an underlying acute neurological lesion (see below). Chronic, frequent use of stimulant drugs may lead to the development of a chronic paranoid perspective or fully formed psychosis that is difficult to differentiate from schizophrenia.

Medical complications of stimulant intoxication may be serious and life-threatening; cocaine intoxication is the commonest cause of myocardial infarction in young males presenting to A&E departments. The medical aspects of cocaine intoxication can be divided into three phases (Weiss, Greenfield & Mirin, 1994). The first phase presents with the psychological/behavioural effects described above and mild physiological effects, usually not requiring specific treatment. The second phase is characterised by myocardial ischaemia or infarction, seizures, malignant encephalopathy, incontinence and ventricular dysrhythmias. The third (premorbid) phase is characterised by coma, paralysis, and fixed, dilated pupils. Other complications include hyperthermia (which may suggest a more severe prognosis (Weiss, Greenfield & Mirin, 1994)) leading to reversible coagulopathy and renal failure, cerebral and pulmonary oedema, cerebral haemorrhage, rhabdomyoloysis, myoglobinuria, nephrotoxicity and hyperkalaemia (Callaway & Clark 1994).