Magnan syndrome in cocaine users

Magnan syndrome is a psychiatric manifestation derived from cocaine intoxication. It is a zoopathic hallucinatory condition in which the affected person feel small animals, insects or parasites above or under your skin.

It can also be called dermatozoic, enterozoic or zopathic formication or delirium. Frequently, and even though the sensation is not real, The itching that patients perceive leads them to scratch, leading to wounds and ulcers. severe on the skin. All of this causes them great anguish and anxiety.

Hallucinations are also known as perceptual deceptions or perceptual aberrations. They consist of an anomalous perceptual experience that is not supported by a really existing stimulus or that persists once the stimulus that caused it has already disappeared. These strange perceptions They may be accompanied by delusional thoughts, as an attempt to explain them.

Before talking about the treatment of Magnan syndrome, we must know something more about cocaine: what exactly it is, where it is obtained from, how it acts in the brain and what disorders can accompany its use.

What is cocaine and how is it consumed?

Cocaine is an alkaloid derivative obtained from the leaves of the coca plant. cultivated in South America, mainly.

From the leaves, with different treatments, three possible forms of cocaine can be obtained: cocaine sulfate (base paste or basuko), cocaine hydrochloride (the classic white powder also known as “farlopa”, “fariña” or “ parakeet”) and the free base.

Another well-known way is crack (“the poor man’s cocaine”). It is obtained by mixing cocaine hydrochloride with sodium bicarbonate.

There are different forms of consumption, depending on the form of the substance:

Coca leaves are chewed (for example, to prevent altitude sickness). Cocaine sulfate or base paste is smoked, as is crack. Cocaine hydrochloride is consumed intranasally (snorted) or administered intravenously. Freebase is smoked or inhaled in water pipes. It can also be consumed mixed with other drugs, such as heroin (speed-ball) or marijuana.

The time it takes to take effect depends on the method of administration. The inhaled or smoked form and the intravenous form are the fastest (which can reach the brain in 5 seconds), followed by the nasal or snorted and oral forms (which can take 30 seconds to reach the brain).

Why can they cause psychotic symptoms, such as Magnan syndrome?

Cocaine, in addition to being an important local anesthetic, is a sympathomimetic agent. (that is, it activates the sympathetic nervous system and produces activation). In addition, it produces a feeling of euphoria, grandiosity, hyperactivity, tachycardia, mydriasis (pupil dilation), elevation of blood pressure and loss of appetite.

Among the symptoms of cocaine intoxication are, in addition to those mentioned: possible respiratory depression, sweating, nausea and vomiting, bradycardia, coma, and even death in cases of severe poisoning.

The effects of cocaine on the brain occur through several mechanisms:

They block Na+ channels (sodium), voltage-dependent, from which the anesthetic properties are derived.They inhibit the reuptake of monoamines (dopamine, serotonin and norepinephrine), so there is an increase in these in the synaptic space. It has an affinity for serotonergic, muscarinic and opioid receptors.

Increased dopamine is related to the appearance of positive symptoms of schizophrenia, such as delusions and hallucinations. It has been proven that the administration of certain dopamine agonists, such as amphetamines or cocaine, can cause psychotic symptoms.

This increase in dopamine can cause the appearance of psychotic episodes, as occurs in cocaine psychosis, which is a transient paranoid psychosis. All this would explain the appearance of hallucinations of any kind, including haptics, typical of Magnan syndrome.

How to treat addiction and drug use disorders

To address hallucinations and other psychotic symptoms derived from cocaine intoxication or consumption, antipsychotic agents can be used.

The objective would be to block dopaminergic D2 receptors, causing a decrease in this neurotransmitter in the synaptic space. In case of agitation, benzodiazepines or other sedatives may be administered.. The person must be protected from possible skin lesions produced with the aim of ending the itching or releasing the parasites that he perceives under his skin.

However, The main goal of treatment should be to stop using the substance.. Cocaine is the second most consumed illegal drug in Spain and one of the most addictive drugs, with a very high degree of psychological dependence, so treatment must be conducted by professionals.

At a pharmacological level, some dopamine agonists (such as amantadine), stimulants (such as modafinil), noradrenergic agonists (such as propranolol) could be useful in patients with severe withdrawal syndrome at the beginning of treatment, opioid agonists (such as buprenorphine) in case of cocaine and opiate users, tricyclic antidepressants and mood stabilizers.

Among the psychological treatments that have shown the greatest effectiveness are those that include contingency management and skills training.

He community reinforcement approach program plus incentive therapy is aimed at abstinence total and is the treatment of choice for cocaine addiction.

For the curious: what is the origin of Magnan syndrome?

Ernst von Fleischl-Marxow was an Austrian doctor dedicated to neuropsychological research. During the dissection of a corpse he suffered an injury to his finger and it had to be amputated. As a result of the pain, he began to consume morphine, becoming an addict..

At that time, Freud was using cocaine and investigating its analgesic effect and its use as a treatment for morphine addiction. Ernst, following the advice of his close friend Freud, began treatment with cocaine. However, he had the “bad luck” that he ended up addicted to both substances.

The worst consequence was not the polydrug use, nor that his pain was not relieved with said treatment, but also that the pain spread throughout the body. The doctor began to feel thousands of worms piercing his skin and eating him from the inside.

Given this, his colleagues took him to the office of Dr. Valentin Magnan, a French doctor who is an expert in addictions and psychiatry. Shortly after, this doctor described the “Magnan sign or syndrome”: a type of psychosis caused by cocaine consumption, which produces painful tactile hallucinations due to the perception of foreign bodies under the skin.

Between 1884 and 1887, Freud published a series of writings on cocaine and its effects, the most important of which was Uber Cocapublished in 1884. In 1891, Ernst died at the age of 45, bankrupt and plunged into a serious depression, but it was not until 1896, after the death of his father, that Freud decided to abandon consumption.

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