Diseases, Disorders information

I want to say something about the hallucinogens. We are seeing LSD nowadays. It’s in lower concentrations than when we were teenagers and so people aren’t flying out the window thinking they can fly like Art Linkletter’s daughter did which is one of the things that turned people off to LSD. But acid is back in a lower concentration and kids are using it at parties and it is producing problems acutely. Tolerance showing it has a serotonergic effect. It can also produce an adrenergic state. PCP, while developed as an anesthetic, has a very interesting dose response and this is one line I would circle just so it stays in your head. At low dose, it acts like alcohol or the benzodiazepines with ataxia. At the middle dose you get illusions and a propensity to violent outbursts with paranoia. At a high dose, 70 mg or greater, you see coma so it’s a particularly bad therapeutic window assuming you think intoxication is therapeutic. So even there it’s bad.
Management. I still find the urine is the key issue and there are several ways to do this. 10% of mental health patients are abusing anticholinergics, particularly Cogentin and just review why because that’s a likely thing to show up on the test.
The final thing is anabolic steroids. One out of 10 high school kids is using them. Mark McGwire didn’t help because androstenedione, while not excluded from baseball, does increase testosterone levels and the withdrawal is the problem. The stimulus to mania is a problem. Rageful behavioral and aggression on withdrawal.