What is the diagnosis for psychotropic intoxication?

From the Guidelines

Psychotropic intoxication is diagnosed based on a combination of clinical presentation, medical history, and laboratory tests, with a focus on identifying the underlying cause of the altered mental status.

Key Considerations

• The diagnosis of psychotropic intoxication involves a thorough evaluation of the patient's symptoms, medical history, and laboratory results, as outlined in the study by Soares et al 1.
• Altered mental status (AMS) is a common presenting symptom in the emergency department, accounting for up to 4% to 10% of chief complaints, and can be caused by a wide range of medical conditions, including psychotropic drug use, as noted in the study by Soares et al 1.
• Validated assessment scales, such as the Richmond Agitation Sedation Scale and Glasgow Coma Scale, can be used to objectively quantify the severity of symptoms, as mentioned in the study by Soares et al 1.
• The cause of AMS in patients across all age groups remains undiagnosed in slightly greater than 5% of cases, highlighting the importance of a thorough diagnostic evaluation, as noted in the study by Soares et al 1.

Diagnostic Approach

• A tiered approach to evaluation, including nonclinical and clinical studies, can be used to assess the effects of psychotropic drugs on driving performance, as outlined in the study by 1.
• The diagnosis of psychotropic intoxication should consider the temporal profile of adverse events affecting driving, as recommended in the study by 1.
• The economic impact of delirium, a common complication of psychotropic intoxication, is profound, with total costs estimated at $38 to $152 billion each year, as noted in the study by Soares et al 1.

Treatment

• Management of psychotropic intoxication is based on treatment of the underlying cause, control of symptoms with nonpharmacological approaches, medication when deemed appropriate, and effective aftercare planning, as outlined in the study by Soares et al 1.
• Psychiatric consultation and screening tools, such as the Confusion Assessment Method (CAM) and briefer CAM variants, can be employed in clinical practice to assess for delirium, as mentioned in the study by Soares et al 1.

From the Research

Diagnosis of Psychotropic Intoxication

The diagnosis of psychotropic intoxication can be complex and requires a comprehensive approach. Some key points to consider include:

• The type of psychotropic drug involved, as different classes of drugs have distinct toxicological profiles 2
• The presence of acute or chronic psychiatric symptoms, such as hallucinations, aggressiveness, and psychotic behavior 3
• The use of specific antagonists, such as flumazenil and naloxone, for the treatment of benzodiazepine and opioid intoxication 4
• The potential for water and electrolyte imbalance disorders, such as primary polydipsia and syndrome of inappropriate antidiuretic hormone secretion, which can be caused by psychotropic drugs 5
• The use of analytical methods, such as gas chromatography-mass spectrometry (GC-MS) and ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS), to detect and quantify psychotropic substances in biological samples 6

Common Symptoms and Treatment

Some common symptoms of psychotropic intoxication include:

• Hallucinations
• Aggressiveness
• Psychotic behavior
• Lethargy
• Confusion
• Seizures
• Coma Treatment may involve the use of specific antagonists, symptomatic treatment, and supportive care. In some cases, hospitalization may be necessary to manage severe symptoms and prevent complications.

Analytical Methods

Analytical methods, such as GC-MS and UHPLC-MS/MS, can be used to detect and quantify psychotropic substances in biological samples, including urine, serum, and hair. These methods can help to confirm the presence of psychotropic substances and monitor their levels over time 3, 6.