Drug Intoxication

and Withdrawal: Signs and Symptoms

Alcohol Intoxication• Recent ingestion of alcohol• Clinically significant maladaptive behavioral or psychological

changes (e.g., inappropriate sexual or aggressive behaviors).• One or more the the following:

– Slurred speech -Impairment in attention or

– Incoordination memory

– Unsteady gait -Stupor or coma

– Nystagmus

Alcohol Withdrawal

• Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

• Two (or more) of the following:– Autonomic hyperactivity (sweating, high pulse rate).– Increased hand tremor -Anxiety– Insomnia -Grand mal seizures– Nausea/vomiting– Psychomotor agitation– Transient visual, tactile, or auditory hallucinations or

illusions

Sedative/Hypnotic/Anxiolytic Intoxication

• Clinically significant maladaptive behavioral or psychological changes (e.g., mood lability, inappropriate sexual or aggressive behavior).

• One or more of the following signs:– Slurred speech -Incoordination– Unsteady gait -Nystagmus– Impairment in attention or memory– Stupor or coma

• Symptoms not due to GMC or other mental disorder

Sedative/Hypnotic/Anxiolytic Withdrawal

• Two or more of the following:– Autonomic hyperactivity (e.g. sweating or PR

>100)– Increased hand tremor -Anxiety– Insomnia -Nausea or vomiting– Psychomotor agitation -Grand mal seizures– Transient visual, tactile, or auditory

hallucinations or illusions

Amphetamine Intoxication

• Recent use of amphetamine• Clinically significant maladaptive behavioral or

psychological changes (e.g., euphoria, hypervigilance).

• 2 or more of the following:– Tachycardia or bradycardia - Pupillary dilation

– Perspiration or chills - Nausea or vomiting

– Evidence of weight loss -Elevated or lowered blood pressure

Amphetamine Intoxication (Cont’d)

– Psychomotor agitation or retardation– Muscular weakness, respiratory depression,

chest pain, or cardiac arrhythmias– Confusion , seizures, dyskinesias, dystonias,

or coma– Not due to GMC or another mental disorder

Amphetamine Withdrawal• Cessation of heavy amphetamine use• Dysphoric mood, and two or more of the following:

– Fatigue– Vivid, unpleasant dreams– Insomnia or hypersomnia – Increased appetite– Psychomotor retardation or agitation

• Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

• Not due to GMC or other mental disorder

Cocaine Intoxication

• Clinically sig. maladaptive behavioral or psychological changes (e.g., euphoria, tension, etc.).

• Two or more of the following:

– Tachycardia or bradycardia -Nausea or vomiting– Pupillary dilation -Perspiration or chills– Elevated or lowered blood pressure– Evidence of weight loss

Cocaine Intoxication (Cont’d)

– Psychomotor agitation or retardation

– Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias

– Confusion, seizures, dyskinesias, dystonias, or coma

– Not due to GMC or other mental disorder

Cocaine Withdrawal• Dysphoric mood and two or more of the following:

– Fatigue– Vivid unpleasant dreams– Insomnia or hypersomnia– Increased appetite– Psychomotor retardation or agitation

• Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning

• Symptoms not due to GMC or other mental disorder.

Caffeine Intoxication

• Recent consumption of caffeine• Five of the following signs:

– Restlessness -Nervousness

– Excitement -Insomnia

– Flushed face -Diuresis

– Gastrointestinal disturbance -Muscle twitching

– Rambling flow of thought or speech

– Tachycardia or cardiac arrhythmia

– Periods of inexhaustibility

– Psychomotor agitation

Caffeine Intoxication (Cont’d)

• Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• Symptoms are not the result of a GMC or other mental disorder.

Nicotine Withdrawal• Daily use of nicotine for at least several weeks

• Abrupt cessation of nicotine use followed within 24 hours by four or more of the following:– Dysphoric or depressed mood -Insomnia– Irritability, frustration, or anger -Anxiety– Difficulty concentrating -Restlessness– Decreased heart rate– Increased appetite or weight gain

• Symptoms cause significant distress in functioning

• Symptoms not due to GMC or other mental disorder

Opioid Intoxication

• Clinically significant maladaptive behavioral or psychological changes (e.g., dysphoria, impaired judgment, euphoria followed by apathy).

• Pupillary constriction (or dilation due to anoxia from severe overdose) and at least one of the following:– Drowsiness or coma -Slurred speech– Impairment in attention or memory

• Symptoms not due to GMC or other mental disorder

Opioid Withdrawal• Three (or more) of the following:

– Dysphoric mood -Nausea or vomiting– Muscle aches -Lacrimation or

rhinorrhea– Diarrhea -Yawning– Fever -Insomnia– Pupillary dilation, piloerection, or sweating

• Symptoms cause significant distress or impairment in functioning

• Symptoms not due to GMC or other mental disorder

Cannabis Intoxication• Recent use

• Clinically significant maladaptive behavioral or psychomotor changes (e.g., euphoria, anxiety).

• Two or more of the following signs:– Conjunctival injection– Increased appetite– Dry mouth– Tachycardia

• Symptoms not due to GMC or other mental disorder

Hallucinogen Intoxication

• Clinically significant maladaptive behavior or psychomotor changes (e.g., paranoid ideation, fear of losing one’s mind).

• Perceptual changes occurring in a state of full wakefulness and alertness (e.g., depersonalization, illusions, etc.).

• Two or more of the following:– Pupillary dilation -Blurring of vision– Tachycardia -Tremors– Sweating -Incoordination– palpitations

Hallucinogen Flashbacks

• Re-experiencing one or more perceptual symptoms that were first experienced while intoxicated by a hallucinogen (e.g., flashes of color, positive after-images).

• Symptoms cause clinically significant distress or impairment

• Symptoms are not due to a GMC or other mental disorder

Inhalant Intoxication• Clinically significant maladaptive behavioral or

psychological changes (e.g., belligerence, apathy, etc.)

• Two or more of the following signs:– Dizziness -Nystagmus– Incoordination -Slurred speech– Unsteady gait -Lethargy– Depressed reflexes -Psychomotor retardation– Tremors -Generalized muscle weakness– Euphoria -Blurred vision or diplopia– Stupor or coma

Phencyclidine Intoxication - PCP

• Clinically significant maladaptive behavioral changes (e.g., belligerence, impulsiveness, etc.)

• Within an hour, two or more of the following:– Hypertension or tachycardia -Hyperacusis– Ataxia -Dysarthria– Muscle rigidity -Seizures or coma – Numbness or diminished responsiveness to pain– Vertical or horizontal nystagmus

• Symptoms are not due to GMC or other mental disorder