Differential Diagnosis for Drug Intoxication with Agitation
- The following differential diagnosis is organized into categories to guide the diagnostic process.
Single Most Likely Diagnosis
- Substance-induced intoxication (e.g., cocaine, amphetamines, or PCP): This is the most likely diagnosis due to the direct association between certain substances and agitation. These substances are well-known to cause agitation, aggression, and altered mental status.
Other Likely Diagnoses
- Alcohol withdrawal: Alcohol withdrawal can cause significant agitation, especially in the context of delirium tremens. This diagnosis should be considered, especially if there's a history of chronic alcohol use.
- Benzodiazepine or opioid withdrawal: Withdrawal from these substances can also lead to agitation, although the presentation may differ from that of alcohol withdrawal.
- Serotonin syndrome: This condition, caused by an excess of serotonin, can result from the use of certain medications or combinations of drugs, leading to agitation, among other symptoms.
Do Not Miss Diagnoses
- Neizophrenia or psychotic episode: Although less likely, an acute psychotic episode can present with agitation and must be considered to avoid missing a potentially treatable psychiatric condition.
- Neuroleptic malignant syndrome (NMS): A life-threatening condition associated with the use of neuroleptic medications, characterized by fever, rigidity, and altered mental status, which can include agitation.
- Intracranial hemorrhage or other acute neurological emergencies: Conditions like stroke or hemorrhage can present with sudden onset agitation and must be ruled out due to their urgency and potential for severe outcomes.
Rare Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, agitation, and other symptoms due to excessive catecholamine release.
- Thyroid storm: A rare and potentially life-threatening condition that occurs in untreated or undertreated hyperthyroidism, which can cause agitation among other severe symptoms.
- Autoimmune or inflammatory conditions affecting the brain: Rare conditions such as autoimmune encephalitis can present with psychiatric symptoms, including agitation, and are crucial to identify due to their treatability.