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8.151: Phencyclidine Abuse and Dependence (305.9)

  • Page ID
    23348
  • DSM-IV-TR criteria

    1. See above for specific abuse and dependence criteria.

    Associated features

    1. Phencyclidine can be sold as a crystalline powder, paste, liquid, or a drug soaked paper. Common street drug names for Phencyclidine are: PCP, angel dust, boat, tic tac, zoom, hog, ozone, rocket fuel, wack, and shermans. It can be smoked, injected or snorted; smoking being the most common way it is used. It is sometimes used as an additive to marjuanna, and in this case the street names could include but are not limited to: super grass, lovelies, wet, fry, killer joints, and waters.
    2. Depending on the route in which the drug is used, as well as the dosage, the effects and severity of the effects will vary. It is often known as the “dissociative anesthetic” because of its distortment in sights and sounds. PCP can give an individual the feeling of detachment from his or her environment and self and have psychological and physiological effects such as: sedation, immobility, amnesia, numbness, slurred speech, rapid and involuntary eye movements, increased blood pressure, elevated tempature and heart rate, analgesia, and (with a high enough dosage) illusions and hallucinations.
    3. Chronic use of the drug can result in several impairments; speech, memory, and thinking. Long-term effects can include suicidal ideation, depression, anxiety, and social isolation. There have also been drowning deaths, violent and accidental deaths, and suicide linked to the usage of PCP.

    Child vs. adult presentation

    PCP abuse occurs more in high school students and young adults, rather than in children. Studies have shown that the usage has varied among ages and has been seen prevalent in anywhere from 12 to 34; 26 to 34 being the highest range where users typically fall under. However, children may be exposed to it due to parental use and neglect.

    Gender and cultural differences in presentation

    It is not very common but more PCP use is among males than females because of association with delinquent peers is most likely male involvement.

    Epidemiology

    • PCP is associated with 10% of substance abuse deaths and 32% of related emergency room visits. Most users are between 18-25 years of age, and account for more than 50% of cases. Most patients are more likely to be white males. Mostly used in the United States.
    • Phencyclidine was once marketed as an anesthetic in United States for medical purposes under the trade names of Sernyl and Sernylan, but is no longer produced or used in the U.S. It was used on patients before surgery to calm them down, and used during and after surgery to ease pain, but after many reports of troubled speech, hallucinations, disoriented behavior, and other disturbing effects, it was withdrawn from the market in 1979.

    Etiology

    Phencyclidine (PCP) is a hallucinogenic drug that can mimic several aspects of the schizophrenic symptomatology in healthy volunteers. In a series of studies PCP was administered to rats to determine whether it was possible to develop an animal model of the positive and negative symptoms of schizophrenia. The rats were tested in the social interaction test and it was found that PCP dose-dependently induces stereotyped behavior and social withdrawal, which may correspond to certain aspects of the positive and negative symptoms, respectively. The effects of PCP could be reduced selectively by anti-psychotic drug treatment, whereas drugs lacking anti-psychotic effects did not alleviate the PCP-induced behaviors. Together these findings indicate that PCP effects in the rat social interaction test may be a model of the positive and negative symptoms of schizophrenia with face and predictive validity and that it may be useful for the evaluation of novel anti-psychotic compounds.

    Empirically supported treatments

    Hospitalization is recommended when acute PCP intoxication occurs because hyperpyrexia and other autonomic instabilities can lead to death; Benzodiazepines, like Lorazepam, are good for these patients and serve well for controlling agitation and seizures. Typical anti-psychotics, such as, Phenothiazines and haloperidol help to control psychotic symptoms. In order to help eliminate Phencyclidine dependence, ammonium chloride should be given to help extract it from the body. As far as psychological treatment goes, out-patient treatment or follow-ups, along with utilizing the communities resources are essential in staying clean from the drug. Life style changes, such as staying away from places, people, and things are encouraged. Psychotherapy is often beneficial to users as well as attending Narcotics Anonymous as a support program.

    DSM-V Proposed Changes: adding “Phencyclidine-Use Disorder”

    DSM-V Phencyclidine-Use Disorder Criteria:

    A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period:

    1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

    2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

    3. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

    4. tolerance, as defined by either of the following:

    • need for markedly increased amounts of the substance to achieve intoxication or desired effect
    • markedly diminished effect with continued use of the same amount of the substance

    (Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta-blockers.)

    5. withdrawal, as manifested by either of the following:

    • the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
    • the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

    (Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta-blockers.)

    6. the substance is often taken in larger amounts or over a longer period than was intended

    7. there is a persistent desire or unsuccessful efforts to cut down or control substance use

    8. a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

    9. important social, occupational, or recreational activities are given up or reduced because of substance use

    10. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

    11. Craving or a strong desire or urge to use a specific substance.

    Severity specifiers:

    Moderate: 2-3 criteria positive

    Severe: 4 or more criteria positive

    Specify if:

    With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 4 or 5 is present)

    Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 4 nor 5 is present)

    Course specifiers (see text for definitions):

    • Early Full Remission
    • Early Partial Remission
    • Sustained Full Remission
    • Sustained Partial Remission
    • On Agonist Therapy
    • In a Controlled Environmen
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