Management of "Bad Trips" in an Evolving Drug Scene

Abstract

"Bad trips" arise out of an increasingly complex drug scene. Rational therapy must consider completely, social, psychological and physiological factors. Complexity results from the development of new drugs, indiscriminate ingestion, contamination, and adulteration. Drug-induced psychological changes occasionally lead to fatal behavior. Bad trips from anticholinergic compounds may be seriously worsened by phenothiazine treatment. Protection of the patient from dangerous behavior is fundamental to treatment. A clear history is invaluable but should be augmented by physical and mental examinations. Treatment begins with establishment of verbal contact without the use of tranquilizers, if possible. Reassurance and reality defining are often sufficient. With severe ego disruption, medication in combination with verbal interaction may be required. Administration of phenothiazines or sedatives helps to reestablish the observing ego with rapid dissolution of perceptual distortion and reestablishment of the premorbid ego functioning in most cases. Optimal treatment includes a follow-up visit.