Mental Disorders and Comorbidity

8/18/2019 Mental Disorders and Comorbidity

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Mental – Behavioural

disorders and Comorbiditydue to stimulants uses

Frida Neila Rahmatika2014.2040.1011.082


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STIMULANT USES

Chapter one


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Overview

• Substance misuse or abuse is frequently classied :

• Eperimental

• !ecreational

• "ependant

• that may result in adverse physical and#or psycholo$icale%ects


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&E!MS – "SM ' C!(&E!()

• maladaptive pattern of substance use leadin$ tosi$nicant adverse consequences

• must recur durin$ a *+,month period-)buse

• maladaptive pattern of substance use leadin$ toclinically si$nicant impairment or distress. as

manifested of the followin$ within a *+ month period:• tolerance.• withdrawl symptom.• /ersistent desire or unsuccessful e%orts to cut down or

control use• Social impairment

"ependence


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• a syndrome due to cessation of. orreduction in. heavy and prolon$edsubstance use

• clinically si$nicant impairment or

distress• lasts several days to + wee0s-

1ithdraw

l

• reversible substance,specic

syndrome with maladaptivebehavioral or psycholo$ical chan$esdevelopin$ durin$ or shortly afterusin$ the substance

(ntoication


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Stimulants 2• are dru$s that are purported to enhance

sociability. condence and alertness while reducin$inhibition-

• &he sensation : euphoria and wellbein$ thesee%ects are usually only short lastin$-


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(ncludes

• Cocaine,

• dexamphetamine,

• methamphetamine (including crystal and

ice,• ecstasy (!," #

Methylenedioxymethamphetamine, M$MA,

• methylphenidate,

•

ephedrine,• %seudoephedrine

• Ca&eine


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• Ori$inally found in plants : Cocca and Ephedra

• Legally uses '• amphetamine 3"eedrine. )dderall4.

methylphenidate 3!italin45 : Both are uses aspsycotrophic a$ents

• Epehdrine – /seudoephedrine : use widely

• Ilegal uses '• Cocaine


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/hysiolo$ical E%ects

(ncreased heart rates

(ncreased blood pressure

(ncreased temperature

)mphetamine : reduce coordination

increase ris0 ta0in$


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E%ect Sou$ht by 6ser

Euphoria

Empathy

Enhanced sociability

(ncreased ener$y level and stamina

)ppetite suppression-


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Associated harms%hysiological '• &achycardia.

• hypertension.

• sei7ures.

• arrhythmias.

• tremor.

• mydriasis.

• dehydration.

•

diaphoresis.• nausea.

• muscle crampin$.

• 8aw clenchin$.

• 8itteriness

Increased ris taing• fear reduction : dan$erous

drivin$. ris0 of suicide

%sychological '• )niety

• /aranoia

•

/sychosis• "epresion

In)ecting drugs associatedris

Long term *rain structure changes


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(C",*9 Classication

• *;- – Mental and behavioural disorders due to use ofcocaine

• *


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Stimulant Overdose

=ow to medium ris0 of overdose for oral use-

hi$h ris0 of overdose associated with smo0in$ orin8ectin$ use

Si$n include :• 'ery fast breathin$ and heartbeat• 6nconsciousness• Chest pains• Midriasis• Sei7ures or >itterin$• Muscle Crampin$• "i77iness• 6rinatin$ /roblem -


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Stimulant +ithdraal

• )cute . lastin$ up to two wee0s :

– "epression. dysphoria. fati$ue.ehaustion and somnolence and loss of

appetite• ollowin$ prolon$ed use. last several

wee0s or months-

–

insomnia. persistent cravin$. intensedreamin$ and irritability


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&reatments for )buse and

"ependency

• "etoication

• Symptomatic

• rehabilitation centers or supportive

housin$


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MENTAL AN$ -E.A/I0U1AL $IS01$E1$UE T0 STIMULANTS USES

Chapter &wo


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"epression and Stimulantsuses

• "epression is common amon$st stimulant users.both in the days followin$ heavy use and durin$withdrawal-

• !ebound phenomen due to monamine depletion

• Stimulant e%ects on sleep may worsen sleep,wa0e cycle disturbances associated withdepression


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• !eductions in stimulant use improve symptoms ofdepression-

• (f depression persists despite adequate withdrawal from

stimulants. then treat as for primary depression

• &here is little consistent evidence that antidepressants arebenecial in mana$ement of stimulant withdrawal

• CB& may address stimulant use and is e%ective


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)niety and Stimulants 6ses

• 6sualy present with withdrawl symptom

• ?i$her stimulant use predictin$ $reater severityof aniety

• Mana$ement : reduce stimulant uses

• can be treated with ben7odia7epines. even CB& isalso e%ective in reducin$ $eneral symptoms ofaniety-


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%sychosis and stimulants use

• characterised by a loss of connectedness withreality

• Stimulants are amon$st the most commonly usedsubstances in individuals with psychosis

• Stimulant,induced psychosis involves bothpositive and ne$ative symptoms includin$paranoid hallucinatory states. bi7arre ideas aswell as volitional disturbances and can often be

indistin$uishable from acute or chronicschi7ophrenia


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)cute psychotic

• treatment should involve e%orts to encoura$e abstinencefrom stimulants which should result in the resolution ofpsychotic symptoms

•

)ntipsychotics may be added


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=on$er term psychotic

• (n those who have eperienced more thanone episode of psychosis. re$ular lowdose use of antipsychotics may be

necessary• Clo7apine is e%ective in individuals with

psychosis and comorbid stimulant use-


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/ersonality "isorder

• 6se of stimulants may eacerbate impulsivity.mood disturbance and an$er in people withCluster B type personality disorders


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