Cannabis and Stimulants

A 32-year-old female with a 5-year history of methamphetamine use presents to the emergency department with acute agitation, paranoia, and visual hallucinations of insects crawling under her skin. Her vital signs are: BP 165/95 mmHg, HR 128/min, temperature 38.2°C. She reports not sleeping for 4 days. On examination, she has multiple excoriations on her arms and legs. Urine drug screen is positive for amphetamines. She denies any prior psychiatric illness. What is the most appropriate initial management?

A 28-year-old man from Delhi presents to the emergency department with acute onset chest pain, palpitations, and tremor lasting 2 hours. He reports smoking cannabis mixed with tobacco ('bidi') 30 minutes before symptom onset. Vital signs: BP 168/104 mmHg, HR 128/min, RR 22/min, temperature 37.2°C. Physical examination reveals diaphoresis and anxiety. ECG shows sinus tachycardia with no ST changes. Troponin I is negative. Urine drug screen is positive for cannabinoids. What is the most likely diagnosis?

Which neurotransmitter system is primarily affected by cocaine and amphetamines, leading to their stimulant and reinforcing properties?

A 32-year-old female with a 5-year history of methamphetamine use presents with severe insomnia, anhedonia, fatigue, and depressed mood lasting 3 weeks after her last use. She reports intense cravings for the drug and feels unable to experience pleasure from previously enjoyable activities. Physical examination shows weight loss and poor hygiene. What is the most appropriate initial pharmacological intervention?

A 28-year-old man presents to the emergency department with severe agitation, paranoia, and visual hallucinations. He reports using methamphetamine intravenously 6 hours ago. On examination, he is diaphoretic, with a heart rate of 128 bpm, blood pressure 165/95 mmHg, and temperature 38.5°C. He is picking at his skin and complaining of insects crawling under his skin. What is the most likely diagnosis?