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Difficulty: EasySubstance-Related and Addictive Disorders

Match each classic clinical presentation with the corresponding substance-related syndrome.

  • Pinpoint pupils (miosis), respiratory depression, and depressed mental statusOpioid intoxication
  • Rotary or horizontal nystagmus, severe agitation, and diminished pain perceptionPhencyclidine (PCP) intoxication
  • Conjunctival injection, increased appetite, and dry mouthCannabis (marijuana) intoxication
  • Dilated pupils (mydriasis), tachycardia, diaphoresis, and severe psychomotor agitationCocaine intoxication

Answer

Opioids cause miosis and respiratory depression. PCP causes nystagmus and analgesia. Cannabis causes conjunctival injection and increased appetite. Cocaine causes sympathetic overactivation with mydriasis and diaphoresis.
Each clinical presentation perfectly aligns with the classic pharmacological effects of the paired substance. Recognizing these distinctive patterns (e.g., nystagmus for PCP, pinpoint pupils for opioids) is a fundamental skill in clinical psychiatry and emergency medicine.

Step-by-Step Solution

1
Analyze the toxidrome with depressed vitals and miosis.
Matches opioid intoxication.
Opioids directly depress the respiratory center in the medulla and stimulate the Edinger-Westphal nucleus, causing miosis.
2
Analyze the presentation with nystagmus and agitation.
Matches PCP intoxication.
PCP is a dissociative anesthetic; rotary or horizontal nystagmus is a unique and high-yield distinguishing finding.
3
Analyze the presentation with red eyes and hunger.
Matches cannabis intoxication.
Cannabinoid receptor activation commonly leads to vasodilation of conjunctival vessels and stimulation of appetite.
4
Analyze the toxidrome with severe sympathetic stimulation.
Matches cocaine intoxication.
Inhibition of norepinephrine reuptake leads to tachycardia, hypertension, diaphoresis, and pupillary dilation.

Key Concept

Clinical recognition of common substance intoxication syndromes (toxidromes) is essential for rapid diagnosis and appropriate acute management in the emergency setting.
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Topics

Substance-Related and Addictive Disorders

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