Cocaine and Psychiatric Symptoms

BACKGROUND: Cocaine is an addictive drug that produces numerous psychiatric symptoms, syndromes, and disorders. The symptoms include agitation, paranoia, hallucinations, delusions, violence, as well as suicidal and homicidal thinking. They can be primary to the drug's effect or secondary to exacerbation of comorbid psychiatric disorders. DATA SOURCES: A computerized literature search was conducted using MEDLINE to identify reports of psychiatric symptoms secondary to cocaine use. Additional reports were found via bibliographies of various published reports. DATA SYNTHESIS: The use of cocaine in the "crack" form is often associated with more frequent and intense symptoms. Paranoia occurs in 68% to 84% of patients using cocaine. Cocaine-related violent behaviors occur in as many as 55% of patients with cocaine-induced psychiatric symptoms. Homicide has also been associated with cocaine use in as many as 31% of homicide victims. In suicide, cocaine has been found to be present in as high as 18% to 22% of cases. Many patients with cocaine dependence have also been found to have a comorbid psychiatric disorder. CONCLUSION: Cocaine can produce a spectrum of psychiatric symptoms with which primary care practitioners need to be familiar. Comorbid psychiatric disorders are frequent in patients with cocaine use disorders and can worsen with cocaine use. Nonaddictive medication may be necessary to treat comorbid conditions such as anxiety and depressive disorders. Primary care practitioners need to be familiar with the treatment programs for patients with cocaine use disorders so appropriate referral can easily take place and follow-up care can be understood and maintained.