Stimulant Intoxication

• The prevalence of stimulant intoxication can be inferred to be similar to rates of stimulant use disorder.

• The magnitude and direction of the behavioural and physiological changes depend on many factors, including the dose, environmental context, and characteristics of the individual (e.g. - tolerance, rate of absorption, chronicity of us).
• Stimulant effects such as euphoria, increased pulse and blood pressure, and psychomotor activity are most common.
• Depressant effects such as sadness, bradycardia, hypotension, and decreased psychomotor activity are less common and generally happen only with chronic high-dose use.^[2]
• Intoxication, either acute or chronic, is often associated with impaired social or occupational functioning.
• Severe intoxication or overdose can lead to seizures, cardiac arrhythmias, hyperpyrexia (fever), and death.^[3]

Recent use of an amphetamine-type substance, cocaine, or other stimulant.

Clinically significant problematic behavioural or psychological changes (e.g. - euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, use of a stimulant.

At least 2 of the following signs or symptoms, developing during, or shortly after, stimulant use:

1. Tachycardia or bradycardia
2. Pupillary dilation
3. Elevated or lowered blood pressure
4. Perspiration or chills
5. Nausea or vomiting
6. Evidence of weight loss
7. Psychomotor agitation or retardation
8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
9. Confusion, seizures, dyskinesias (i.e. - involuntary, erratic, writhing “dance-like” movements of the face, arms, legs or trunk), dystonias (i.e. - slow repetitive movements or abnormal posture), or coma

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

• Amphetamine intoxication: euphoria, grandiosity, pupillary dilation, prolonged wakefulness, hyperalertness, hypertension, paranoia, fever, fractured teeth, skin excoriations (in methamphetamine use)
  • Paranoia is a more characteristic feature of amphetamine intoxication (than cocaine).
  • Severe events can include cardiac arrest, seizures, and death.
• Cocaine intoxication: impaired judgment, pupillary dilation, hallucinations (including tactile), paranoia, angina, sudden cardiac death.
  • Chronic use may lead to perforated nasal septum due to vasoconstriction and resulting ischemic necrosis.

• Stimulant-induced disorders
  • Stimulant intoxication is different from the other stimulant-induced disorders (e.g. - stimulant-induced depressive disorder, bipolar disorder, psychotic disorder, anxiety disorder) because the severity of the intoxication symptoms exceeds that associated with the stimulant-induced disorders, and the symptoms warrant additional independent clinical attention. Stimulant intoxication delirium is characterized by a fluctuation in level of awareness and change in cognition.
• Other mental disorders
  • Salient mental disturbances associated with stimulant intoxication should be distinguished from the symptoms of schizophrenia spectrum disorders, bipolar disorder, depressive disorders, generalized anxiety disorder, and panic disorder.

• Urine drug screen may be helpful to identify the specific stimulant intoxication.

• The physical signs and symptoms in the diagnostic criteria above can be helpful to confirm the diagnosis (e.g. - dyskinesias, pupillary dilation)