Phencyclidine

Phencyclidine (PCP) was developed initially as an anesthetic. However, a large number of patients developed postoperative psychosis after its administration. These occurrences stopped its use for this purpose in humans. Significantly, PCP affects all neurotransmitter systems. During the 1970s PCP was sold as "angel dust," and its use was rampant. At present, PCP is mainly used by lower middle class white men in a very few localities. It can be injected, snorted, smoked, or eaten, and has been found in samples of LSD, amphetamines, and marijuana. PCP has been sold as mescaline or as one of the hallucinogens.

PCP can cause a mixed euphoric-dysphoric syndrome with increasing doses of the drug. Users have reported sensations of time slowing, of relaxation, and of numbness. High doses of PCP can cause a psychotic picture similar to that of schizophrenia, with increasing agitation, hallucinations, and bizarre and violent behaviors. Catatonia has also been reported. Patients with PCP-induced psychosis may show increased body temperature, hypertension, and increased sweating. Neurological abnormalities include miosis, horizontal and vertical nystagmus, and ataxia. Increased muscle tone, hyperreflexia, and tremors have also been reported. Very high doses of the drug have been reported to cause seizures and even coma. Delirium lasting for several days is common in patients recovering from PCP-induced coma.

Treatment of an intoxicated PCP user involves putting the subject in a very calm environment. Neuroleptic drugs are relatively contraindicated because they have the potential to cause development of the neuroleptic malignant syndrome or to precipitate seizures. Benzodiazepines are the drugs of choice in treatment of PCP-induced intoxication. Enhancement of PCP clearance by acidification of the urine is recommended in comatose patients.

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