Clinical presentation and physical signs
Since cocaine belongs to the group of psychoactive substances, its use causes systemic changes in the body. Diagnosis is often based on identifying a complex of indirect signs, as patients are prone to anosognosia (lack of awareness of the illness) and dissimulation.
The main somatic and vegetative manifestations of cocaine dependence include:
- Specific reactions: in a state of cocaine intoxication, the patient exhibits marked facial pallor and mydriasis (pupillary dilation). When abstinence syndrome (withdrawal) develops, the pupillary reaction changes.
- Weight changes: like most drugs, cocaine causes anorexia. The lack of appetite against the background of intoxication and subsequent withdrawal leads to a sharp and dangerous weight loss.
- Injection marks and risky behavior: if the substance is administered intravenously, subcutaneous hematomas, sclerosed veins, and phlebitis with the risk of gangrene are possible. Uncontrollable craving for cocaine leads to a loss of caution: casual unprotected sex, use of non-sterile syringes. The detection of HIV, syphilis, or viral hepatitis in a patient should always alert the physician.
Mental and behavioral changes
Cocaine addiction inevitably leads to severe social and personal degradation. The search for and use of psychoactive substances becomes an overvalued need, overshadowing all other aspects of life.
- Emotional lability. Sharp mood swings are observed. Intoxication is accompanied by complacency and euphoria, which are replaced during withdrawal by malice, gloom, anxiety, and aggression.
- Circadian rhythm disorders. Sleep inversion is characteristic: nighttime activity is replaced by daytime drowsiness. Upon drug withdrawal, persistent insomnia and depression develop.
- Social degradation. The patient tends to isolate, locks themselves in a room or leaves home, and skips classes or work. Egocentrism and indifference to loved ones develop.
- Antisocial behavior. To obtain a new dose, patients get into debt, commit thefts, and participate in illegal schemes.
Challenges and differential diagnosis
The main diagnostic method is a thorough analysis of all clinical information. Laboratory detection of psychoactive substances in urine and blood has limitations and is not absolutely reliable.
Differential diagnosis of cocaine addiction with endogenous diseases (schizophrenia, affective psychoses) presents particular difficulty, as symptoms may overlap. For example, endogenous depression also features marked weight loss, dry skin, and pupillary dilation.
Differences between addiction and endogenous psychoses:
- In addiction, productive psychotic disorders (hallucinations, delusions) develop rarely and last briefly (hours). In schizophrenia, delusional ideas are persistent and can last for weeks.
- Addiction is characterized by sharp, short-lived mood fluctuations (from euphoria to gloom) and pronounced vegetative reactions (flushing or pallor, tachycardia replaced by bradycardia), which is atypical for classical endogenous diseases.
Principles and stages of treatment
Treatment of cocaine addiction in the Russian Federation is carried out on a strictly voluntary basis (except for court orders) and aims at complete cessation of psychoactive substance use. Foreign substitution therapy programs are banned in Russia.
Therapy must be comprehensive, prolonged, and strictly phased:
- Management of intoxication and withdrawal syndrome. At this stage, the physician uses medications and psychotherapy to calm the patient. Non-benzodiazepine hypnotics (hydroxyzine, doxylamine) or sedative antipsychotics (chlorprothixene, quetiapine) are used. Tranquilizers are prescribed only for a short course.
- Establishment of remission. The goal is emotional control. For depression and anxiety, antidepressants (sertraline, paroxetine, mirtazapine) are prescribed; for irritability, anticonvulsants (valproates, carbamazepine) or antipsychotics are used.
- Stable remission. The focus shifts to group psychotherapy, social rehabilitation, correction of core personality traits, and restoration of family relationships.
Briefly: answers to topical questions
What vegetative and somatic signs are characteristic of acute cocaine intoxication?
Acute cocaine intoxication is characterized by a mania-like state and marked vegetative shifts. The following manifestations are observed:
- Vegetative and somatic reactions (marked pupillary dilation, pallor, dry mouth, tachycardia, elevated blood pressure, chills);
- Additional symptoms (rhinitis, cough, hyperglycemia, urinary retention, and constipation);
- Specific symptom (the sensation of formication and hair crawling on the head).
What is the mechanism of action of cocaine on synaptic transmission in the central nervous system?
The mechanism of action of cocaine on synaptic transmission consists in blocking the transmembrane transport of biogenic amines into neurons and inhibiting the reuptake of catecholamines by adrenergic nerve endings. The substance blocks and clogs transport proteins in the presynaptic membrane, preventing dopamine from returning. This leads to the excessive accumulation of dopamine in the synaptic cleft and activation of the sympathoadrenal system.
What specific cocaine psychoses can develop against the background of chronic intoxication?
Against the background of dose escalation and chronic intoxication, hallucinatory-delusional psychosis can develop with unstable mood, irritability, irritability, anxiety, and suspiciousness. The clinical picture includes persecutory delusions, auditory hallucinations and illusions in the form of ringing in the ears, being called by name and comments addressed to oneself, as well as specific tactile hallucinations.
What severe cardiovascular complications does chronic cocaine use cause?
Sources for cocaine poisoning indicate sudden cardiac death, acute coronary insufficiency, arterial hypertension, tachycardia, and arrhythmia. Enhanced platelet aggregation can lead to thrombosis and myocardial infarction.
Class and exam questions
Can a diagnosis be made solely based on a cocaine urine test?
No, laboratory diagnostics have limitations. The main method is a thorough clinical analysis of all information, anamnesis, and behavioral signs.
Why do difficulties arise when taking an anamnesis from such patients?
Patients often conceal their addiction out of fear of punishment or loss of access to the substance (dissimulation), and relatives may remain unaware for a long time.
Is substitution therapy used in cocaine addiction?
In the Russian Federation, substitution therapy with narcotic drugs is completely prohibited by law. The goal of treatment is solely the complete cessation of psychoactive substances.
Which medications must not be prescribed for the long-term treatment of addiction?
Strictly avoid prescribing psychoactive substances capable of independently causing addiction: barbiturates, psychostimulants, and long courses of benzodiazepine tranquilizers.
What else to study on this topic
- Features of opioid addiction and overdose (heroin, methadone)
- Differential diagnosis with exogenous organic brain lesions
- Patient management tactics and conflict prevention in the inpatient setting
- Symptomatic pharmacotherapy of psychoorganic syndrome (nootropics, antioxidants)
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Other topics in «Chapter 21. Disorders due to use of alcohol and other psychoactive substances»
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