PSYCHOSTIMULANTS—CLINICAL MANIFESTATIONS

PSYCHOSTIMULANTS—CLINICAL MANIFESTATIONS is a topic covered in the Harrison's Manual of Medicine.

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All psychostimulants produce the same acute CNS effects: euphoria, increased energy/decreased fatigue, reduced need for sleep, decreased appetite, decreased distractibility, increased self-confidence and alertness, increased libido, and prolonged orgasm, independent of the specific psychostimulant or route of administration. Peripheral effects may include tremor, diaphoresis, hypertonia, tachypnea, hyperreflexia, and hyperthermia. Many of the effects are biphasic; for example, low doses improve psychomotor performance, while higher doses may cause tremors or convulsions. Alpha-adrenergically mediated cardiovascular effects are also biphasic, with low doses resulting in increased vagal tone and decreased heart rate, and high doses causing increased heart rate and blood pressure. Psychostimulant use can result in restlessness, irritability, and insomnia and, at higher doses, suspiciousness, repetitive stereotyped behaviors, and bruxism. Endocrine effects may include impotence, gynecomastia, menstrual function disruptions, and hyperprolactinemia.

Overdose presents as sympathetic nervous system overactivity with psychomotor agitation, hypertension, tachycardia, headache, and mydriasis, and can lead to convulsions, cerebral hemorrhage or infarction, cardiac arrhythmias or ischemia, respiratory failure, or rhabdomyolysis. It is a medical emergency; treatment is largely symptomatic and should occur in an intensive care or telemetry unit. Inhalation of crack cocaine that is vaporized at high temperatures can cause airway burns, bronchospasm and other symptoms of pulmonary disease. MDMA can raise body temperature and result in liver, kidney, or heart failure, or death.

Psychostimulants are often used with other drugs, including opioids and alcohol, whose CNS-depressant effects tend to attenuate psychostimulant-induced CNS stimulation.

Adulteration of psychostimulants, particularly cocaine, with other drugs is common and can have additional potential health consequences.

Withdrawal from psychostimulants often includes hypersomnia, increased appetite, and depressed mood. Acute withdrawal typically lasts 7–10 days, but residual symptoms, possibly associated with neurotoxicity, may persist for several months. Psychostimulant withdrawal is not thought to be a driver of ongoing use.

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