special subjects
Amphetamines
Symptoms and Signs ofAmphetamineUse
Many psychologic effects of amphetamines are similar to those of Cocaine ; they include increased alertness and concentration, euphoria, and feelings of well-being and grandiosity. Palpitations, tremor, diaphoresis, and mydriasis may also occur during intoxication. Binges (perhaps over several days) lead to an exhaustion syndrome, involving intense fatigue and need for sleep after the stimulation phase. Tachycardia, arrhythmias, chest pain, hypertension, dizziness, nausea, vomiting, and diarrhea can occur. Central nervous system effects include acute delirium and toxic psychosis. Overdose can also cause stroke (usually hemorrhagic), seizures, muscle rigidity, and hyperthermia (>40°C); all of these effects may precipitate rhabdomyolysis, which can lead to renal failure. A paranoid psychosis may result from long-term use of amphetamines; rarely, the psychosis is precipitated by a single high dose or by repeated moderate doses. Typical features include delusions of persecution, ideas of reference (notions that everyday occurrences have special meaning or significance personally meant for or directed to the patient), and feelings of omnipotence. Some users experience a prolonged depression, during which suicide is possible. Recovery from even prolongedamphetaminepsychosis is usual but is slow. The more florid symptoms fade within a few days or weeks, but some confusion, memory loss, and delusional ideas commonly persist for months. Users have a high rate of severe tooth decay affecting multiple teeth; causes include decreased salivation, acidic combustion products, Bruxism , and poor oral hygiene. Although no stereotypical withdrawal syndrome occurs when amphetamines are stopped, electroencephalogram changes occur, considered by some experts to fulfill the physical criteria for dependence. Chronicamphetamineusers who abruptly stop using the drug may feel dysphoria, fatigue, anxiety, irritability, insomnia or hypersomnia, or unpleasant dreams. Withdrawal may uncover or exacerbate underlying depression or precipitate a serious depressive reaction. Withdrawal symptoms typically start within 24 hours of the lastamphetamineuse. Severe symptoms may subside within a week, but some less severe symptoms, such as sleep disturbance, may last for weeks to months. 