Clinical Features and Management of Intoxication Due to Hallucinogenic Drugs

Abstract

Hallucinogenic drugs are unique in that they produce the desired hallucinogenic effects at what are considered non-toxic doses. The hallucinogenic drugs can be categorised into 4 basic groups: indole alkaloid derivatives, piperidine derivatives, phenylethylamines and the cannabinols. The drugs reviewed include lysergic acid diethylamide (LSD), phencyclidine (PCP), cocaine, amphetamines, opiates, marijuana, psilocybin, mescaline, and 'designer drugs.' Particularly noteworthy is that each hallucinogen produces characteristic behavioural effects which are related to its serotonergic, dopaminergic or adrenergic activity. Cocaine produces simple hallucinations, PCP can produce complex hallucinations analogous to a paranoid psychosis, while LSD produces a combination of hallucinations, pseudohallucinations and illusions. Dose relationships with changes in the quality of the hallucinatory experience have been described with amphetamines and, to some extent, LSD. Flashbacks have been described with LSD and alcohol. Management of the intoxicated patient is dependent on the specific behavioural manifestation elicited by the drug. The principles involve differentiating the patient's symptoms from organic (medical or toxicological) and psychiatric aetiologies and identifying the symptom complex associated with the particular drug. Panic reactions may require treatment with a benzodiazepine or haloperidol. Patients with LSD psychosis may require an antipsychotic. Patients exhibiting prolonged drug-induced psychosis may require a variety of treatments including ECT, lithium and l-5-hydroxytryptophan.

Occurrence and use of hallucinogenic mushrooms containing psilocybin alkaloids

“…This report does not aim to cover the management of poisoning of psilocybin-containing mush-rooms. The readers interested in this area are referred to reviews available (e.g., Leikin et al, 1989;Köppel, 1993).…”

5 -HT1A Receptor agonist (8-OH-DPAT) and 5-HT2 receptor agonist (DOI) disrupt the non-cognitive performance of rats in a working memory task

“…Thus, abnormal activation of 5-HT2 receptors could result in a disruption of behaviour, such as that found in pathological conditions related to the overactivity of the 5-HT system (Griebel, 1995) or up-regulation of 5-HT2 receptors [suicidal tendencies, depression, Arora and Meltzer (1989), Biegon et al (1990a,b), Pandey et al (1990), schizophrenia, Joyce et al (1993) or drug abuse (e.g. LSD), Leikin et al (1989), Hurlbut (1991)]. The behavioural disturbances associated with Alzheimer's disease, such as depression or aggressive behaviour, have also been related to abnormalities in the serotonergic system (Palmer et al, 1988), but in Alzheimer's disease there is a reduction of 5-HT~ receptors in the cortex (Cross, 1990).…”

Champignons hallucinogènes d'Europe et des Amériques : mise au point mycologique et toxicologique

“…Cependant, l'action de la psilocybine pure a été décrite de façon très précise par Shulgin (14) lors d'expé-riences sur lui-même, où il constatait que l'ampleur des phénomènes hallucinatoires était dose-dépendante. Les effets cliniques sont de trois ordres, somatiques, sensoriels et émotionnels et peuvent être résumés ainsi: la symptomatologie se développe dans les 20 à 30 minutes qui suivent la prise orale, dure en général moins de 4 heures et disparaît complètement dans les 12 heures (4,8,(15)(16)(17)(18)(19).…”