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Try out PMC Labs and tell us what you think. Learn More. Background: Cocaine is an addictive drug that produces numerous psychiatric symptoms, syndromes, and disorders. The symptoms include agitation, paranoia, hallucinations, delusions, violence, as well as suicidal and homicidal thinking. They can be primary to the drug's effect or secondary to exacerbation of comorbid psychiatric disorders. Additional reports were found via bibliographies of various published reports. Many patients with cocaine dependence have also been found to have a comorbid psychiatric disorder.
Conclusion: Cocaine can produce a spectrum of psychiatric symptoms with which primary care practitioners need to be familiar. Comorbid psychiatric disorders are frequent in patients with cocaine use disorders and can worsen with cocaine use. Nonaddictive medication may be necessary to treat comorbid conditions such as anxiety and depressive disorders. Primary care practitioners need to be familiar with the treatment programs for patients with cocaine use disorders so appropriate referral can easily take place and follow-up care can be understood and maintained.
The likelihood is high that primary care practitioners will encounter patients with substance use problems, as these disorders are not rare. In the United States, there is currently an Chemical dependence to Cocaine and mental illness is a psychiatric, psychological, and biological disorder that affects almost all areas of a person's life. Cocaine has the potential to produce a spectrum of psychiatric symptoms and exacerbate many mental disorders.
Additional reports were located by reviewing the bibliographies of the reports found in the initial search. This article reviews some of the more frequent symptoms, offers an explanation for their presence, and discusses possible treatments of the symptoms as well as the addiction. Cocaine is one of the most addictive substances used in today's society. Crack is cocaine cocaine basebut not in the powder form. The powder has a slower onset of action to produce the euphoric effects compared with crack, which is a solid formed by mixing cocaine powder with water and baking soda.
This transformation makes crack a drug that is easier and more economical to market and, consequently, much less expensive. Getting cocaine into a vapor form or smoke is important to cocaine users for 2 reasons. The first is that, when smoked, the drug is delivered through the lungs to the brain almost immediately. It then causes release of brain chemicals in the pleasure centers of the brain, resulting in the desired stimulating, euphoric effects.
The second reason is that the crack form does not waste cocaine by burning it up. Cocaine has numerous effects on many important neurotransmitters in the brain; however, the most dramatic effect is on the increase as well as the release of dopamine. Dopamine is thought to be the primary neurotransmitter involved in the pleasure centers of the brain. Excessive dopamine levels have also been hypothesized to be associated with anger, aggressiveness, hallucinations, delusions, and other psychotic symptoms.
Cocaine also initially increases levels of norepinephrine and serotonin, 2 other essential neurotransmitters. Serotonin is partially responsible for regulating mood, appetite, and sleep, as well as other essential behaviors. A person's compulsive use may be an attempt to maintain the neurotransmitters at homeostatic levels.
Crack produces effects almost instantaneously, within seconds, whereas intranasal powder cocaine may require 5 to 10 minutes to produce effects. These effects consist of intense euphoria, pleasure, and ecstasy, states in which everything pleasurable is intensified. Moving around a lot. Talking a lot. But the rush is gone. I dunno… it's crazy. When a patient is using cocaine excessively, there is little difficulty in arriving at the diagnosis of cocaine dependence. To satisfy the criteria for the diagnosis of cocaine dependence, only 3 of the following conditions must be present according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition 3 :.
Developing tolerance to the euphoric effects of cocaine and requiring more drug to produce the desired effects. Stopping cocaine usually in withdrawal symptoms such as fatigue, sleep disturbances, agitation, or depressionand these symptoms can be relieved by using cocaine again. Using cocaine in large amounts whenever it is available. Seldom do people save some for later. Inability to successfully maintain employment while using cocaine because of ineffectiveness at work, increased absenteeism, inability to hold a job, or inability to find work.
Practitioners may consider the voluntary use of cocaine to be an issue. While voluntary use almost always occurs the first time cocaine is tried, cocaine dependence involving compulsive use frequently follows. Cocaine and mental illness compulsive use is often biologically based, yet many clinicians mistakenly believe the cocaine user can stop using the drug whenever he or she wants. In helping to understand the compulsive use found in patients with cocaine dependence, the following description and commentary by Dr.
Sidney Cohen is quite helpful:. In an unlimited access situation, monkeys will self-administer cocaine by bar pressing for it until they die in status epilepticus. In one study primates bar pressed 12, times in order to get a single dose of cocaine. They will work for cocaine in preference to food even though they are starving. They will continue to bar press even though a receptive female Cocaine and mental illness in their cage.
They will prefer an electric shock in order to obtain a large dose of cocaine despite the fact that they could have received a lesser dose without a shock. Such animal cravings take place in the absence of personality disorders, situation stresses, or some characterological inadequacy. All monkeys respond in this compulsive manner. If humans had unlimited access to cocaine, they probably would behave in a similar way.
The highly Cocaine and mental illness properties of cocaine can make obsessive users of the most mature and well integrated among us. Cocaine is not selective in its effects on neurochemistry. Besides stimulating the pleasure centers in the brain, it at the same time activates other systems that control arousal, survival, appetite, mood, and sleep. Although intense pleasure is experienced, a person can also experience nervousness, restlessness, agitation, suspiciousness, paranoia, confused thinking, delirium, hallucinations, delusions, violence, suicide, and homicide.
Paranoia and suspiciousness are often initial symptoms of psychosis. These psychotic symptoms may be related to an imbalance of dopamine. Psychosis appears to be more common with the use of crack compared with other routes, such as intravenous and intranasal use. Violence has been associated with cocaine use.
Cocaine-induced psychiatric symptoms undoubtedly contribute to the emergence of violence. Besides an 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, hyperactivity, impaired judgment, and paranoia. Inhalation of crack cocaine has been found to produce a greater amount of anger and violence than intranasal use of cocaine. Homicide also has been associated with cocaine use. Other cities have reported similar disturbing findings.
Suicide can be viewed as a form of self-destructive, violent behavior. One investigator has postulated that cocaine may produce impatience, irritability, paranoia, and edginess leading to violent behavior. Cocaine abusers may have problems with thinking logically. The resultant effects would be poor judgment in an individual experiencing impulsivity in the face of severe cocaine craving. Delirium, a potentially fatal syndrome marked by severe, fluctuating confusion and autonomic nervous system instability such as severe blood pressure changes, pulse changes, and sweatingcan occur with cocaine use.
Changes in dopamine, norepinephrine, and serotonin levels have been associated with these effects. Delirium can be accompanied by psychotic symptoms such as paranoia, hallucinations, delusions, and agitated behavior. One report noted that 7 individuals with fatal cocaine intoxication developed an excited delirium with intense paranoia and bizarre and violent behavior, requiring forcible restraint. However, he has also described the patterns that evolve when cocaine is stopped: the cocaine abstinence syndrome. During the withdrawal phase, anxiety, hostility, paranoia, and depression have been observed.
The rapid reduction in the intensity of these withdrawal symptoms can constitute a major reason a crack addict continues use. In this situation, the reward is a reduction or elimination of the withdrawal symptoms. Successful treatment often occurs in an outpatient setting.Cocaine and mental illness
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