Cocaine related disorders

Substance-related disorders

Clinicals - History

Fact Explanation
Seizures Cocaine intoxication.These changes are caused by the changes in the neurotransmitter levels in brain Seizures
Cocaine intoxication.These changes are caused by the changes in the neurotransmitter levels in brain
Chest pain and palpitations Due to cocaine intoxication
Cocaine abuse is associated with left ventricular dysfunction
Chest pain and palpitations
Due to cocaine intoxication
Cocaine abuse is associated with left ventricular dysfunction
Somnolence Cocaine withdrawal. Withdrawal symptoms develop within hours or days after cocaine use that has been heavy and prolonged and then abruptly stopped. Insomnia also occurs due to cocaine induced sleep disorders Somnolence
Cocaine withdrawal. Withdrawal symptoms develop within hours or days after cocaine use that has been heavy and prolonged and then abruptly stopped. Insomnia also occurs due to cocaine induced sleep disorders
Body pains, joint pains,craving Cocaine withdrawal symptoms.While cocaine use results in a sensation of energy, excitement and confidence, withdrawing from cocaine pretty much results in the opposite effect.The extent of craving variation can depend on certain personality styles Body pains, joint pains,craving
Cocaine withdrawal symptoms.While cocaine use results in a sensation of energy, excitement and confidence, withdrawing from cocaine pretty much results in the opposite effect.The extent of craving variation can depend on certain personality styles
Inability to concentrate or pay attention,change in the ability to think Cocaine induced delirium.These symptoms have rapid onset within hours or days of using cocaine and the symptoms fluctuate throughout the course Inability to concentrate or pay attention,change in the ability to think
Cocaine induced delirium.These symptoms have rapid onset within hours or days of using cocaine and the symptoms fluctuate throughout the course
Hallucinations Cocaine induced psychotic disorder.
Cocaine has numerous effects on many important neurotransmitters in the brain.Excessive dopamine gives rise to hallucinations, specially visual hallucinations.
Hallucinations
Cocaine induced psychotic disorder.
Cocaine has numerous effects on many important neurotransmitters in the brain.Excessive dopamine gives rise to hallucinations, specially visual hallucinations.
Delusions Cocaine induced psychotic disorder. Mainly persecutory delusions due to changes in the dopamine levels Delusions
Cocaine induced psychotic disorder. Mainly persecutory delusions due to changes in the dopamine levels
Violence Increase in levels of neurotransmitters in the brain's pleasure centers, dramatic change in levels of norepinephrine and serotonin in other parts of the brain might provoke aggression Violence
Increase in levels of neurotransmitters in the brain's pleasure centers, dramatic change in levels of norepinephrine and serotonin in other parts of the brain might provoke aggression
Anxiety and Panic attacks Cocaine induced anxiety disorder.Cocaine addiction is linked to changes within neural systems and brain regions that are critical mediators of stress system sensitivity Anxiety and Panic attacks
Cocaine induced anxiety disorder.Cocaine addiction is linked to changes within neural systems and brain regions that are critical mediators of stress system sensitivity
Shoplifting, theft, burglary Cocaine dependency.Spending a great deal of time and energy obtaining and using cocaine Shoplifting, theft, burglary
Cocaine dependency.Spending a great deal of time and energy obtaining and using cocaine
Impaired sexual desire, impaired arousal Cocaine induced sexual disorders Impaired sexual desire, impaired arousal
Cocaine induced sexual disorders
Epistaxis, loss of smell Chronic cocaine snorting leads to destruction of nasal bone. Repeated snorting sets up a cascade of ischemia, inflammation, micronecrosis, infection, and then macronecrosis leading to perforation Epistaxis, loss of smell
Chronic cocaine snorting leads to destruction of nasal bone. Repeated snorting sets up a cascade of ischemia, inflammation, micronecrosis, infection, and then macronecrosis leading to perforation
Diplopia Adjacent bony structures may become eroded and vital tissues (eg:optic tract) may get damaged Diplopia
Adjacent bony structures may become eroded and vital tissues (eg:optic tract) may get damaged
Dental erosions, oral mucosal ulceration Topically applied cocaine (Gingival application) can be locally destructive to the oral mucosa and dentition. Acute ulceration, necrosis, and rapid recession of gingival tissues, as well as erosion of both dentin and enamel, have been reported Dental erosions, oral mucosal ulceration
Topically applied cocaine (Gingival application) can be locally destructive to the oral mucosa and dentition. Acute ulceration, necrosis, and rapid recession of gingival tissues, as well as erosion of both dentin and enamel, have been reported
Symptoms of drug dependence A compulsion to take the substance
Escalation of amount used
A withdrawal syndrome following reduction in use
Tolerance
Neglect of other activities in favour of substance use
Persistent use despite evidence of harm
Symptoms of drug dependence
A compulsion to take the substance
Escalation of amount used
A withdrawal syndrome following reduction in use
Tolerance
Neglect of other activities in favour of substance use
Persistent use despite evidence of harm

Clinicals - Examination

Fact Explanation
Hypertention Cocaine intoxication.Cocaine leads to impaired neurotransmitter release Hypertention
Cocaine intoxication.Cocaine leads to impaired neurotransmitter release
Tachycardia Cocaine intoxication.Due to impaired neurotransmitter release Tachycardia
Cocaine intoxication.Due to impaired neurotransmitter release
Tremors Cocaine intoxication.Due to impaired neurotransmitter release Tremors
Cocaine intoxication.Due to impaired neurotransmitter release
Blood pressure fluctuations Cocaine induced delirium.Changes in dopamine, norepinephrine, and serotonin levels have been associated with these effects Blood pressure fluctuations
Cocaine induced delirium.Changes in dopamine, norepinephrine, and serotonin levels have been associated with these effects
Shortness of breath Due to panic attacks caused by anxiety disorders Shortness of breath
Due to panic attacks caused by anxiety disorders
Depressed mood Cocaine induced psychotic disorder.Due to imbalance of neurotransmitters Depressed mood
Cocaine induced psychotic disorder.Due to imbalance of neurotransmitters
Nasal septal defects,saddle nose deformity Chronic cocaine snorting leads to destruction of nasal bone. Repeated snorting sets up a cascade of ischemia, inflammation, micronecrosis, infection, and then macronecrosis leading to perforation Nasal septal defects,saddle nose deformity
Chronic cocaine snorting leads to destruction of nasal bone. Repeated snorting sets up a cascade of ischemia, inflammation, micronecrosis, infection, and then macronecrosis leading to perforation
Palatal perforation,nasopalatal fistula Chronic cocaine snorting leads to destruction of palatal bones Palatal perforation,nasopalatal fistula
Chronic cocaine snorting leads to destruction of palatal bones
Dental erosions, oral mucosal ulceration Topically applied cocaine (Gingival application) can be locally destructive to the oral mucosa and dentition. Acute ulceration, necrosis, and rapid recession of gingival tissues, as well as erosion of both dentin and enamel, have been reported Dental erosions, oral mucosal ulceration
Topically applied cocaine (Gingival application) can be locally destructive to the oral mucosa and dentition. Acute ulceration, necrosis, and rapid recession of gingival tissues, as well as erosion of both dentin and enamel, have been reported
Loss of visual acuity Adjacent bony structures may become eroded and vital tissues (eg:optic tract) may get damaged Loss of visual acuity
Adjacent bony structures may become eroded and vital tissues (eg:optic tract) may get damaged

Investigations - Diagnosis

Fact Explanation
Urine tests to detect cocaine metabolites The breakdown products of cocaine remain in the urine.Maximum concentration tends to be high after intravenous route Urine tests to detect cocaine metabolites
The breakdown products of cocaine remain in the urine.Maximum concentration tends to be high after intravenous route
Neuropsychological assessments Diagnosis can be done according to ICD 10 or DSM-IV criteria. Neuropsychological tests are designed to examine a variety of cognitive abilities, including speed of information processing, attention, memory, and language Neuropsychological assessments
Diagnosis can be done according to ICD 10 or DSM-IV criteria. Neuropsychological tests are designed to examine a variety of cognitive abilities, including speed of information processing, attention, memory, and language
Drug dependence Diagnostic features for substance dependence
Three or more of the following should have been present in the previous year:
1.A compulsion to take the substance 2.Escalation of amount used
3.A withdrawal syndrome following reduction in use
4.Tolerance
5.Neglect of other activities in favour of substance use (salience)
6.Persistent use despite evidence of harm
Drug dependence
Diagnostic features for substance dependence
Three or more of the following should have been present in the previous year:
1.A compulsion to take the substance 2.Escalation of amount used
3.A withdrawal syndrome following reduction in use
4.Tolerance
5.Neglect of other activities in favour of substance use (salience)
6.Persistent use despite evidence of harm

Investigations - Management

Fact Explanation
Neuropsychological assessments Studies have shown dose-related effects on complex tasks of higher cortical functions (attention, planning, mental flexibility, executive functioning, psychomotor functioning) which improve with treatment Neuropsychological assessments
Studies have shown dose-related effects on complex tasks of higher cortical functions (attention, planning, mental flexibility, executive functioning, psychomotor functioning) which improve with treatment
Echocardiography To identify left ventricular hypertrophy which is positive in long term cocaine users Echocardiography
To identify left ventricular hypertrophy which is positive in long term cocaine users
Coronary Angiography Coronary artery occlusion due to increased thrombotic risk (increased platelets) due to chronic cocaine use Coronary Angiography
Coronary artery occlusion due to increased thrombotic risk (increased platelets) due to chronic cocaine use
ECG / blood pressure To detect effects of cocaine on cardiovascular system
Cocaine blocks the reuptake of norepinephrine and dopamine, causing an accumulation of catecholamines causing high blood pressure and increased heart rate
ECG / blood pressure
To detect effects of cocaine on cardiovascular system
Cocaine blocks the reuptake of norepinephrine and dopamine, causing an accumulation of catecholamines causing high blood pressure and increased heart rate
Echocardiogram, cardiovascular magnetic resonance Included measurement of left and right ventricular (LV, RV) dimensions and ejection fraction (EF),to detect effects of cocaine on heart Echocardiogram, cardiovascular magnetic resonance
Included measurement of left and right ventricular (LV, RV) dimensions and ejection fraction (EF),to detect effects of cocaine on heart
Platelet count Cocaine increases the risk of thrombus formation due to associated increase in platelet count, increased platelet activation Platelet count
Cocaine increases the risk of thrombus formation due to associated increase in platelet count, increased platelet activation
Neuropsychological assessments Neuropsychological tests are designed to examine a variety of cognitive abilities, including speed of information processing, attention, memory, and language Neuropsychological assessments
Neuropsychological tests are designed to examine a variety of cognitive abilities, including speed of information processing, attention, memory, and language
Information from the patient's relatives/caregivers To inquire about the symptoms of cocaine induced disorders Information from the patient's relatives/caregivers
To inquire about the symptoms of cocaine induced disorders

Management - Supportive

Fact Explanation
Cognitive behavioral therapy Typical cognitive strategies employed are recognizing and challenging dysfunctional thoughts about substances and recognizing seemingly irrelevant decisions that lead to a relapse Cognitive behavioral therapy
Typical cognitive strategies employed are recognizing and challenging dysfunctional thoughts about substances and recognizing seemingly irrelevant decisions that lead to a relapse
Motivational interviews Helps people to explore and resolve their ambivalence about their substance use and begin to make positive behavioral and psychological changes Motivational interviews
Helps people to explore and resolve their ambivalence about their substance use and begin to make positive behavioral and psychological changes
Relapse prevention Has been theorized to be a set of strategies to help the client maintain treatment gains rather than a specific intervention Relapse prevention
Has been theorized to be a set of strategies to help the client maintain treatment gains rather than a specific intervention
Self help groups Support groups and group therapy led by a therapist can be helpful because other addicts can share coping and relapse-prevention strategies Self help groups
Support groups and group therapy led by a therapist can be helpful because other addicts can share coping and relapse-prevention strategies
Social support Studies have shown that normalization of social bonding and rewarding can strengthen cognition against drug intake
Social function (marital disharmony, work relationships etc.) is a strong predictor of the subjective effects of cocaine addiction, thus good social support is needed in the management
Social support
Studies have shown that normalization of social bonding and rewarding can strengthen cognition against drug intake
Social function (marital disharmony, work relationships etc.) is a strong predictor of the subjective effects of cocaine addiction, thus good social support is needed in the management

Management - Specific

Fact Explanation
Anti psychotics Typical antipsychotics, which promote a potent blockage of D2 receptors, show little effectiveness in the treatment of dependence. In contrast, atypical antipsychotics, which act on serotoninergic receptors, dissociate from the D2 receptor faster than the typical Anti psychotics
Typical antipsychotics, which promote a potent blockage of D2 receptors, show little effectiveness in the treatment of dependence. In contrast, atypical antipsychotics, which act on serotoninergic receptors, dissociate from the D2 receptor faster than the typical
Fluoxetine Chronic fluoxetine treatment attenuated cocaine-primed reinstatement.However, SSRIs have had limited success in clinical trials for cocaine abuse, possibly due to neurobiological changes that occur during chronic administration Fluoxetine
Chronic fluoxetine treatment attenuated cocaine-primed reinstatement.However, SSRIs have had limited success in clinical trials for cocaine abuse, possibly due to neurobiological changes that occur during chronic administration
Dopaminergic medication Normalizes dopamine signaling.To date, the most promising results are with a combination of a dopaminergic medication with a contingency management behavioral intervention Dopaminergic medication
Normalizes dopamine signaling.To date, the most promising results are with a combination of a dopaminergic medication with a contingency management behavioral intervention
Propranolol The beta-blocker, propranolol, appears to be promising for the treatment of patients who present for treatment with severe cocaine withdrawal symptoms
It also increases the duration of abstinence
Propranolol
The beta-blocker, propranolol, appears to be promising for the treatment of patients who present for treatment with severe cocaine withdrawal symptoms
It also increases the duration of abstinence
Baclofen Baclofen is GABA B agonist used as a muscle relaxant. As a GABA agonist, baclofen may reduce the amount of dopamine released into the nucleus accumbens as a result of cocaine stimulation or cocaine craving Baclofen
Baclofen is GABA B agonist used as a muscle relaxant. As a GABA agonist, baclofen may reduce the amount of dopamine released into the nucleus accumbens as a result of cocaine stimulation or cocaine craving
Tiagabine Tiagabine is another GABAergic medication that may be promising for the treatment of cocaine dependence.Currently approved for the treatment of seizures Tiagabine
Tiagabine is another GABAergic medication that may be promising for the treatment of cocaine dependence.Currently approved for the treatment of seizures
Topiramate An excellent medication for relapse prevention based on its effects on both GABA neurotransmission and glutamate neurotransmission
It also increases the rate of abstinence
Topiramate
An excellent medication for relapse prevention based on its effects on both GABA neurotransmission and glutamate neurotransmission
It also increases the rate of abstinence
Disulfiram Cocaine relapse prevention medication.It blocks the enzymatic degradation of cocaine and dopamine and leads to extremely high cocaine and dopamine levels when cocaine is ingested.This does not increase the cocaine-induced high, as one might expect, but rather it makes the high less pleasant by increasing the associated anxiety.
It also increases the duration of abstinence
Disulfiram
Cocaine relapse prevention medication.It blocks the enzymatic degradation of cocaine and dopamine and leads to extremely high cocaine and dopamine levels when cocaine is ingested.This does not increase the cocaine-induced high, as one might expect, but rather it makes the high less pleasant by increasing the associated anxiety.
It also increases the duration of abstinence
Modafinil May be efficacious for cocaine dependence by ameliorating glutamate depletion seen in chronic cocaine users Modafinil
May be efficacious for cocaine dependence by ameliorating glutamate depletion seen in chronic cocaine users
The vaccine (TA-CD) For relapse prevention.Works by stimulating the production of cocaine-specific antibodies that bind to cocaine molecules and prevent them from crossing the blood brain barrier The vaccine (TA-CD)
For relapse prevention.Works by stimulating the production of cocaine-specific antibodies that bind to cocaine molecules and prevent them from crossing the blood brain barrier

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