From the Research
Phencyclidine (PCP) use is associated with a wide range of symptoms, including agitation, confusion, hallucinations, paranoia, and feelings of detachment from reality, which can lead to significant morbidity and mortality if not properly managed. The symptoms of PCP use can be divided into physical and mental symptoms. Common physical symptoms include elevated blood pressure, rapid heart rate, increased body temperature, nystagmus (involuntary eye movements), muscle rigidity, and decreased pain sensitivity 1. Mental symptoms typically include agitation, confusion, hallucinations, paranoia, and feelings of detachment from reality. Users may exhibit violent or bizarre behavior, appear disoriented, and have slurred speech. Severe cases can lead to seizures, coma, or respiratory depression.
The symptoms of PCP use occur because PCP acts as an NMDA receptor antagonist in the brain, disrupting glutamate signaling and affecting multiple neurotransmitter systems including dopamine 2. This disruption causes altered perception, thought processes, and motor function. Symptoms usually begin within minutes of use and can last for several hours, though residual effects may persist for days. Treatment focuses on supportive care, managing agitation with benzodiazepines like lorazepam 1-2mg IV/IM as needed, and addressing specific symptoms as they arise 1.
Some key points to consider when managing PCP use include:
- PCP-induced psychosis can be recognized as a "hallucinogen" psychosis, with features such as neurologic abnormalities, dose-related severity of symptoms, and regularity of the length of illness 3.
- The psychosis produced by PCP can often be distinguished from other psychedelic drugs, and is thought to be a drug effect rather than a brief functional psychosis precipitated by the disintegrating PCP experience 3.
- PCP use has been noted to produce a psychosis of several week's duration in a small fraction of users, with descriptions of the premorbid personalities of those who became psychotic resembling descriptions of LSD and marijuana users who experienced prolonged psychiatric difficulty 3.
- Treatment with antipsychotic medication may not always be effective in managing PCP-induced psychosis, and the psychotic episodes can persist for more than 30 days 4.
In summary, the management of PCP use should prioritize supportive care, agitation management, and addressing specific symptoms as they arise, with a focus on minimizing morbidity and mortality.