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Hallucinogen intoxication symptoms happen at the same time as, or shortly after, using hallucinogenic drugs.

The marked anxiety, depression, paranoid ideation, and impaired judgment can contribute to agitation and potentially aggressive behavior in the patient. (Morgan, 2024, p. 425).

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Given the potential for agitation and aggressive behavior resulting from the patient's symptoms of hallucinogen intoxication, the priority is to ensure the safety of all individuals involved.

Remove any potentially harmful objects from the patient's proximity and create a calm and secure environment. Additionally, closely monitor the patient's behavior and be prepared to implement de-escalation techniques as needed to manage agitation effectively.

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Experiencing “bad trips, fear of dying, going insane, and unexpected flashbacks or a spontaneous recurrences of hallucinogenic state without ingestion of the drug“, sometimes months after the initial consumption (Morgan, 2024, p. 423).

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While there's no specific medication-assisted treatment approved by the FDA for hallucinogen use disorders, medications like benzodiazepines may be used to manage acute anxiety or panic episodes related to these substances (Morgan, 2024, p. 448).

If the person experiences a psychotic reaction, antipsychotic medications may be considered. The intervention aims to reduce harm to the patient and others during adverse reactions (Morgan, 2024, p. 448).

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Morgan, K. (2023). Davis Advantage for Townsend's Psychiatric Mental Health Nursing (11th ed., pp. 425). F. A. Davis  https://fadavisreader.vitalsource.com/books/9781719649872

Morgan, K. (2024). Davis Advantage for Townsend’s Psychiatric Health Nursing. (11th ed., pp. 423, 448). Susan Rhyner. https://fadavisreader.vitalsource.com/reader/books/9781719649872/epubcfi/6/74[%3Bvnd.vst.idref%3Dc23]!/4/2/2/642/3:36[MDM%2CA%5E)]

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Rapid Tolerance Development to a High Degree 

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Rapid Tolerance Development to a High Degree 

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Tolerance is complete after 3-4 consecutive days of use and desired effects have often faded. It has been reported in chronic users, psychological addiction characterized by the craving for the drug and the development of tolerance where the drug has a reduced effect.

The disappointed user might seek to overcome tolerance by consumption of higher drug amounts, which increases the burden on the body. Usually more unpleasant effects might manifest over time, and quitting the drug may cause a withdrawal syndrome; where there used to be a burst of energy, there's now depletion, mood disturbances, malaise, poor concentration, irritability, and sleep disturbances. (Morgan, 2024, p. 424-425).

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1:1 monitoring

Prescribe haloperidol

Referral to psychiatry and psychologist

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Stabilization: The patient's vital signs indicate tachycardia (137 bpm), hypertension (150/114 mmHg), and fever (39.0°C or 102.2°F). Immediate measures should be taken to stabilize her vital signs. This may involve administering antipyretics to lower the fever and monitoring the blood pressure closely to prevent complications such as hypertensive crisis.

Assessment and Monitoring: Continuous monitoring of the patient's vital signs, including heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation, is essential to ensure her stability and detect any deterioration promptly.

Psychosocial Support and Safety: The patient requires a calm and supportive environment to reduce anxiety. Encouraging her to express her feelings can help alleviate distress. Safety measures, including constant supervision and removing harmful objects, are crucial to prevent self-harm or harm to others, particularly due to the patient's reported emotional numbness and statement about feeling already dead.

Mental Health Assessment: Conduct a thorough mental health assessment to evaluate the severity of the dissociative symptoms, hallucinations, and risk of self-harm or harm to others.

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1) Place the patient on suicide precautions and have a 1:1 sitter

2) Manage sx’s

Anxiety or panic treat w/ benzodiazepines (e.g. diazepam)

Psychotic reactions treat w/ antipsychotic (e.g. haloperidol)

3) Frequently orient the patient to reality and the surroundings

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Situation:

A 27 year-old female patient has been brought to the ED via ambulance with vague complaints of "feeling weird" after having ingested some colorful tablets. There is suspicion of hallucinogenic ingestion due to her presentation of symptoms.

Background:

The patient is a poor historian, making it challenging to gather detailed information about her medical and psychiatric history. However, her symptoms suggest the possibility of hallucinogenic substance ingestion, leading to dissociative effects.

Assessment:

The patient's current vital signs include a heart rate of 137 beats per minute, blood pressure of 150/114 mmHg, respiratory rate of 22 breaths per minute, temperature of 39.0°C (102.2°F), and oxygen saturation of 99% on room air. Additionally, the patient exhibits symptoms of depersonalization, feeling detached from her body and observing herself from an external perspective. She also experiences derealization, perceiving her surroundings as surreal and dream-like. Furthermore, there is an alteration in her perception of time, with time appearing to move slowly. The patient reports feeling confused and disoriented, alongside emotional numbing, rendering her inability to experience strong emotions. Expressing a sense of hopelessness, she states, "I can't live anymore—I'm already dead." These symptoms suggest a profound dissociative episode requiring immediate medical attention and psychological evaluation.

Recommendation:

Safety Measures: Implement safety measures to prevent self-harm or harm to others, considering the patient's altered state of consciousness.

Medical Assessment: Conduct a thorough physical examination and vital signs monitoring to rule out any medical complications related to substance ingestion.

De-escalation: Provide a calm and supportive environment to help alleviate the patient's distress. Use therapeutic communication techniques to validate her feelings and offer reassurance.

Monitoring: Continuously monitor the patient's mental status, vital signs, and level of consciousness. Document any changes in symptoms or behavior.

Psychosocial Support: Involve the patient's family or support system, if available, to provide additional support and information about the patient's history.

Education: Provide education to the patient and her family about the potential risks of hallucinogenic substance use and the importance of seeking help for mental health concerns.

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Acute toxicity and bad trips usually can be managed with placement of the individual in a quiet, non-stimulating environment with immediate and direct supervision so that the patient does not cause harm to herself or to others. Occasionally, a low dose of a short or intermediate acting benzodiazepine may be useful to control anxiety and promote sedation.

Group therapy - learning more about adaptive ways of coping, how to deal with problems that may have arisen from or were exacerbated by the former substance use, and ways to improve quality of life and function more effectively without substances. (Morgan, 2024, p. 451).