Neurological Effects of Stimulants and Hallucinogens.

This article reviews the history, pharmacodynamics, and neurotoxicity of psychostimulants and hallucinogens. Psychostimulants such as cocaine, methamphetamine/amphetamines, and cathinones produce a euphoric high and are associated with seizures, strokes, rhabdomyolysis, and movement disorders. Hallucinogens cause hallucinations, altered perception, and cognitive dysfunction, which can be unpredictable and dysphoric, leading to anxiety and panic. Recognizing these neurotoxicities and managing them appropriately is critical. Many of these drugs are not detectable by standard laboratory tests, complicating diagnosis.

Study at a glance

Abstract

In this article, we will discuss the history, pharmacodynamics, and neurotoxicity of psychostimulants and hallucinogens. The drugs discussed are widely used and have characteristic toxidromes and potential for neurological injuries with which the practicing clinician should be familiar. Psychostimulants are a class of drugs that includes cocaine, methamphetamine/amphetamines, and cathinones, among others, which produce a crescendoing euphoric high. Seizures, ischemic and hemorrhagic strokes, rhabdomyolysis, and a variety of movement disorders are commonly encountered in this class. Hallucinogens encompass a broad class of drugs, in which the user experiences hallucinations, altered sensorium, distorted perception, and cognitive dysfunction. The experience can be unpredictable and dysphoric, creating a profound sense of anxiety and panic in some cases. Recognizing the associated neurotoxicities and understanding the appropriate management is critical in caring for these patient populations. Several of these agents are not detectable by standard clinical laboratory analysis, making identification and diagnosis an even greater challenge.