Amphetamine-Related Psychiatric Disorders Workup

Updated: Sep 12, 2017
  • Author: Amy Barnhorst, MD; Chief Editor: Glen L Xiong, MD  more...
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Workup

Laboratory Studies

The purpose of the workup is to exclude complications of amphetamine abuse and other causes of psychosis and altered mental status.

Laboratory evaluation should include the following tests:

  • Finger-stick blood glucose test

  • CBC determination

  • Determination of electrolyte levels, including magnesium, amylase, albumin, total protein, uric acid, BUN, alkaline phosphatase, and bilirubin levels

  • Urinalysis

  • Stat urine or serum toxicology screening to exclude acetaminophen, tricyclic antidepressants, aspirin, and other potential toxins: Individuals who abuse drugs may ingest a substance called Urine Luck, or pyridinium chlorochromate (PCC), to produce invalid results on urine drug screens. PCC alters the results for cannabis and opiates but elevates levels of amphetamines.

  • Blood test for an alcohol level if the patient appears intoxicated

  • HIV and rapid plasma reagin (RPR) tests

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Imaging Studies

In the presence of neurologic impairments, CT or MRI helps in evaluating for subarachnoid and intracranial hemorrhage.

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Other Tests

Perform ECG to evaluate for cardiac involvement.

Perform EEG if a seizure disorder is considered possible.

Use of the brief psychotic rating scale (BPRS), Beck Depression Scale, violence and suicide assessment, and other measures may be helpful.

If persistent psychiatric conditions are noted, neuropsychological testing can be beneficial to assess levels of psychosocial and neurologic function to guide treatment and to assess the need for placement.

Results of projective testing, such as the Rorschach test and the Thematic Apperception Test, can help in clarifying thought disorders.

During amphetamine intoxication, the Mini-Mental State Examination (MMSE) can be helpful in measuring cognitive change.

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Histologic Findings

Repeated exposure to amphetamines is theorized to alter the morphology of dendrites in the prefrontal cortex and in the nucleus accumbens. Amphetamines may increase the length of dendrites for longer than 1 month. These alterations may help explain the behavioral cravings and psychosis that long-term abuse of amphetamines produces.

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