Search

Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen. In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments., (Copyright © 2022 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary major depressive disorder (P-MDD) and cocaine-induced major depressive disorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD) in CUD patients., Methods: Secondary data analysis was carried out with a cross-sectional sample of 160 patients presenting CUD and MDD. Clinical assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD., Results: Men represented 80% of the sample, the mean age was 38.61 years, and 64.5% had elementary studies. CI-MDD diagnosis (61.3%) was more frequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had another substance use disorder diagnosis. The criterion "Changes in weight or appetite" was more prevalent (57.1%) in P-MDD group., Conclusions: We found differences in the criterion "Changes in weight or appetite". Further research is needed in this field to establish a differential diagnosis and thus provide better treatment for CUD patients.

Background: In Uruguay, cocaine base paste (CBP, pasta base) is a widely used form of cocaine. The aim of our study is to determine the main clinical characteristics of CBP abusers., Methods: Retrospective, single-center study of consultations at the Montevideo Poison Control Center between January 1, 2004 and December 31, 2005., Results: One hundred and thirteen consultations were included, with an average age of 22 years (+ - 0.5 years) and a female-male sex ratio of 1:4.3. The consultations were related to drug overdose (77%), suicide attempt (16.8%), and wanting to give up CBP use (6.2%). In 48.1% the time elapsed since inhalation of CBP was less than 6 hours. Doses varied between 0.5 gr. and 25 gr. Use of other drugs at the same time, such as alcohol, marijuana or benzodiazepines, was common (51 cases). The symptoms most frequently observed were neuropsychiatric and cardiovascular, followed by respiratory symptoms. In 16.8% of patients, reason for the consultation was intentional acute ingestion of drugs, considered as a suicide attempt, occurring within a few hours of drug consumption., Discussion: CBP users are mostly young males. Although clinical findings are compatible with those for cocaine abuse, euphoria is a major clinical feature in CBP abusers. The presence of respiratory symptoms reflects the complications associated with the ingestion route. Suicide attempts occurring within a few hours of CBP confirm the high prevalence of suicidal ideation reported by other authors. cocaine base paste, clinical features, suicide attempts.

In the past 10 years, chronic drug abuse health problems have become complex medical-legal problems. These include Cocaine-Induced Agitated Delirium, an idiosyncratic illness appears 1-2 hours after regular drug intake and can cause death without overdose is detected at autopsy. This review studies the molecular changes caused by cocaine abuse that derived into Cocaine-Induced Agitated Delirium. The molecular-clinical correlation links the phenomena induced by the abuse expressed at different levels of complexity, from the biochemical to the social. The purpose here is to induce a greater awareness of this illness to improve its prevention, to obtain its early diagnosis and to achieve its appropriate therapeutic-legal approach. Cocaine-Induced Agitated Delirium should be considered as the result of several unseen changes, that if they reach a critical threshold trigger the fatal outcome. This makes the abuse of cocaine and the individual predisposition solely responsible for its appearance.

Objective: To assess the metric properties of the abridged, 10-item version of the Cocaine Craving Questionnaire-Now (CCQ-N-10) in its Spanish adaptation., Method: The sample consists of 63 people beginning treatment for cocaine-abuse (n=23) or dependence (n=40) disorders according to DSM-IV criteria. Participants completed an assessment battery that included the extended, 45-item version of the Cocaine Craving Questionnaire (CCQ-N-45) - in which the CCQ-N-10 is embedded -, the Cocaine Craving Scale (CCS), a Visual Analog Craving Scale (VAS), the Severity of Dependence Scale (SDS), and the Clinical Psychiatric Impression (CPI)., Results: Cronbach's values for the CCQ-N-10, CCQ-N-45, SDS and CCS scales were 0.95, 0.88, 0.79 and 0.93, respectively, indicating that all instruments show high internal consistency. Test-retest reliability for the CCQ-N-10 was fair (Intraclass Correlation Coefficient=0.59; p<0.001). A factor analysis of the CCQ-N-10 (KMO=0.85) shows a one-factor structure explaining 68.6% of the variance, with factor loadings ranging from 0.64 to 0.92. Confirmatory factor analysis supports the unidimensionality of the scale (CF =0.91; SRMR=0.06). The CCQ-N-10 explains 86.6% of the variance accounted for by the CCQ-N extended version (CCQ-N-45) and shows convergent validity with related measures such as the CCS (r=0.64, p<0.001), VAS (r=0.65, p<0.001), SDS (r=0.53, p<0.001) and CPI (r=0.50, p<0.001). Persons fulfilling criteria for cocaine-dependence disorder, compared to those who present cocaine abuse, show higher CCQ-N-10 scores (F(1;60.6)=7.16, p=0.010)., Conclusions: The Spanish adaptation of the CCQ-N-10 shows metric adequacy, and can be considered as a suitable assessment instrument in relation to cocaineuse disorders.

Introduction: Abuse of cocaine and other sympathomimetic drugs has been reported as a significant risk factor for stroke. The physiopathologic mechanisms implicated are multifactorial. Chronic cocaine use leads to extensive destruction of osteocartilaginous structures of nose, sinuses and palate., Case Report: We report the case of a 56 years-old woman with hypertension and smoke abuse who was admitted with a pontine paramedian infarction. Cranial resonance findings of midline destructive lesions lead to the suspicion of chronic cocaine consumption. The initial outcome was good but she was re-admitted nine months later with an extent pontomesencephalic infarction., Conclusions: Abuse of cocaine is a risk factor for stroke that should be considered not only in young patients. The pathogenic relationship between stroke and midline cocaine related destructive lesions is discussed.

Background and Objective: The consumption of cocaine has increased in Spain in recent years, leading to a probable increase in overdoses. The associated use of other drugs of abuse may be increasing the toxicity of cocaine, and therefore, increasing consultations to the emergency department (ED)., Patients and Method: We collected patients seen by the ED of our hospital who reported cocaine consumption in the previous hours. The relationship between cocaine consumption and the reason for attending the ED was analysed. We reviewed the medical records of a sample of overdoses to determine the clinical profile., Results: During the period 2002-2004, 745 patients were detected (average age 31 years, 68% males). The annual distribution was 223 cases in 2002, 232 in 2003, and 290 in 2004. Fifty-three percent of patients attended the ED at the weekend and 53% from 0:00 to 12:00 h. The main drugs associated with cocaine consumption were ethyl alcohol (38%), opiates (14%), cannabis (13%) and amphetamine derivatives (9%). Cocaine was the substance causing clinical symptoms in 70% of cases. The main reasons for attending the ED were anxiety or agitation (48%) and thoracic pain or palpitations (25%). Eleven percent of cases required hospital admission (19 intensive care unit) and 3 patients died., Conclusions: The consumption of cocaine, almost always associated with other drugs of abuse, has generated an increase in patients attending the ED. Although mortality is low, cocaine consumption generates substantial morbidity and frequent hospital admissions.

We report a 29 years old male, with a history of cocaine abuse and excessive alcohol intake, who was admitted to the hospital with an acute peritonitis. The patient was operated and multiple perforations of the cecum were found. A right hemicolectomy was performed and the pathological study of the surgical piece showed an ischemic colitis. A literature review reveals 22 reported cases of ischemic colitis associated to cocaine abuse.

Objective: To study the presence of psychopathology in patients seeking treatment for cocaine abuse., Design: Case/control study., Setting: Addictive conduct unit. Treatment of addiction to legal and illegal drugs. Primary care., Patients: Patients seeking treatment for cocaine abuse (n = 35). Control group of people with no drug-abuse problems (n = 40)., Measurements and Results: Evaluation of psychopathology through the Brief Symptom Inventory (BSI, Derogatis, 1975). Patients who abused cocaine scored high in the BSI, especially in the paranoid ideas (mean = 1.48) and obsessive-compulsive (mean = 1.25) dimensions. When the cocaine group was compared with the control group, there were significant differences in 11 of the 12 indicators. The most relevant significance occurred in the paranoid ideas and psychotic dimensions (p = 0.000)., Conclusions: The high prevalence of psychiatric symptoms in patients seeking cocaine-abuse treatment was confirmed. The high scores in the obsessive-compulsive, anxiety and general malaise dimensions hindered the process of treatment in order to stop using the drug, in that the scores drop when consumption stops but start up again intensively in the following days. Given the characteristics of these patients, the BSI seems a useful instrument for guiding the diagnosis and treatment of people who abuse cocaine.

The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, Valencia and Gran Canaria during 1994 were retrospectively analyzed. Seventy-three emergencies related to the consumption of design drugs, hallucinogens or amphetamines (100 times lower than because of opiates or cocaine) were recorded. Apart from the responsible drug for the emergency visit, in most cases the usual consumption of other substances was mentioned. Acute psychopathological reactions predominated. Three patients were admitted and five were derived to other hospitals; the remaining patients improved and were discharged. The number of emergencies on account of these drugs is relatively low, with a proportion of less than one in 10,000 emergencies attended in these areas and might not radically change if the current predominant consumption pattern is maintained.