EUPHORIA

Ask the following questions:

1. Is there a history of drug ingestion? The patient will frequently not tell the truth about drug ingestion, but one should ask family and friends about whether the patient uses any illicit drugs such as LSD, marijuana, or cocaine. Other drugs that are prescribed by physicians may cause euphoria, such as corticosteroids and various narcotics.
2. Is the neurologic examination abnormal? The patient may demonstrate simple disorientation or disturbance in the thought process or excessive jocularity, as may be seen in witzelsucht. All these findings may suggest a frontal lobe tumor, a general paresis, or other forms of dementia. When there are long tract signs, such as posterior column or pyramidal tract involvement, one must consider the possibility of multiple sclerosis or a pontine glioma.
3. Is there significant incoherence, delusions, or hallucinations? These findings would most likely suggest schizophrenia.
4. Is the euphoria sustained for long periods, or is it very short-lived? If the euphoria is intermittent and very brief, one should consider temporal lobe epilepsy. If it is more sustained, one would consider manic-depressive psychosis.

DIAGNOSTIC WORKUP

A drug screen should be axiomatic on all patients, as the patient may lie. If this is negative, one may proceed with the more expensive testing, such as MRI, or at least a CT scan to rule out a brain tumor. If these tests are negative and the problem persists, the patient should be referred to a psychiatrist.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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