eMedicine Specialties > Psychiatry > Addiction

Hallucinogens: Differential Diagnoses & Workup

Author: Brooke S Parish, MD, Assistant Professor, Department of Psychiatry, University of New Mexico School of Medicine
Coauthor(s): Michael E Richards, MD, MPA, FACEP, Associate Professor, Department of Emergency Medicine, University of New Mexico School of Medicine; Scott Cameron, MD, Consulting Staff, Department of Emergency Medicine, Regions Hospital
Contributor Information and Disclosures

Updated: Oct 30, 2009

Differential Diagnoses

Alcohol-Related Psychosis
Hyperthyroidism
Bipolar Affective Disorder
Panic Disorder
Caffeine-Related Psychiatric Disorders
Posttraumatic Stress Disorder
Cocaine-Related Psychiatric Disorders
Schizoaffective Disorder
Delirium
Schizophrenia
Delirium Tremens
Schizophreniform Disorder
Delusional Disorder
Eastern Equine Encephalitis

Other Problems to Be Considered

Acute mania
Cerebral abscess
Cerebral neoplasm
Herpes encephalitis
Seizures
Corticosteroids
Endocarditis
Carbon monoxide poisoning
Gamma hydroxybutyrate

Workup

Laboratory Studies

  • In general, laboratory studies do not play a large role in the diagnosis and treatment of hallucinogen poisoning.
    • Only a few hallucinogenic agents show up on standard toxicological screens. These include MDMA (positive for amphetamines), PCP, and marijuana.
    • Treatment of hallucinogen poisoning is rarely affected by drug screen results.
    • Dextromethorphan (as in Robitussin DM) may cause a false-positive result for the presence of PCP.
  • Metabolic abnormalities should be sought and aggressively treated.
    • MDMA may cause hyponatremia.
    • PCP and MDMA may cause rhabdomyolysis and subsequent myoglobinuric renal failure. Check the creatine kinase level.
    • Always exclude hypoglycemia as a cause of altered mental status.

Imaging Studies

A CT scan of the head is indicated in all patients with an unexplained alteration in mental status.

More on Hallucinogens

Overview: Hallucinogens
Differential Diagnoses & Workup: Hallucinogens
Treatment & Medication: Hallucinogens
Follow-up: Hallucinogens
Multimedia: Hallucinogens
References

References

  1. de la Torre R, Farre M. Neurotoxicity of MDMA (ecstasy): the limitations of scaling from animals to humans. Trends Pharmacol Sci. Oct 2004;25(10):505-8. [Medline].

  2. Wilcox JA, Wilcox AH. Movement disorders and MDMA abuse. J Psychoactive Drugs. Jun 2009;41(2):203-4. [Medline].

  3. SAMHSA. 2003 National Survey on Drug Use and Health. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Available at http://www.oas.samhsa.gov/nhsda/2k3nsduh/2k3Results.htm. Accessed October 30, 2009.

  4. Lin DL, Liu HC, Liu RH. Methylenedioxymethamphetamine-related deaths in Taiwan: 2001-2008. J Anal Toxicol. Sep 2009;33(7):366-71. [Medline].

  5. Erowid. The Vaults of Erowid: Documenting the Complex Relationship Between Humans and Psychoactives [Web site]. [Full Text].

  6. Greene SL, Kerr F, Braitberg G. Review article: amphetamines and related drugs of abuse. Emerg Med Australas. Oct 2008;20(5):391-402. [Medline].

  7. Halpern JH, Sewell RA. Hallucinogenic botanicals of America: a growing need for focused drug education and research. Life Sci. Dec 22 2005;78(5):519-26. [Medline].

  8. Ompad DC, Galea S, Fuller CM, et al. Club drug use among minority substance users in New York City. J Psychoactive Drugs. Sep 2004;36(3):397-9. [Medline].

  9. Passie T, Halpern JH, Stichtenoth DO, Emrich HM, Hintzen A. The pharmacology of lysergic acid diethylamide: a review. CNS Neurosci Ther. 2008;14(4):295-314. [Medline].

  10. Prisinzano TE. Psychopharmacology of the hallucinogenic sage Salvia divinorum. Life Sci. Dec 22 2005;78(5):527-31. [Medline].

  11. SAMSHA. Ecstasy, Other Club Drugs, & Other Hallucinogens. Available at http://www.oas.samhsa.gov/ecstasy.htm.

  12. Tucker JR, Ferm RP. Lysergic acid diethylamide and other hallucinogens. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Hoffman RS, eds. Goldfrank's Toxicological Emergencies. 6th ed. Stamford, Conn: Appleton & Lange; 1998:1111-9.

  13. Williams LC, Keyes C. Psychoactive drugs. In: Ford MD, Delaney KA, Ling LJ, Erickson T, eds. Clinical Toxicology. Philadelphia, Pa: WB Saunders; 2001:640-9.

Further Reading

Keywords

psychedelics, LSD, acid, phencyclidine, PCP, psilocybin, psilocin, MDMA, ecstasy, ketamine, peyote, mescaline, MDEA, Eve, enactogens, cannabinols, THC, DMT, bufotenine, 5-MeO-DMT, foxy, Amanita muscaria, psychoactives, Colorado River toad, ibotenic acid, hallucinogenic drugs, drug abuse, illicit drugs, illegal drugs, drugs of abuse, lysergic acid diethylamide, Delysid, lysergamide, phenylethylamine, piperidine, indolealkylamine, cannabinol, morning glory, Hawaiian baby woodrose, bufotenin, dimethyltryptamine, methamphetamine, ketamine, special K, tetrahydrocannabinol, marijuana, Mary Jane, pot, herb, weed, ganja, dope, dip dope, indica, grass, hashish, hash, microdot, window pane, acid, cid, synesthesia, flashbacks, hallucinogen persisting perception disorder, HPPD, ecstasy, Sernylan, peace pill, angel dust, magic mushrooms, shrooms

Contributor Information and Disclosures

Author

Brooke S Parish, MD, Assistant Professor, Department of Psychiatry, University of New Mexico School of Medicine
Brooke S Parish, MD is a member of the following medical societies: American College of Physicians and American Psychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

Michael E Richards, MD, MPA, FACEP, Associate Professor, Department of Emergency Medicine, University of New Mexico School of Medicine
Michael E Richards, MD, MPA, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Scott Cameron, MD, Consulting Staff, Department of Emergency Medicine, Regions Hospital
Scott Cameron, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ronald C Albucher, MD, Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center
Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: 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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