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Phencyclidine or 1-(1-phenylcyclohexy-1) piperidine (known as PCP, “angel dust”, and many other names) was originally developed as an anesthetic, but was abused as an illicit drug from the late 1960s onwards. It is a dopamine receptor agonist and an antagonist at the N-methyl- d -aspartate (NMDA) subtype of glutamate receptors. It has anticholinergic properties through blockade of ion channels in acetylcholine receptors. It has been used in some countries as an anti-parkinsonian agent [ ].
The psychoactive effects of phencyclidine are stimulant and similar to the effects of hallucinogens. The hallucinations it can cause are often bizarre, frightening, and challenging. Aggressive behavior, usually with amnesia, is common. Self-destructive actions are also seen. Overdosage is associated with paresthesia, slurred speech, ataxia, and later catatonia, dilated pupils, and coma, with tachycardia, hypertension, and dysrhythmias. Seizures and deaths have occurred [ ].
Although the effects of phencyclidine are usually short-lived, it can cause prolonged and severe behavioral disturbances, exaggeration of pre-existing thoughts, and serious medical complications [ ].
Among 107 consecutive patients with phencyclidine intoxication, the diagnosis was confirmed by positive urine assay in 27 [ ]. The most common abnormalities were mental/behavioral (89%) and nystagmus (85%). There were also increases in blood pressure, temperature, and heart rate. The most common serious medical complication requiring hospitalization was rhabdomyolysis, which occurred in three patients, two of whom developed acute renal insufficiency.
Four major and five minor clinical patterns of acute phencyclidine intoxication have been described in 1000 patients [ ]. Major patterns were acute brain syndrome (24.8%), toxic psychosis (16.6%), catatonic syndrome (11.7%), and coma (10.6%). Minor patterns included lethargy or stupor (3.8%) and combinations of bizarre behavior, violence, agitation, and euphoria in patients who were alert and oriented (32.5%). Patients with major patterns of toxicity usually required hospitalization and had most of the complications. Patients with minor patterns generally had mild intoxication and did not require hospitalization, except for treatment of injuries or autonomic effects of phencyclidine. There were various types of injuries in 16%, and aspiration pneumonia in 1.0%. There were 22 cases of rhabdomyolysis (2.2%), and three patients required dialysis for renal insufficiency. One patient who had been comatose died suddenly with a pulmonary embolism.
Of 68 users of phencyclidine (37 men, 31 women; aged 14–38 years), 42 used it daily, and 14 used it intravenously; 25 considered themselves to be addicted to it [ ]. The effects that they reported are listed in Table 1 , the self-reported unwanted behaviors in Table 2 , and the withdrawal effects in Table 3 .
Effect | % | Effect | % |
---|---|---|---|
Reduced appetite | 62 | Increased sex drive | 29 |
Confused thoughts | 60 | Visual hallucinations | 28 |
Loss of memory | 59 | Paranoia | 27 |
Increased strength | 57 | Ringing in ears | 24 |
Feeling “speedy” | 56 | Headaches | 22 |
Euphoria | 54 | Reduced sex drive | 21 |
Drowsiness | 52 | Fatigue | 21 |
Bad trips | 44 | Auditory hallucinations | 21 |
Insomnia | 41 | Feeling hot | 19 |
Depression | 35 | Reduced strength | 18 |
Dizziness | 34 | Vomiting | 13 |
Increased anger | 34 | Feeling of detachment | 13 |
Increased anxiety | 34 | Increased appetite | 7.4 |
Increased violence | 32 | Reduced anxiety | 7.4 |
Behavior | % | Behavior | % |
---|---|---|---|
Lost money | 48.5 | Hurt someone else | 23.5 |
Got lost | 39.7 | Unwanted sexual encounter | 19.1 |
Took drugs | 35.3 | Attempted suicide | 13.2 |
Got into fight | 30.9 | Committed crime | 11.8 |
Hurt yourself | 26.5 | Had car accident | 10.3 |
Symptom | % | Symptom | % |
---|---|---|---|
Craving for PCP | 52 | Headache | 16 |
Increased need for sleep | 49 | Insomnia | 15 |
Poor memory | 46 | None | 15 |
Depression | 44 | Recurring tastes | 13 |
Laziness | 44 | Panic | 12 |
Increased appetite | 38 | Reduced appetite | 8.8 |
Confused thoughts | 35 | Reduced need for sleep | 4.4 |
Flashbacks | 32 | Feeling “speedy” | 1.5 |
Irritable | 31 | Feeling hot | 1.5 |
Feeling weak | 31 | Ringing in ears | 1.5 |
Increased anxiety | 22 |
In seven cases of poisoning with phencyclidine, death followed a hypertensive crisis [ ]. In one case an acute episode of hypertension resulted in coma and blindness [ ].
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