A 28-year-old man is hospitalized due to the acute onset of severe depression and suicidal ideation for several days. He was recently thrown out of his mother's home after stealing her money to support his drug habit. The patient reports fatigue and vivid, disturbing dreams. The nursing staff note that he is irritable, withdrawn, hypersomnolent, and hyperphagic. The patient has an extensive history of substance abuse and has been hospitalized previously for alcohol detoxification. Blood pressure is 110/80 mm Hg and pulse is 64/min. Physical examination shows old injuries from a motorcycle accident but no other abnormalities. On mental status examination, he appears lethargic and dysphoric. This patient's current symptoms are most likely the result of which of the following conditions?

Question

A 28-year-old man is hospitalized due to the acute onset of severe depression and suicidal ideation for several days.  He was recently thrown out of his mother's home after stealing her money to support his drug habit.  The patient reports fatigue and vivid, disturbing dreams.  The nursing staff note that he is irritable, withdrawn, hypersomnolent, and hyperphagic.  The patient has an extensive history of substance abuse and has been hospitalized previously for alcohol detoxification.  Blood pressure is 110/80 mm Hg and pulse is 64/min.  Physical examination shows old injuries from a motorcycle accident but no other abnormalities.  On mental status examination, he appears lethargic and dysphoric.  This patient's current symptoms are most likely the result of which of the following conditions?

Quizplus · Accepted Answer

11ec160b_360d_ad13_9249_5dc0c0bfffad_MD0001_00 This patient's depression, fatigue, hypersomnia, hyperphagia, and vivid dreams are characteristic of cocaine withdrawal. Symptoms occur within hours to days of cessation or reduction of heavy or prolonged use. Following a binge, patients may experience a period of acute, intense symptoms, including severe depression with suicidal ideation, pronounced lassitude (the "crash"), and drug cravings. In contrast to withdrawal from opiates, alcohol, and benzodiazepines, withdrawal from cocaine and other stimulants usually results in minor physical symptoms. No medication has proven to be effective in treating cocaine withdrawal, and treatment is supportive only. (Choice A) Alcohol withdrawal is a medically serious syndrome characterized by initial symptoms of agitation, tremors, tachycardia, and hypertension (12-24 hours), with some patients progressing to seizures and delirium tremens. (Choice B) Symptoms of benzodiazepine withdrawal include anxiety, insomnia, perceptual disturbances, tachycardia, seizures, and psychosis. (Choice C) Patients who cease heavy and prolonged cannabis use may have irritability, anxiety, depressed mood, insomnia, restlessness, and decreased appetite. Nonspecific physical symptoms such as muscle aches may also be present. (Choice E) Insufficient duration of symptoms and probable relationship to substance use make major depressive disorder less likely. (Choice F) Opioid withdrawal is characterized by abdominal cramps, nausea, vomiting, yawning, muscle aches, piloerection, lacrimation, and dilated pupils. Although withdrawal is uncomfortable, it is generally not life-threatening. Educational objective: Cocaine withdrawal is characterized by the development of acute depression accompanied by fatigue, hypersomnia, hyperphagia, and vivid dreams. __________ References: Substance use, intoxication, and withdrawal in the critical care setting. (http://www.ncbi.nlm.nih.gov/pubmed/28601134)

A 28-Year-Old Man Is Hospitalized Due to the Acute Onset