Match each of the following substance withdrawal syndromes with its most characteristic clinical presentation.
- Opioid withdrawalYawning, piloerection, rhinorrhea, lacrimation, severe myalgias, and hyperactive bowel sounds
- Cocaine withdrawalProfound dysphoria ('crash'), hypersomnolence, hyperphagia, and vivid unpleasant dreams
- Cannabis withdrawalIrritability, aggression, insomnia, decreased appetite, and restlessness peaking days after cessation
- Nicotine withdrawalDysphoric mood, intense cravings, difficulty concentrating, anxiety, and increased appetite with weight gain
- Severe alcohol withdrawalFluctuating sensorium, visual hallucinations, and marked autonomic hyperactivity 48 to 96 hours after cessation
Answer
Opioid withdrawal pairs with yawning/piloerection; Cocaine withdrawal pairs with hypersomnolence/hyperphagia; Cannabis withdrawal pairs with irritability/decreased appetite; Nicotine withdrawal pairs with intense cravings/weight gain; Severe alcohol withdrawal pairs with fluctuating sensorium/autonomic hyperactivity.
Each substance withdrawal syndrome is accurately paired with its classic constellation of symptoms based on DSM-5 criteria and standard clinical presentation. Withdrawal symptoms generally represent a homeostatic rebound; for instance, the withdrawal of a stimulant (cocaine) leads to lethargy and hypersomnolence, while the withdrawal of a depressant (alcohol) leads to dangerous autonomic hyperactivity and delirium. Specific signs like piloerection and yawning are highly specific to opioid withdrawal.
Step-by-Step Solution
Key Concept
The clinical presentation of substance withdrawal syndromes typically represents a rebound effect, manifesting as the physiological opposite of the substance's acute intoxication effects.