Review Question - QID 105816

The patient presents with behavioral changes in adolescence with conjunctival injection consistent with possible drug use. The best initial test to rule out drug use is a urine toxicology screening.

Adolescence is a time when drug use and sexual activity become more common. Often parents will recognize behavioral changes in their children including drop in school performance, depression, euphoria, and trouble with the law among many other behavioral changes. An initial test to be performed to rule out drug use is a urine toxicology screening. Other common causes of adolescent behavioral change that one must rule out include abuse, rape, and pregnancy.

Griswold et al. review substance abuse in adolescents and the role of the family physician in recognition. Other then toxicology screening, the CRAFFT questionnaire is used to screen for risky behaviors and drug encounters associated with substance abuse. Proper management of substance abuse includes any of a combination of family management, a psychology consult, anticipatory guidance, brief therapeutic counseling, day treatment programs, or inpatient/outpatient treatment programs.

Fournier et al. discuss the common co-morbid psychiatric conditions with substance abuse in adolescents. These include depression, anxiety, bipolar disorder, ADHD, and conduct disorder. Diagnosing these conditions and treating them is important for proper management and resolution of drug abuse.

Incorrect answers:
Answer 1: There is no need for a complete blood count at this time unless more serious health complications are suspected and substance abuse is ruled out.
Answer 2: There are no signs of infection in this patient, thus a blood culture is unnecessary.
Answer 3: The patient denies sexual activity and does not complain of any STI symptoms, thus STI testing is unnecessary.
Answer 5: The patient's blood-shot eyes are more likely to be a side-effect of drug use rather than a primary eye pathology