History | Possible past history of episodes and family history of disorder and no report of substance use | Use may be acknowledged with sensitive enquiry and corroborative reports (eg, from family, friends, etc) |
Clinical features |
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Symptoms may be similar Episodes may self-limit after a few days Irritability and aggression are more common Sub-syndromal presentations are more likely than full syndromes Close temporal relationship to use Association with high dose and multiple substance use
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Physical exam | Signs of increased arousal may be present (eg, increased pulse and/or blood pressure) | The following signs may be present:
AAS
use – acne, needle marks, female hirsutism, jaundice, gynaecomastia (men), breast atrophy (women), testicular atrophy or prostatic hypertrophy (men), clitoromegaly (women)
Stimulant use – increased arousal, dilated pupils, tics
Cannabinoid
use – characteristic smell, conjunctival injection, drowsy, slowed responses, impaired short term memory
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