especially in the case of PCP intoxication.
  • 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 metabolic 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 coupled with mass spectrometry (GC/MS), as with other drugs, is the confirmatory test providing the highest confidence level for PCP.
  • Because rhabdomyolysis is a potential complication of PCP intoxication, serum enzyme levels may be useful, particularly skeletal muscle creatine phosphokinase (CPK).
Next

Imaging Studies

  • Imaging studies have not proved clinically useful as yet in delineating PCP-induced psychosis from other causes of such disorders. 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 it is hoped that diagnostic clues to PCP psychosis may be found from more complex imaging techniques than those currently available.
Previous
Next

Other Tests

  • No other tests help identify PCP intoxication.
Previous
Next

Staging

PCP use may begin as recreational and intermittent, but some evidence suggests that people can progress to abuse and finally, possibly, to dependence. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR lists both PCP abuse and PCP dependence. Thus, determining where the patient is on this continuum is important.

In addition, assess for stage of change. This includes whether the patient is in the "precontemplation," "contemplation," "planning," "action," or "maintenance/relapse" phase of decision making (as described by Prochaska and DiClemente) regarding his or her use of PCP.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Alan D Schmetzer, MD  Professor Emeritus, Interim Chairman, Vice-Chair for Education, Associate Residency Training Director in General Psychiatry, Fellowship Training Director in Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Addiction Psychiatrist, Midtown Mental Health Cener at Wishard Health Services

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: Eli Lilly & Co. Grant/research funds Other

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; Attending Psychiatrist, Indiana University Hospital Adult Outpatient Clinic, Indianapolis, Indiana

David R Diaz, MD is a member of the following medical societies: American Psychiatric Association, Indiana Psychiatric Society, Indiana State Medical Association, and Indianapolis Medical Society

Disclosure: Eli Lilly and Company Honoraria Speaking and teaching

Specialty Editor Board

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

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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 None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Acknowledgments

The authors would like to acknowledge Indiana University School of Medicine, William Niles Wishard Memorial Hospital, and Larue D. Carter Memorial Hospital for their support of the faculty involved in the preparation of this eMedicine article.

References

  1. Allen RM, Young SJ. Phencyclidine-induced psychosis. Am J Psychiatry. Sep 1978;135(9):1081-4. [Medline].

  2. Aniline O, Allen RE, Pitts FN Jr, Yago LS, Pitts AF. The urban epidemic of phencyclidine use: laboratory evidence from a public psychiatric hospital inpatient service. Biol Psychiatry. Oct 1980;15(5):813-7. [Medline].

  3. Barton CH, Sterling ML, Vaziri ND. Rhabdomyolysis and acute renal failure associated with phencyclidine intoxication. Arch Int Med. 1980;140(4):568-569.

  4. Bey T, Patel A. Phencyclidine intoxication and adverse effects: a clinical and pharmacological review of an illicit drug. Cal J Emerg Med. Feb 2007;8(1):9-14. [Medline].

  5. Corales RL, Maull KI, Becker DP. Phencyclidine abuse mimicking head injury. JAMA. Jun 13 1980;243(22):2323-4. [Medline].

  6. Crider R. Phencyclidine: changing abuse patterns. NIDA Res Monogr. 1986;64:163-73. [Medline].

  7. Fauman B, Baker F, Coppleson LW, Rosen P, Segal MB. Psychosis induced by phencyclidine. J Am College Emerg Med. 1978;4(3):223-225.

  8. Giannini AJ, Loiselle RH, Price WA, Giannini MC. Chlorpromazine vs. meperidine in the treatment of phencyclidine psychosis. J Clin Psychiatry. Feb 1985;46(2):52-4. [Medline].

  9. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Various stimulant drugs show continuing gradual declines among teens in 2008, most illicit drugs hold steady. University of Michigan News Service, Ann Arbor, MI. Dec 11, 2008. Available at http://www.monitoringthefuture.org. Accessed 02/04/2009.

  10. Koek W, Woods JH. Correlations between phencyclidine-like activity and N-methyl-D-aspartate antagonism: behavioral evidence. In: Sigma and Phencyclidine-like Compounds as Molecular Probes in Biology. Ann Arbor, Mich: NPP Books; 1988.

  11. Lundberg GD, Gupta RC, Montgomery SH. Phencyclidine: patterns seen in street drug analysis. Clin Toxicol. 1976;9(4):503-11. [Medline].

  12. McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA. Acute phencyclidine intoxication: clinical patterns, complications, and treatment. Ann Emerg Med. Jun 1981;10(6):290-7. [Medline].

  13. Meyer JS, Greifsenstein F, Devault M. A new drug causing symptoms of sensory deprivation. J Nerv Ment Dis. 1959;129:29-40.

  14. Olney JW, Labruyere J, Price MT. Pathological changes induced in cerebrocortical neurons by phencyclidine and related drugs. Science. Jun 16 1989;244(4910):1360-2. [Medline].

  15. Pestaner JP, Southall PE. Sudden death during arrest and phencyclidine intoxication. Am J Forensic Med Pathol. Jun 2003;24(2):119-22. [Medline].

  16. Petersen RC, Stillman RC. Phencyclidine: an overview. NIDA Res Monogr. Aug 1978;1-17. [Medline].

  17. Phillips WA, Silverstein SM. Convergence of biological and psychological perspectives on cognitive coordination in schizophrenia. Behav Brain Sci. Feb 2003;26(1):65-82; discussion 82-137. [Medline].

  18. Prochaska JO and DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy Theory, Research and Practice. 1982;19:276-288.

  19. Sena SF, Kazimi S, Wu AH. False-positive phencyclidine immunoassay results caused by venlafaxine and O-desmethylvenlafaxine. Clin Chem. 2002;48(4):676-7. [Medline].

  20. Shulgin AT, Mac Lean DE. Illicit synthesis of phencyclidine (PCP) and several of its analogs. Clin Toxicol. 1976;9(4):553-60. [Medline].

  21. Stockard JJ, Werner SS, Aalbers JA, Chiappa KH. Electroencephalographic findings in phencyclidine intoxication. Arch Neurol. Mar 1976;33(3):200-3. [Medline].

  22. Tennant FS Jr, Rawson RA, McCann M. Withdrawal from chronic phencyclidine (PCP) dependence with desipramine. Am J Psychiatry. Jun 1981;138(6):845-7. [Medline].

  23. Weiss CJ, Millman RB. Hallucinogens, phencyclidine, marijuana, inhalants. In: Clinical Textbook of Addictive Disorders. New York, NY: Guilford Press; 1991.

  24. Wong LK, Biemann K. Metabolites of phencyclidine. Clin Toxicol. 1976;9(4):583-591.

  25. Yago KB, Pitts FN Jr, Burgoyne RW, Aniline O, Yago LS, Pitts AF. The urban epidemic of phencyclidine (PCP) use: clinical and laboratory evidence from a public psychiatric hospital emergency service. J Clin Psychiatry. May 1981;42(5):193-6. [Medline].

  26. Ziedonis D, Wyatt S. Psychotic Disorders. In: Principles of Addiction Medicine. 2nd ed. American Society of Addiction Medicine: Chevy Chase, Md; 1998.

  27. Zukin SR, Zukin RS. Phencyclidine. In: Substance Abuse: A Comprehensive Textbook. Baltimore, Md: Williams & Wilkins; 1992.

 
Previous
Next
 
PCP molecule.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.