Post on 13-Feb-2016
description
Disorders Due to Psychoactive Substances
as. MUDr. Olga PecinovskáDepartment of Psychiatry, First Faculty of Medicine,
Charles University and General University Hospital in Prague
Disorders Due to Psychoactive Substances
Mental disorders due to substance abuse Intoxication Abuse Addiction
Withdrawal syndrom Psychotic disorders due to addiction
Physical complications of substance abuse
Abused Psychoactive Substances Alcohol (F10) Opioids (F11) Cannabinoids (F12) Sedatives/hypnotics and benzodiazepins
(F13) Cocaine (F14) Other stimulants (F15) Hallucinogens(F16) Tobacco (F17) Inhalants (F18) Other substances or combinations (F19)
Mental Disorders due to Substance (ab)useF 1x.0 Intoxication F 1x.1 Substance abuseF 1x.2 Addiction (syndrome of
dependence)F 1x.3 Withdrawal syndromeF 1x.4 DeliriumF 1x.5 PsychosisF 1x.6 Amnestic disorderF 1x.7 Residual psychotic disorder
Psychoactive Substance AbuseContinuing to use substance even
though the person knows there are reoccurring physical or psychological problems being caused by using the substance
Psychoactive Substance Dependence Craving (strong desire or sense of
compulsion to take a drug) Change of tolerance (needing increased
amounts to achieve the same effect) Difficulties in controlling drug-taking
behavior (onset, termination, levels of use) Progressive neglect of alternative
pleasures or interests because of drug use (increasing time for drug)
Withdrawal symptoms Persisting with drug use despite clear
evidence of harmful consequences
Alcohol IntoxicationAlteration in behavior depending on
the amount of used alcohol and individual variation and tolerance(impaired judgment, mood lability, disinhibition of aggressive
impulses, social dysfunction)0,3g/l euphoric effect0,5g/l cognitive deficits, motor coordination
problem2,5g/l significant confusion, decreased state of
consciousness4g/l coma, death
Alcohol Withdrawal Syndrome Uncomplicated Tremor, hyperreflexia Anxiety Increased heart rate and blood presure Sweating Nausea, vomiting insomnia Alcohol withdrawal seizure
Alcohol Withdrawal Delirium Disorientation Fluctuating consciousness Vivid hallucinations Agitation Mild hyperpyrexia Onset 48-72hours after the last
drink (up to 7 days) Mortality: 10-15% (untreated)
Alcohol Psychotic Disorders Alcoholic paranoid psychosis
Heresy jealous, persecute Alcoholic hallucinosis
Auditory hallucinations without clouding of sensorium
Alcohol amnestic disorder (Korsakoff‘s psychosis) Memory defect, confabulations, intellectual
function is preserved Alcoholic dementia
Physical Complications of Alcohol Abuse/dependence Alcoholic peripheral neuropathy Alcoholic encephalopathy Alcoholic liver disease (steatosis, hepatitis,
cirrhosis) Cardiovascular disorders (dilated
cardiomyopathy, hypertension, hemorrhagic stroke, „holiday heart syndrome“)
Hematological disorders (anemia, macrocytosis, leukopenia, thrombocytopenia, abnormalities of homeostasis)
Physical Complications of Alcohol Abuse/dependence GIT complications (gastritis, peptic ulcer,
esophagitis, esophageal varices, diarrhea, malabsorption, acute or chronic pancreatitis)
Malnutrition (thinning of the hair, ecchymosis, glossitis, peripheral oedema, abdominal distension, neuropathy, tetany)
Endocrinological Disease (amenorrhoea, hypogonadism, virilisation/feminization)
Acute or chronic alcoholic myopathy Osteoporosis FAS
Orofacial Consequencies of Alcohol Addiction Parotid gland enlargement Neglected teeth, early loss of teeth Gingivitis, parodontitis Stomatitis, glossitis, cheilitis Cancer of the mouth Carcinoma of the pharynx
Sedatives/hypnotics/benzodiazepins Addiction Most often: Alprazolam, bromazepam,
clonazepam, diazepam, zolpidem High doses (multiple LD) Signs of intoxication and withdrawal as
alcohol addiction, withdrawal often complicated by seizure or delirium
Consequences: seizures, memory impairment, dementia, accidents!
Combinations with alcohol or replacement of alcohol
Opioids Illegal drugs (heroin=diacetylmorphine,
brown=codeine) Subutex (buprenorphine), methadone Opioid analgetics (morphine,
dihydrocodeine, hydromorphone, oxycodone)
Opioid-like analgetics (pethidine, tramadol, fentanyl)
Medicaments with contents of codeine Alnagon, Korylan, Spasmoveralgin, Spasmopan Pleumolysin, Talvosilen
Opioid Intoxication Euphoria immediately after use, then
apathy and psychomotor retardation Miosis Slow regular respiration Slurred speech Impairment of judgment, attention,
concentration, memory analgesia
Opioid Withdrawal Craving Lacrimation, rhinorrhea, yawning, sweating Mydriasis, piloerection Anorexia, tremor, irritability, insomnia Weakness Nausea, vomiting, diarrhoea Muscle spasms, restless lower extremities Abdominal pain Flushing, fever
Medical Complications of Opioid Abuse/addictionMental: depression, dementia, personality
dis.Physical:
illness of dirty needles: abscesses, lymphadenopathy, osteomyelitis, endocarditis, glomerulonephritis, septicemia, memingitis, septic emboli
Infective diseases: hepatitis (C,B,A), AIDS, tbc, syphilis
Pneumonia, pulmonary hypertension Consequences of overdoses (paralysis,
dementia, blindness, acute transverse myelitis) Consequences of analgesia (peritonitis,
osteomyelitis etc)
Stimulants Cocaine, pervitin, phentermine, ephedrine Intoxication
Anxiety, irritability, agitation, paranoia, confusion, hallucinations, sympathomimetic effects (dizziness, tremor, mydriasis, tachycardia, hypertension, hyperpyrexia)
Withdrawal Dysphoria, insomnia/hypersomnia, hyperphagia
Risks Convulsions, heart attack, psychosis, accidents
Marihuana Intoxication:
Tachycardia, conjunctival injection, dry mouth, increased appetite,
Impaired short-term memory, labile affect, altered time perception, enhanced sociability
Withdrawal: Craving, insomnia, dysphoria, irritability
Medical and psychological consequences: Bronchitis, impaired sexual function,
chromosomal damage Panic attacks, amotivational syndrome,
cannabis psychosis, dementia
Inhalants Abused inhalants: alkyl-nitrites, toluene and
toluene mixtures – glues, paints, thinners, gasoline, ketones – nail polish remover, printing ink, halogenated hydrocarbons – halothane, trichloroethylene, ethylene glycol…
Clinic similar to alcohol, high toxicity!!, high risk of overdoses!!
Consequences: hepatopathia, neuropathia, nefropathia, cardiopathia, pneumonia, organic mental syndrome, pulmonary and brain oedema
Addicts at the Doctor´s Abstining addicts
Good collaboration Valid anamnesis including information
about addiction in an. Carefully asking for used medication CAVE: no psychoactive substances
excluding vital indication (benzodiazepines, tramadol etc.)
Addicts at the Doctor´s Active addicts
Poor collaboration, not valid anamnesis Come in intoxication or withdrawal syndrome Often come even with inflammatory complications Irritability, manipulative Asking for psychoactive substances
CAVE: alcohol: vomiting reflex, seizure IUD: infection!!, analgesia or hypersensitivity Cave combination therapy with abused
substances Cave high tolerance to psychoactive substances