Cocaine and Psychiatric Symptoms
Primary Care Companion J Clin Psychiatry 1999;1(4):109-113
© Copyright 2015 Physicians Postgraduate Press, Inc.
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
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.