Substance intoxication or withdrawal

Alcohol, methamphetamine, cocaine, GHB, alcohol/benzo/GHB withdrawal

EmergentReview due

Compare (8)

At a glance

High-risk causes: 7
Immediate actions: 5
Related differentials: 8

Safety snapshot

Alcohol/benzo withdrawal, stimulant crash suicidality, aggression, delirium.

Watch forHyperthermiaseizuresdeliriumchest painAlcohol/benzo withdrawalstimulant crash suicidality

Presentation hinge

Shifts are reactive, brief, and relationship-linked rather than sustained episodic elevation with reduced need for sleep.

Separates the Aggression / Violence / Homicidal Ideation group. It is not specific to Substance intoxication or withdrawal.

Points for this presentation

Applies to the Aggression / Violence / Homicidal Ideation group — not specific to Substance intoxication or withdrawal

Violence in psychosis is often defensive from perceived threat
Mixed irritability is easy to underestimate
One of the commonest reversible drivers of acute violence
Agitation in dementia is frequently delirium, pain, or environment-driven

Clinical review

Rows marked “Whole group”: Applies to the Aggression / Violence / Homicidal Ideation group — not specific to Substance intoxication or withdrawal

Why it fits

Alcohol, methamphetamine, cocaine, GHB, alcohol/benzo/GHB withdrawal

Key features2 features

Aggression is often fear- or belief-driven rather than predatory.
Mood swings around intoxication, rebound, or withdrawal periods

Must-not-miss

Alcohol/benzo withdrawal, stimulant crash suicidality, aggression, delirium.

High-risk causes7 causes

Hyperthermia
seizures
delirium
chest pain
Alcohol/benzo withdrawal
stimulant crash suicidality
aggression

Bedside question

Applies to the Aggression / Violence / Homicidal Ideation group.

Shifts are reactive, brief, and relationship-linked rather than sustained episodic elevation with reduced need for sleep.

Helpful clues1 clue

Aggression is often fear- or belief-driven rather than predatory.

Immediate action

Applies to the Aggression / Violence / Homicidal Ideation group.

Violence in psychosis is often defensive from perceived threat Mixed irritability is easy to underestimate One of the commonest reversible drivers of acute violence Agitation in dementia is frequently delirium, pain, or environment-driven Recognising the interpersonal trigger can prevent the next escalation

Priority steps5 steps

1Violence in psychosis is often defensive from perceived threat
2Mixed irritability is easy to underestimate
3One of the commonest reversible drivers of acute violence
4Agitation in dementia is frequently delirium, pain, or environment-driven
5Recognising the interpersonal trigger can prevent the next escalation

Investigations

Applies to the Aggression / Violence / Homicidal Ideation group.

None listed

Core tests

Mimics / overlap

Applies to the Aggression / Violence / Homicidal Ideation group.

None listed

Consider

Clinical reference — not validated decision support. Review before use.