© 1999 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
Symptomatic Overlap of Cocaine Intoxication and Acute Schizophrenia at Emergency Presentation
Assistant Professor of Psychology, Hofstra University Hempstead, NY, and Research Assistant Professor of Psychiatry, NYU School of Medicine New York, NY
Assistant Professor of Psychiatry, NYU School of Medicine and Research Psychiatrist at the Nathan Kline Institute for Psychiatric Research Rockland, NY
Clinical Assistant Professor of Psychiatry, NYU School of Medicine and CPEP Director, Bellevue Hospital New York, NY
Research Scientist, Nathan Kline Institute for Psychiatric Research
Professor and Chair of Psychiatry, NYU School of Medicine and Director of the Nathan Kline Institute for Psychiatric Research
Reprint requests should be sent to Dr. M.R. Serper, Dept. of Psychology, Hofstra University, Hempstead, NY 11550. e-mail: Mark.Serper{at}nyu.edu
Cocaine intoxication and acute abstinence alter brain dopaminergic functioning, resulting in behavioral changes closely mimicking the positive and negative symptoms of schizophrenia. In emergency room settings, recent cocaine abuse can be mistaken for schizophrenia and may cause inappropriate diagnosis and in some instances medical mismanagement. Schizophrenia patients presenting with recent cocaine abuse may also present with significant diagnostic and treatment dilemmas. This study attempts to distinguish between cocaine and schizophrenic psychosis by examining patients who present with both recent cocaine abuse and acute schizophrenia (CA+SZ), cocaine intoxication without schizophrenic illness (CA), and acute schizophrenia with no comorbid substance abuse (SZ) within the first 24 hours after arrival at the Bellevue psychiatric emergency service. Clinical assessment included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Positive Symptoms, and the Schedule for the Assessment of Negative Symptoms. Both cocaine abusing groups were required to have positive urine toxicology screens for inclusion in the study. Multivariate analysis of variance showed the CA+SZ patients present with a clinical profile that overlaps with CA patients on mood and negative symptom dimensions and overlaps with SZ patients on most positive symptoms. CA+SZ patients differed from both groups, however, by presenting with significantly more hallucinatory experiences than cocaine abusing or schizophrenia patient counterparts. Despite considerable overlap, each group of patients presented with a discernible cross-sectional symptom pattern.
Keywords: Cocaine intoxication / psychosis / emergency assessment
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