From the Guidelines
Cocaine induces paranoia as part of its CNS stimulation and neuropsychiatric effects.
Mechanism of Action
- Cocaine produces a sympathomimetic toxidrome marked by tachycardia, hypertension, hyperthermia, seizures, diaphoresis, and increased psychomotor activity due to its effects on the sympathetic nervous system and CNS stimulation 1.
- The reuptake blockade of norepinephrine, epinephrine, dopamine, and serotonin causes the CNS and neuropsychiatric symptoms of cocaine poisoning, including paranoia.
Management
- Benzodiazepines are used as the mainstay of initial management of psychomotor agitation for patients with acute cocaine poisoning, which may include paranoia 1.
- Other therapies such as CCBs, α1-adrenergic receptor antagonists, and nitrates can be used for severe cocaine-induced hypertension and chest pain.
From the Research
Cocaine-Induced Paranoia
- Cocaine consumption can induce transient psychotic symptoms, including paranoia and hallucinations 2, 3, 4.
- Studies have shown that heavy cocaine users who experience transient paranoia while intoxicated may be at higher risk for development of psychosis than cocaine users who do not experience paranoia 5.
- The prevalence of cocaine-induced paranoia ranges from 12% in clinical studies to 100% in experimental studies 2.
- Potential risk factors for cocaine-induced paranoia include age of first use, length of use, amount of substance, route of administration, body mass index, genetic factors, personal vulnerability, and comorbidity with other disorders 2, 3.
Characteristics of Cocaine-Induced Paranoia
- Cocaine-induced paranoia has a particular clinical presentation and needs to be clearly identified due to its harmful consequences 2.
- The most frequently reported psychotic symptoms under the influence of cocaine are paranoid beliefs and suspiciousness 3.
- A logistic regression analysis found that a model consisting of amount of cocaine consumption, presence of an antisocial personality disorder, and cannabis dependence history can predict the presence of cocaine-induced psychosis with 66.2% sensitivity and 75.8% specificity 3.
Assessment and Treatment
- The Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP) is a useful instrument for quantifying the severity of cocaine-induced psychosis according to operational criteria 4.
- Neuroleptic treatment can reduce cocaine-induced paranoia but not euphoria, suggesting that euphoria and paranoia may have discriminable neurophysiological substrates 6.