ELDER TIP Remember to consider the possibility of alcohol abuse when evaluating older patients. Research suggests that alcoholism affects 2% to 10% of adults older than age 60. More than half of all elderly hospital admissions are due to alcohol-related problems.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Substance abuse and induced disorders:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
The signs and symptoms of acute intoxication vary, depending on the drug. The drug user seldom seeks treatment specifically for his drug problem. Instead, he may seek emergency treatment for drug-related injuries or complications, such as a motor vehicle accident, burns from freebasing, an overdose, physical deterioration from illness or malnutrition, or symptoms of withdrawal. Friends, family members, or law enforcement officials may bring the patient to the hospital because of respiratory depression, unconsciousness, acute injury, or a psychiatric crisis.
Examine the patient for signs and symptoms of drug use or drug-related complications as well as for clues to the type of drug ingested. For example, fever can result from stimulant or hallucinogen intoxication, from withdrawal, or from infection caused by I.V. drug use.
Inspect the eyes for lacrimation from opiate withdrawal, nystagmus from central nervous system (CNS) depressants or phencyclidine intoxication, and drooping eyelids from opiate or CNS depressant use. Constricted pupils occur with opiate use or withdrawal; dilated pupils, with the use of hallucinogens or amphetamines.
Examine the nose for rhinorrhea from opiate withdrawal and the oral and nasal mucosa for signs of drug-induced irritation. Drug sniffing can result in inflammation, atrophy, or perforation of the nasal mucosa. Dental conditions commonly result from the poor oral hygiene associated with chronic drug use. Also inspect under the tongue for evidence of I.V. drug injection.
Inspect the skin. Sweating, a common sign of intoxication with opiates or CNS stimulants, also accompanies most drug withdrawal syndromes. Drug use sometimes induces a sensation of bugs crawling on the skin, known as formication; as a result, the patient’s skin may be excoriated from scratching.
Needle marks or tracks are an obvious sign of I.V. drug abuse. Keep in mind that the patient may attempt to conceal or disguise injection sites with tattoos or by selecting an inconspicuous site such as under the nails. In addition, self-injection can sometimes cause cellulitis or abscesses, especially in the patient who also is a chronic alcoholic. Puffy hands can be a late sign of thrombophlebitis or of fascial infection due to self-injection on the hands or arms.
Auscultation may disclose bilateral crackles and rhonchi caused by smoking and inhaling drugs or by opiate overdose. Other cardiopulmonary signs of overdose include pulmonary edema, respiratory depression, aspiration pneumonia, and hypotension. CNS stimulants and some hallucinogens may precipitate refractory acute-onset hypertension or cardiac arrhythmias. Withdrawal from opiates or depressants also can provoke arrhythmias and, occasionally, hypotension.
During opiate withdrawal, the patient may report abdominal pain, nausea, or vomiting. He may also complain of hemorrhoids, a consequence of the constipating effects of these drugs. Palpation of an enlarged liver, with or without tenderness, may indicate hepatitis.
Neurologic symptoms of drug abuse include tremors, hyperreflexia, hyporeflexia, and seizures. Abrupt withdrawal may precipitate signs of CNS depression (ranging from lethargy to coma), hallucinations, or signs of overstimulation, including euphoria and violent behavior.
Carefully review the patient’s medical history. Suspect drug abuse if he reports a painful injury or chronic illness but refuses a diagnostic workup. In his attempt to obtain drugs, the dependent patient may feign illnesses, such as migraine headaches, myocardial infarction, and renal colic; claim an allergy to over-the-counter analgesics; or even request a specific medication. Also be alert for a history of overdose or a high tolerance for potentially addictive drugs. An I.V. drug user may have a history of hepatitis or human immunodeficiency virus (HIV) infection from sharing dirty needles. A female drug user may report a history of amenorrhea.
A patient who abuses drugs may give you a fictitious name and address, be reluctant to discuss previous hospitalizations, or seek treatment at a medical facility across town rather than in his own neighborhood. If possible, interview family members to verify his responses.
If the patient admits to drug use, try to determine the extent to which this behavior interferes with his normal functioning. Note whether he expresses a desire to overcome his dependence on drugs. If possible, obtain a drug history consisting of substances ingested, amount, frequency, and last dose. Expect incomplete or inaccurate responses. Drug-induced amnesia, a depressed level of consciousness, or ignorance may distort the patient’s recollection of the facts; he also may fabricate answers to avoid arrest or to conceal a suicide attempt.
The hospitalized drug abuser is likely to be uncooperative, disruptive, or even violent. He may experience mood swings, anxiety, impaired memory, sleep disturbances, flashbacks, slurred speech, depression, and thought disorders. He may resort to plays on sympathy, bribery, or threats to obtain drugs, or he may try to pit one caregiver against another.
Psychoactive substances may be used in cultural practices. For instance, some Native Americans use hallucinatory drugs to help achieve spiritual experiences. Therefore, use and abuse must be carefully distinguished.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Alcoholism:
Signs and symptoms
(Handbook of Diseases)
Because people with alcohol dependence may hide or deny their addiction and may temporarily manage to maintain a functional life, assessing a patient for alcoholism can be difficult. However, there are various physical and psychosocial symptoms that can facilitate assessment.
The patient’s history may suggest a need for daily or episodic alcohol use to maintain adequate functioning, an inability to discontinue or reduce alcohol intake, episodes of anesthesia or amnesia (blackouts) during intoxication, episodes of violence during intoxication, or interference with social and familial relationships and occupational responsibilities.
Many minor complaints that the patient may have may also be alcohol related. He may mention malaise, dyspepsia, mood swings, depression, or more infections. Note any evidence of an unusually high tolerance for sedatives and narcotics.
Secretive behavior is another indication. When confronted, the patient may deny or rationalize his problem with alcohol. Alternatively, he may be guarded or hostile in his response. He also may project his anger or feelings of guilt or inadequacy onto others to avoid confronting his illness.
With chronic alcohol abuse, the patient may experience malnutrition, cirrhosis of the liver, peripheral neuropathy, brain damage, or cardiomyopathy.
After abstaining from alcohol or significantly reducing his intake, the patient may experience signs and symptoms of withdrawal, and they may last for 5 to 7 days. The patient initially experiences anorexia, nausea, anxiety, fever, insomnia, diaphoresis, and tremor, progressing to severe tremulousness, agitation and, possibly, hallucinations and violent behavior. Major tonic-clonic seizures (known as rum fits) can occur during withdrawal. Suspect alcoholism in any patient with unexplained seizures.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Drug abuse and dependence:
Signs and symptoms
(Handbook of Diseases)
Indications of acute intoxication vary, depending on the drug.
Clinical tip The drug user seldom seeks treatment specifically for his drug problem. Instead, he may seek emergency treatment for drug-related injuries or complications.
Friends, family members, or law enforcement officials may bring the patient to the hospital because of respiratory depression, unconsciousness, acute injury, or a psychiatric crisis.
Physical examination
Examine the patient for signs and symptoms of drug use or drug-related complications as well as for clues to the type of drug ingested. For example, fever can result from stimulant or hallucinogen intoxication, from withdrawal, or from infection from I.V. drug use.
Inspect the eyes for lacrimation from opioid withdrawal, nystagmus from central nervous system (CNS) depressants or phencyclidine intoxication, and drooping eyelids from opioid or CNS depressant use. Constricted pupils occur with opioid use or withdrawal; dilated pupils, with the use of hallucinogens or amphetamines.
Examine the nose for rhinorrhea from opioid withdrawal and the oral and nasal mucosa for signs of drug-induced irritation. Drug sniffing can result in inflammation, atrophy, or perforation of the nasal mucosa. Dental conditions commonly result from the poor oral hygiene associated with chronic drug use. Also inspect under the tongue for evidence of I.V. drug injection.
Inspect the skin. Sweating, a common sign of intoxication with opioids or CNS stimulants, also accompanies most drug withdrawal syndromes. Drug use sometimes induces a sensation of bugs crawling on the skin, known as formication; as a result, the patient’s skin may be excoriated from scratching.
Needle marks or tracks are an obvious sign of I.V. drug abuse. Keep in mind that the patient may attempt to conceal or disguise injection sites with tattoos or by selecting an inconspicuous site, such as under the nails.
In addition, self-injection can sometimes cause cellulitis or abscesses, especially in patients who also are chronic alcoholics. Puffy hands can be a late sign of thrombophlebitis or of fascial infection from self-injection on the hands or arms.
Auscultation may disclose bilateral crackles and rhonchi caused by smoking and inhaling drugs or by opioid overdose. Other cardiopulmonary signs of overdose include pulmonary edema, respiratory depression, aspiration pneumonia, and hypotension.
CNS stimulants and some hallucinogens may precipitate refractory acute-onset hypertension or cardiac arrhythmias. Withdrawal from opioids or CNS depressants can also provoke arrhythmias and, occasionally, hypotension.
During opioid withdrawal, the patient may report abdominal pain, nausea, or vomiting. Opioid abusers also commonly complain of hemorrhoids, a consequence of the constipating effects of these drugs. Palpation of an enlarged liver, with or without tenderness, may indicate hepatitis.
Neurologic symptoms of drug abuse include tremors, hyperreflexia, hyporeflexia, and seizures. Abrupt withdrawal may precipitate signs of CNS depression (ranging from lethargy to coma), hallucinations, or signs of overstimulation, including euphoria and violent behavior.
Medical history
Carefully review the patient’s medical history. Suspect drug abuse if he reports a painful injury or chronic illness but refuses a diagnostic workup. In his attempt to obtain drugs, the dependent patient may feign illnesses, such as migraine headaches, myocardial infarction, and renal colic; claim an allergy to over-the-counter analgesics; or even request a specific medication.
Also, be alert for a previous history of overdose or a high tolerance for potentially addictive drugs. I.V. drug users may have a history of hepatitis or human immunodeficiency virus (HIV) infection from sharing dirty needles. Female drug users may report a history of amenorrhea.
A patient who abuses drugs may give you a fictitious name and address, be reluctant to discuss previous hospitalizations, or seek treatment at a medical facility across town rather than in his own neighborhood. If possible, interview family members to verify his responses.
If the patient admits to drug use, try to determine the extent to which this behavior interferes with his normal functioning. Note whether he expresses a desire to overcome his dependence on drugs.
If possible, obtain a drug history consisting of substances ingested, amount, frequency, and last dose. Expect incomplete or inaccurate responses. Drug-induced amnesia, a depressed level of consciousness, or ignorance may distort the patient’s recollection of the facts; he also may deliberately fabricate answers to avoid arrest or to conceal a suicide attempt.
The hospitalized drug abuser is likely to be uncooperative, disruptive, or even violent. He may experience mood swings, anxiety, impaired memory, sleep disturbances, flashbacks, slurred speech, depression, and thought disorders.
Some patients resort to plays on sympathy, bribery, or threats to obtain drugs. They may also try to manipulate caregivers by pitting one against another.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Medical articles and books on symptoms:
These general reference articles may be of interest
in relation to medical signs and symptoms of disease in general:
Full list of premium articles on symptoms and diagnosis
About signs and symptoms of Chemical addiction:
The symptom information on this page
attempts to provide a list of some possible signs and symptoms of Chemical addiction.
This signs and symptoms information for Chemical addiction has been gathered from various sources,
may not be fully accurate,
and may not be the full list of Chemical addiction signs or Chemical addiction symptoms.
Furthermore, signs and symptoms of Chemical addiction may vary on an individual basis for each patient.
Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they
are indeed Chemical addiction symptoms.
Alcoholism is a widespread disease. Unfortunately, many sufferers are not aware that they are have a problem. What are the symptoms of alcoholism?...
Alcoholism is a widespread disease. Unfortunately, many sufferers are not aware that they are have a problem. What are the symptoms of alcoholism?...
For all alcoholics, therapy is essential. But it's not always enough. For these patients, there is a variety of medications available to help...
Alcoholism is a devastating disease for anyone who suffers from it. But it can also take a terrible toll on the families involved. Join us for a...
See full list of 10 related videos
» Next page: Diagnostic Tests for Chemical addiction
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
