A 19-year-old college student comes to the office with new-onset fatigue. The patient has had difficulty getting up in the morning for the past week and states he would sleep 10-12 hours if his schedule allowed. He also reports vivid dreams. The patient was diagnosed with attention-deficit hyperactivity disorder at age 10 and has been treated with dextroamphetamine since then. However, his prescription ran out early recently after he doubled the dosage to help him study during exams. Which of the following findings is most likely to be present in this patient?

Question

A 19-year-old college student comes to the office with new-onset fatigue.  The patient has had difficulty getting up in the morning for the past week and states he would sleep 10-12 hours if his schedule allowed.  He also reports vivid dreams.  The patient was diagnosed with attention-deficit hyperactivity disorder at age 10 and has been treated with dextroamphetamine since then.  However, his prescription ran out early recently after he doubled the dosage to help him study during exams.  Which of the following findings is most likely to be present in this patient?

Quizplus · Accepted Answer

11ec160b_364a_6831_9249_c723b1bcf40c_MD0001_00 This patient's new-onset fatigue, hypersomnia, and vivid dreams following abrupt cessation of prolonged stimulant (eg, dextroamphetamine) use is most likely due to stimulant withdrawal. Decreased appetite and insomnia are the most common adverse effects of stimulant medications used to treat attention-deficit hyperactivity disorder, and abrupt stimulant withdrawal is associated with the opposite symptoms of fatigue, hypersomnia, and hyperphagia. Dysphoric mood may also occur. Use of supratherapeutic doses of prescribed stimulants or use that deviates from prescription instructions (eg, insufflation to attain a euphoric effect) increases the risk for withdrawal and adverse effects. Depending on the half-life of the agent used, symptoms of stimulant withdrawal typically present within hours to days of cessation or reduction of heavy or prolonged use and resolve without treatment. In contrast to withdrawal from alcohol, benzodiazepines, and opiates, physical symptoms in stimulant withdrawal are minor. (Choices A and C) Dilated pupils and rhinorrhea are classic symptoms of opioid withdrawal. Pupillary dilation may be seen during acute intoxication with stimulants but not during withdrawal. (Choices D, E, and F) Seizures, tachycardia, and tremors are features of alcohol and benzodiazepine withdrawal syndromes. These features may be seen in stimulant overdose but not in stimulant withdrawal. Educational objective: Stimulant withdrawal is characterized by dysphoric mood, fatigue, hypersomnia, hyperphagia, and vivid dreams. In contrast to many other withdrawal syndromes, stimulant withdrawal is not associated with significant findings on physical examination. __________ References: Food consumption and weight gain after cessation of chronic amphetamine administration. (http://www.ncbi.nlm.nih.gov/pubmed/24667154)

A 19-Year-Old College Student Comes to the Office with New-Onset