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Hallucinogen Use Follow-up

  • Author: Brooke S Parish, MD; Chief Editor: Eduardo Dunayevich, MD  more...
 
Updated: Nov 23, 2015
 

Further Outpatient Care

Patients who are discharged should receive follow-up care from their primary care physician, their psychiatrist, or a drug counseling facility.

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Further Inpatient Care

Patients with anxiety or panic reactions who present following an uncomplicated hallucinogen ingestion can often be "talked down" and sent home with responsible family members.

Observe stable patients in the emergency department if any doubt exists as to the diagnosis.

Any patient who persists with confused or psychotic behavior should be admitted.

Patients whose ingestion is complicated by seizures, hyperthermia, or rhabdomyolysis should be admitted for monitoring.

Those who present following massive overdose or those who demonstrate severe hyperthermia or any hemodynamic instability should be admitted to an intensive care unit.

Those who present with suicidal ideation, homicidal ideation, or command hallucinations should be admitted to a mental health facility if they are medically stable.

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Transfer

Stable patients with a persistent psychosis that does not wane as the hallucinogenic effect of the drug abates should be transferred to a mental health facility for evaluation and treatment.

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Complications

Long-term effects of LSD use may include prolonged psychotic reactions, severe depression, and flashbacks (ie, HPPD). Flashbacks are the recurrence of LSD-like effects several months to years after cessation of use. They may be triggered by stress or illness and may cause significant distress.

Patients using LSD are more at risk for injuries and death from behavior-related trauma than from the toxicological effects of LSD.

Rarely, massive overdoses of LSD may result in hyperthermia, hypertension, coma, respiratory arrest, and bleeding.

Severe hyperthermia, rhabdomyolysis, myoglobinuric renal failure, and DIC may occur after PCP or MDMA use.

MDMA use may cause permanent degradation of serotonergic neurons.

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Patient Education

Encourage changes in the patient's life-style. Emphasize the importance of avoiding people, places, and things related to hallucinogen use.

Treatment emphasis should focus on the disease concept of addiction, the recognition of the negative consequences of hallucinogen abuse, and the construction of support systems.

Patients should be encouraged to confront their denial and avoid any situational cues that may stimulate drug use.

Offer referral to available psychiatric and community resources for follow-up.

Users may benefit from referral to Narcotics Anonymous.

Educate family members regarding the signs and symptoms of drug dependence. Enlist their help as a support system for the patient.

Websites of value to the patient and family include the following:

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Contributor Information and Disclosures
Author

Brooke S Parish, MD Associate 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, American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Medical Association

Disclosure: Nothing to disclose.

Michael E Richards, MD, MPA Associate Professor and Chair, Department of Emergency Medicine, University of New Mexico School of Medicine

Michael E Richards, MD, MPA is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Eduardo Dunayevich, MD Executive Director, Clinical Development, Amgen

Eduardo Dunayevich, MD is a member of the following medical societies: Schizophrenia International Research Society

Disclosure: Received salary from Amgen for employment; Received stock from Amgen for employment.

Acknowledgements

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.

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