The essential feature of stimulant intoxication, related to amphetamine-type stimulants and cocaine, is the presence of clinically significant behavioral or psychological changes that develop during, or shortly after, use of stimulants (Criteria A and B). Auditory hallu— cinations may be prominent, as may paranoid ideation, and these symptoms must be dis- tinguished from an independent psychotic disorder such as schizophrenia. Stimulant intoxication usually begins with a ”high" feeling and includes one or more of the follow- ing: euphoria with enhanced vigor, gregariousness, hyperactivity, restlessness, hypervig- ilance, interpersonal sensitivity, talkativeness, anxiety, tension, alertness, grandiosity, stereotyped and repetitive behavior, anger, impaired judgment, and, in the case of chronic intoxication, affective blunting with fatigue or sadness and social withdrawal. These be- havioral and psychological changes are accompanied by two or more of the following signs and symptoms that develop during or shortly after stimulant use: tachycardia or bra- nausea or vomiting; evidence of weight loss; psychomotor agitation or retardation; mus- cular weakness, respiratory depression, chest pain, or cardiac arrhythmias; and confu- sion, seizures, dyskinesias, dystonias, or coma (Criterion C). Intoxication, either acute or chronic, is often associated with impaired social or occupational functioning. Severe in- toxication can lead to convulsions, cardiac arrhythmias, hyperpyrexia, and death. For the diagnosis of stimulant intoxication to be made, the symptoms must not be attributable rion D). While stimulant intoxication occurs in individuals with stimulant use disorders, in- toxication is not a criterion for stimulant use disorder, which is confirmed by the presence of two of the 11 diagnostic criteria for use disorder.
The magnitude and direction of the behavioral and physiological changes depend on many variables, including the dose used and the characteristics of the individual using the sub- stance or the context (e.g., tolerance, rate of absorption, chronicity of use, context in which it is taken). Stimulant effects such as euphoria, increased pulse and blood pressure, and psychomotor activity are most commonly seen. Depressant effects such as sadness, brady- cardia, decreased blood pressure, and decreased psychomotor activity are less common and generally emerge only with chronic high-dose use.
Stimulant—induced disorders. Stimulant intoxication is distinguished from the other stimulant-induced disorders (e.g., stimulant-induced depressive disorder, bipolar disor- der, psychotic disorder, anxiety disorder) because the severity of the intoxication symp- toms exceeds that associated with the stimulant-induced disorders, and the symptoms warrant independent clinical attention. Stimulant intoxication delirium would be distin- guished by a disturbance in level of awareness and change in cognition.
Other mental disorders. Salient mental disturbances associated with stimulant intoxi- cation should be distinguished from the symptoms of schizophrenia, paranoid type; bi- described 1n DSM- 5.
A. Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use.
B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:
Fatigue.
Vivid, unpleasant dreams.
Insomnia or hypersomnia.
Increased appetite.
Psychomotor retardation or agitation.
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C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.