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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
Posted:Ok, this was on this morning's exam.

IF (by some astronomically small chance) YOU HAPPEN TO BE A UNIVERSITY OF MICHIGAN M2, AND YOU HAVEN'T TAKEN THE MARCH 10 QUIZ YET, STOP READING NOW!


A 24-year old unemployed man lives with his parents. He stays out all weekend and returns home on Sunday evening. He feels restless and depressed. He is irritable with his parents and speaks of committing suicide. He eats ravenously on Monday evening. By Wednesday he is completely recovered. This patient's symptoms are most consistent with:
(I've narrowed it down to my two best choices)

A) Cocaine withdrawal
B) MDMA withdrawal

I picked MDMA. What do you folks think?


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Dom
BRONZE Member since Dec 2001

Dom

Carpal \'Tunnel
Location: Bristol, UK

Total posts: 3009
Posted:How do you spell stereotype?

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_Stix_


_Stix_

Pooh-Bah
Location: la-la land

Total posts: 2419
Posted:sounds like a bad coke comedown to me.. is he still grumpy on wednesday or still totally fine? Coz if it was MDMA he'd still grumpy on a wednesday... I know these things..


how can he afford coke and MDMA with no job?? is he a prostitute as well?? If not I wanna be on the dole where he is..! not that I do drugs - coz they is Baaaddd umkay?


I honour you as an aspect of myself..

You are never to old to storm a bouncey castle..

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DeepSoulSheep
GOLD Member since Sep 2002

DeepSoulSheep

Carpal \'Tunnel
Location: Berlin, Ireland

Total posts: 2617
Posted:Reckon your correct. The eating ravenously indicates he may have taken some appetite suppressents. Plus the other less decisive symptoms.

I live in a world of infinite possibilities.

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Trippie Hippie
BRONZE Member since May 2002

Trippie Hippie

old hand
Location: Bewildered state of nothingnes...

Total posts: 733
Posted:I recon it's a coke come down, i know what i used to be like. Gone are the days thank god!!!!
LOL
Taking it easy
Trippy

----------------------------------------------------------------------------------------------------
Last night i met some pixies and we danced around a stone.
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Trippie Hippie- Monty Dons secret love child

Fly like a mouse, run like a pillow, be the small book case.

"Last night i met some pixies and we danced around a stone".

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the mind gap.


the mind gap.

old hand
Location: Brigadoon

Total posts: 829
Posted:there's only one way to find out for sure.

this weekend, take lots of coke, next weekend take lots of mdma. under strict medical supervision, of course. then you'll have valuable first-hand experience and you'll be able to pass your exam in the happy knowledge that you know what you're talking about.

and then, the weekend after that, take them both at once and come to sheffield for headcharge. just for fun.
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that should give you your answer.


wherever you go, there you are.

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_Stix_


_Stix_

Pooh-Bah
Location: la-la land

Total posts: 2419
Posted:quote:Originally posted by Trippy Hippy:
Gone are the days thank god!!!!
do you manage to miss the come down now Trippy - body got to used to it??


I honour you as an aspect of myself..

You are never to old to storm a bouncey castle..

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DeepSoulSheep
GOLD Member since Sep 2002

DeepSoulSheep

Carpal \'Tunnel
Location: Berlin, Ireland

Total posts: 2617
Posted:Sorry I meant that Mike was correct there. I think it is MDMA.

[ 11. March 2003, 05:35: Message edited by: DeepSoulSheep ]


I live in a world of infinite possibilities.

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_Stix_


_Stix_

Pooh-Bah
Location: la-la land

Total posts: 2419
Posted:sill think he'd still be a grumpy bastard on wednesday if it was MDMA.. but you cuold be right.. might not be very good mdma..

I honour you as an aspect of myself..

You are never to old to storm a bouncey castle..

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DeepSoulSheep
GOLD Member since Sep 2002

DeepSoulSheep

Carpal \'Tunnel
Location: Berlin, Ireland

Total posts: 2617
Posted:Serves him right!

I live in a world of infinite possibilities.

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Kyrian


Dreamer
Location: York, England

Total posts: 4308
Posted:Sounds quite like coke to me, but not from personal expirience, just from watching/taking too classmates and coworkers.

Keep your dream alive
Dreamin is still how the strong survive

Shalom VeAhavah

New Hampshire has a point....

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s-p-l-a-t


member
Location: Brisbane, Qld, Australia

Total posts: 383
Posted:Guess it depends on whether he's a regular user of either or not. e.g. usually comedowns will be soo much worse if you take strong stuff and you've been doing so for a fair amount of time (e.g. 12 months)..

But I reckon coke ... I reckon that you'd still be grumpy on wednesday..well maybe not *grumpy*... just still a bit down kinda. That's speaking from my past extensive experience.

hmmm... and if he was paying a lot for the coke and had heaps.. then he'd have no money which might make him suicidal cos he can't fork out more money for more coke... hmmm .. idunno


The beautiful thing about learning is that no one can take it away from you.- B.B.King

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BlackFireJack


member
Location: Bergen , Norway

Total posts: 167
Posted:my guess is that there is Coke involved....
but mixed with what I cant say...
Cause if he's out for a whole weekend with his mates there is probably more than one drug involved.....Coke mix well with other drugs
also alcohol....
You can still get high on expensive drugs when you're unemployed....good mates can be enough....
Also is he a druggie? Cause then you can only guess what he's been up to....
But I could be wrong....I'm not an expert

Treatment........give him a big bag of good smelly weed


I like Fire.. :)

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simian


simian

110% MONKEY EVERY TIME ALL THE TIME JUST CANT STOP THE MONKEY
Location: London

Total posts: 3149
Posted:Hmm, 24, unemployed, lives with his parents.

Well, he's been out for the weekend with his friends. They'll likely have jobs and be living in their own places. I assume his money would be from his parents (or benefits). This lack of independence would depress and anger him, in contrast to his friends who don't have to worry about money so much, and don't have to explain where they've been to anyone when they get back home.

He takes this depression and anger out on the people who he's dependent on, his parents. He does this through non-confrontational means (moping and sulking). He gets over it and realises he's acting a little childishly by Wednesday.

As for the eating ravenously on Monday. Hey, he was hungry, ok? Probably only grabbed a few snacks over the weekend.

Or were Coke & MDMA the only options?


"Switching between different kinds of chuu chuu sometimes gives this "urgh wtf?" effect because it's giving people the phi phenomenon."

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Kat
BRONZE Member since Dec 2000

Kat

Pooh-Bah
Location: London, Wales (UK)

Total posts: 2211
Posted:Okay, this poor bloke goes away with his friends for a weekend on the beer. He arrives back Sunday hungover and depressed cause his friends were all going out for dinner in a nice rest. which he could not afford as he is broke and spent all his money on drink. Needless to say he is depressed that he cannot live the life of riley like his friends so he talks about commmitting suicide. On Monday he gets his dole check, goes shopping and stuffs himself with food! Tuesday he has terrible pains from all the crap he has eaten and on Wednesday he is fine!!

Oh - I would say b!


Come faeries, take me out of this dull world, for I would ride with you upon the wind and dance upon the mountains like a flame.

- W B Yeats

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vanize
SILVER Member since Aug 2001

vanize

Carpal \'Tunnel
Location: Austin, Texas, USA

Total posts: 3899
Posted:I personally beleive that this question was in fact not to test your knowledge, but to see if and what kind of drugs the person taking the test uses by seeing what kind of bias they respond with.

-v-

Wiederstand ist Zwecklos!

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coleman
SILVER Member since Aug 2002

coleman

big and good and broken
Location: lunn dunn, yoo kay, United Kin...

Total posts: 7330
Posted:i would say that a lot of people that have taken one of these two drugs will have also had the opportunity to try the other. if they wanted to find out who the druggies were they could have described characteristic features of a certain high then a comedown and asked which drug they were describing.

and sorry dr g but i would have said cocaine.


"i see you at 'dis cafe.
i come to 'dis cafe quite a lot myself.
they do porridge."
- tim westwood

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Posted:A relevant excerpt from DSM IV;

http://psy.ucsd.edu/~bingerso/SUBSTANCE.htm


DSM IV seems to classify MDMA as a hallucinogen, and gives the specific criteria required for someone to be classified as 'dependent'.

I'd suggest that for extra points he's not in withdrawal, as to be classified as being in withdrawal you would have to show dependence - which I dont think you can with E in the vast majority of cases...

blah blah

eh

I'm a bit tired of everyone lumping physically addicting drugs in with potentially psychologically addictive drugs.

My answer - cocaine withdrawal, because generally speaking, you dont get cases of MDMA withdrawal.

Josh

[ 12. March 2003, 06:28: Message edited by: [Josh] ]


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DeepSoulSheep
GOLD Member since Sep 2002

DeepSoulSheep

Carpal \'Tunnel
Location: Berlin, Ireland

Total posts: 2617
Posted:It's not that he's going through withdrawal. For a few days taking MDMA, serotonin levels are low and that's what causes the depression and iritability.

It seems like an acedemic question and I thought the "He eats ravenously on Monday evening". Was what differentiated because of the appetite represent properties of MDMA.


I live in a world of infinite possibilities.

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
Posted:AGAIN, IF YOU HAPPEN TO BE A UNIVERSITY OF MICHIGAN M2, READING THIS THREAD IS A VIOLATION OF THE HONOR CODE. GOT IT?

So, first of all, I didn't write the question, but, rather a professor who is an "expert" in substance abuse/addiction and recovery (and a man who probably hasn't even ever touched a drop of coffee, let alone MDMA) wrote it.

The five choices were (I think)
A) Caffeine
B) Alcohol
C) Cocaine
D) Hallucinogens
E) Marijuana

Ok, it doesn't take a genius to rule out A, B, and E.

According to our syllabus, hallucinogens include MDMA (I disagree, I call MDMA an entactogen because mechanistically it is not a serotonergic receptor agonist but a serotonergic release agonist as well has having direct dopaminergic and noradrenergic effects...in case anyone cares).

Now, my reasoning is that I've seen MDMA do this and generally by Wednesday night, people are pretty much OK. Especially if they rolled Saturday and not on Sunday. MDMA suppresses apetite, people can be restless and irritable the day after, and MDMA is much more common than coke.

As to those of you who got offended by the question, it was a test question for second-year medical students. The point was made that drug use and abuse comes in all forms, some of them hidden behind very functional facades. 25% of surgeons in the U.S. will be active alcoholics at some point during their careers. That is much higher than the national rate for the general population of 14%. However, when it comes to writing a fair test question for a multiple choice exam (which is nothing like reality because patients don't come in saying "I have a) endocarditis b) occult neoplasm c) sepsis d) coagulopathy or e) faticious disorder"), the questions need to be straightforward.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Dr.NoodleHead
BRONZE Member since Mar 2001

member
Location: The Giant Mushroom, United Kin...

Total posts: 170
Posted:I reckon it's got to be coke - initial appetite loss, suicidal tendancies, personality shifts, la-de-dah, etc. Beaners tend to just vacate for a while. Think dopamine vs serotonion depletion.

Still, ask yourself who wrote the exam - are they speaking from personal experience? Can they get you some good samples to do some controlled trials yourself? If so PM me

Hope the rest of the exam was easy-peasy.

Bestest


Fish are just like trees except they move and they're invisible

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Mr Majestik
SILVER Member since Mar 2004

Mr Majestik

coming to a country near you
Location: home of the tiney toothy bear,...

Total posts: 4693
Posted:mega bump, so what was the answer Doc? can you remember haha

i would say hallucinogen such as MDMA, purely because it sounds right for the symptoms and a (otherwise law abiding) unemployed man couldnt afford coke.

he is fully recovered by wednesday could mean anything, that the toxins are finally out of his system, yet he hasnt had outward symptoms since monday. sever depression and appetite loss immediately after the drug wears off (we'll assume some time saturday morning then he chilled somewhere sunday day) are pretty consistant with MDMA use.

now if you dont mind i'm going to continue browsing HoP for Euthanasia topics tongue2


"but have you considered there is more to life than your eyelids?"

jointly owned by Fire_Spinning_Angel and Blu_Valley

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Mother_Natures_Son
SILVER Member since Aug 2007

Mother_Natures_Son

Rampant whirler.
Location: Geelong, Victoria, Australia!

Total posts: 2418
Posted:I would say coke... from what I have seen a person tends to be slightly effected for about a week after taking MDMA, even if the subject isnt completely aware of it.

i would say by "hallucinogen" it would refer to LSD, psilocybin or similar... Why? Marijuana was included... Marijuana is a hallucinogen, is it not? So this leads me to think that they are referring to the commonly held psychoactive substances, unless of course thats the tricky part of the question.

If that is indeed the tricky part of the question I honestly think full credit should be given to both answers... different people react to different drugs so you can't narrow down MDMA and cocaine reactions based on such rigidly defined criteria... you could put together quite strong cases for either...


hug

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Fine_Rabid_Dog


Internet Hate Machine
Location: They seek him here, they seek ...

Total posts: 10530
Posted:What a necrobump!


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The heck were you searching dude? laugh3


The existance of flamethrowers says that someone, somewhere, at sometime said "I need to set that thing on fire, but it's too far away."

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newgabe
SILVER Member since Mar 2005

newgabe

what goes around comes around. unless you're into stalls.
Location: Bali, Australia

Total posts: 4030
Posted:Originally Posted By: Mother_Natures_Son
Marijuana is a hallucinogen, is it not?

No


.....Can't juggle balls but I sure as hell can juggle details....

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ElectricBlue
GOLD Member since Feb 2002

ElectricBlue

Now with extra strawberries
Location: Canberra, Australia

Total posts: 810
Posted:Quote:i would say hallucinogen such as MDMA, purely because it sounds right for the symptoms and a (otherwise law abiding) unemployed man couldnt afford coke.

From what i have heard the price of coke in the states is much lower than it is here in aus, I think that maybe why you hear about it a lot more in American tv than you do in Australian.


I {Heart} hand me downs and spinning in the snow.<br /><br />

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Mother_Natures_Son
SILVER Member since Aug 2007

Mother_Natures_Son

Rampant whirler.
Location: Geelong, Victoria, Australia!

Total posts: 2418
Posted:Originally Posted By: newgabeOriginally Posted By: Mother_Natures_Son
Marijuana is a hallucinogen, is it not?

No

I'd contest that. ^_^ Most classifications have it in as a "Mild hallucinogen" And I do know a lot of people that have hallucinated on that particular drug... Especially closed eye visuals.

Originally Posted By: ElectricBlueQuote:i would say hallucinogen such as MDMA, purely because it sounds right for the symptoms and a (otherwise law abiding) unemployed man couldnt afford coke.

From what i have heard the price of coke in the states is much lower than it is here in aus, I think that maybe why you hear about it a lot more in American tv than you do in Australian.

He might be the one that is able to get his hands on it, perhaps he buys a heap of it for his mates and keeps the extra he would get for the discount of buying a heap of it (All his friends combined)


hug

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Mr Majestik
SILVER Member since Mar 2004

Mr Majestik

coming to a country near you
Location: home of the tiney toothy bear,...

Total posts: 4693
Posted:Originally Posted By: Mother_Natures_SonI would say coke... from what I have seen a person tends to be slightly effected for about a week after taking MDMA, even if the subject isnt completely aware of it.

it depends on the dosage, i know of people recovering in a one day after time frame. i suspect with a higher dosage/lower resistance the after effects would last longer.

that is a good point about the comparative price of coke in the us to australia. anyone know how much it is over there?


"but have you considered there is more to life than your eyelids?"

jointly owned by Fire_Spinning_Angel and Blu_Valley

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Mother_Natures_Son
SILVER Member since Aug 2007

Mother_Natures_Son

Rampant whirler.
Location: Geelong, Victoria, Australia!

Total posts: 2418
Posted:Quote:By Wednesday he is completely recovered.

Sorry, to better explain my point what I was referring to was the fact that it says the subject is completely recovered.

My opinion is that with MDMA you would only appear completely recovered... or even feel completely recovered, but you won't be feeling 100% until a week or so after. Most people I know tend not to take much and not very often at all. (so you know what my opinion is based on)


hug

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_Aime_
SILVER Member since Jan 2004

_Aime_

Carpal \'Tunnel
Location: Hastings, United Kingdom

Total posts: 4172
Posted:Class A drug talk on HoP.

This has made my evening.


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Fine_Rabid_Dog


Internet Hate Machine
Location: They seek him here, they seek ...

Total posts: 10530
Posted:Originally Posted By: _Aime_Class A drug talk on HoP.

This has made my evening.




PG BOARD!

PG BOOOOOOOOOOOOOARD!

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The existance of flamethrowers says that someone, somewhere, at sometime said "I need to set that thing on fire, but it's too far away."

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