Transcript Substance abuse

Disorders Due to Psychoactive
Substance Use
Department of Psychiatry
1st Faculty of Medicine
Charles University, Prague
Head: Prof. MUDr. Jiří Raboch, DrSc.
Psychoactive Substance
Psychoactive (psychotropic) substance
is any substance which after
absorption has influence on mental
processes both cognitive and
affective.
1. stimulative
2. suppressive
3. hallucinogenic
Mental and Behavioural Disorders
Due to Psychoactive Substance Use
Disorders due to use of:
F10.x alcohol
F11.x opioids
F12.x cannabinoids
F13.x sedatives or hypnotics
F14.x cocaine
F15.x other stimulants (caffeine)
F16.x hallucinogens
F17.x tobacco
F18.x volatile solvents
F19.x multiple drugs and other
psychoactive drugs
Mental and Behavioural Disorders
Due to Psychoactive Substance Use
Specific Clinical Conditions:
F1x.0 Acute intoxications
F1x.1 Harmful use
F1x.2 Dependence syndrome
F1x.3 Withdrawal state
F1x.4 Withdrawal state with delirium
F1x.5 Psychotic disorder
F1x.6 Amnesic syndrome
F1x.7 Residual state, late-onset psychotic
disorder
F1x.8 Other mental and behavioural disorders
F1x.9 Unspecified mental and behavioural
disorder
F1x.0 Acute Intoxication
Df.:
 A transient condition following the administration
of psychoactive substance resulting in
disturbances in level of consciousness, cognition,
perception, affect or behaviour, or other
psychophysiological functions and responses
 Closely related to dose levels
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Uncomplicated
With trauma or other medical complications
With delirium
With coma
With convulsions
Pathological intoxication (applies only to
alcohol)
F1x.1 Harmful Use
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The damage may be physical and/or mental.
Socially negative consequences are not
evidence (neither acute intoxication or
hangover).
F1x.2 Dependence Syndrome
(Addiction)
a) A strong desire or sense of compulsion to
take the substance („craving“)
b) Difficulties in controlling substance-taking
c) Withdrawal sy characteristic for the
substance
d) Evidence of tolerance
e) Progressive neglect of pleasures and
interests
f) Persisting with substance use despite clear
evidence of overtly harmful consequences
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Physical dependence
Psychic (psychological) dependence
F1x.2 The Course of Dependence
Syndrome
F1x.20 currently abstinent (remission)
F1x.21 currently abstinent in a protected
environment
F1x.22 currently abstinent on a maintenance
regime
F1x.23 currently abstinent - receiving
treatment with aversive or blocking
drugs (naltrexone, disulfiram)
F1x.24 currently active dependence
F1x.25 continuous (chronic) use
F1x.26 episodic use (dipsomania)
F1x.3 Withdrawal State
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Symptoms occurring on absolute or
relative withdrawal of a substance
after repeated and prolonged use of
the substance
• Uncomplicated
• With convulsions
F1x.4 Withdrawal State with
Delirium
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Delirium tremens - in severely
dependent users with a long history of
use of alcohol
Prodromal symptoms: insomnia,
tremor, fears followed by illusions,
hallucinations, clouding of
consciousness and marked tremor
F1x.5 Psychotic Disorder
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Psychotic phenomena occurring during or
immediately after psychoactive substance
use
Schizophrenia-like
Predominantly delusional, hallucinatory,
depressive, manic (alcoholic hallucinosis,
jealousy)
Persistence for more than 48 hours
F1x.6 Amnesic Syndrome
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Impairment of recent memory (learning of
new material)
Absence of defect in immediate recall, of
impairment of consciousness, and of
generalized cognitive impairment
History of chronic use of psychoactive
substance (Korsakov’s psychosis or syndrome)
F1x.7 Residual and late-onset
psychotic disorder
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Onset related to the use of psychoactive
substance, the disorder should persist beyond
any period of time during which direct effects
of the psychoactive substance might be
assumed
Flashbacks - duration in seconds or minutes,
duplication of previous drug-related
experiences
Personality disorder
Dementia
F10.x Mental Disorders Due to
Use of Alcohol
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Acute intoxication:
• euphoria, flushed face, ataxia, slowed reaction
time, impaired motor performance, slurred
speech, poor concentration; in higher doses
behavioural changes – disinhibition of sexual and
aggressive impulses, increased suicidal and
homicidal behaviour
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Pathological intoxication:
• sudden change of consciousness with aggressive
behaviour and amnesia
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Harmful use:
• physical complications – hypertension,
arteriosclerosis, heart infarction, cardiomyopathy,
brain stroke, liver cirrhosis, fatty liver, gastritis,
etc.
• psychic complications - depression
F10.x Mental Disorders Due to
Use of Alcohol
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Dependence syndrome:
• increased tolerance to alcohol, morning
drinking, alcohol bouts, blackouts,
deterioration in occupational and marital life,
behavioural changes, withdrawal symptoms
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Withdrawal state:
• tremor, anxiety, easy getting startled,
agitation, insomnia, nausea, sweating,
epileptic seizures and delirium tremens
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Delirium tremens:
• usually starts in evening hours – growing
tremulousness, severe agitation, anxiety and
perceptual distortion
• a state seriously endangering patient's life
• recovery after several days, retrograde
amnesia
F10.x Mental Disorders Due to
Use of Alcohol
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Other psychotic disorders:
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alcoholic hallucinosis
pathological jealousy
Korsakov's psychosis
Wernicke encephalopathy
alcoholic dementia
Treatment of alcoholism
• Withdrawal from alcohol, benzodiazepines,
clomethiazol
• Aversion therapy
• Alcohol-Antabuse (disulfiram) Reaction (AAR)
• Psychotherapy
F11.x Mental Disorders Due to
Use of Opioids
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Morphine, heroin (diacetylmorphine),
codeine, pethidine, methadone
Heroin:
• dependence develops within two weeks of daily
use
• overdose may lead to death
• withdrawal symptoms are extremely
unpleasant
• needle-sharing represents a serious risk of
transmission of HIV and hepatitis B + C
viruses
• treatment of the withdrawal state –
buprenorphine, benzodiazepines, spasmolytics;
in serious cases of dependence heroin is
replaced by methadone
F12.x Mental Disorders Due to
Use of Cannabinoids
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Marijuana (marihuana) is a colloquial term for dried leaves and
flowers of cannabis plant (Cannabis sativa L.)
Δ9-tetrahydrocannabinol (Δ9-THC) is responsible for the
psychoactive properties of the cannabis plant
Complex physiological functions of the cannabinoid system:
motor coordination, memory procession, control of appetite,
pain modulation and neuroprotection
Summary of adverse effects:
• acute: anxiety, panic, impaired attention, memory, reaction
time and psychomotor performance and coordination,
increased risk of road accident, and increased risk of
psychotic symptoms among vulnerable persons
• chronic: chronic bronchitidis, a cannabis dependence
syndrome, subtle impairments of attention, short-term
memory and ability to organize and integrate complex
information
F12.x Mental Disorders Due to
Use of Cannabinoids
Effect of cannabinoids on central nervous system:
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Euphoria, enhancement of sensory perception, tachycardia,
antinociception, difficulties in concentration, impairment of
memory
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Cannabis use may exacerbate symptoms of schizophrenia
and may precipitate disorders in persons who are
vulnerable to developing psychosis; heavy cannabis use
may increase depressive symptoms among some users
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Tolerance develops; the relatively long half-life and complex
metabolism of cannabis may result in a low intense
withdrawal syndrome
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Marijuana use tends to impair executive function in the
brain, e.g. higher risk for all types of injuries is associated
with cannabis use
 Cannabis abuse and dependence were highly associated
with increasing risks of other substance dependence
F13.x Mental Disorders Due to
Use of Sedatives and Hypnotics
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benzodiazepines – potentiate the action of
GABA
risk of dependence
short-acting benzodiazepines: alprazolam,
flunitrazepam, oxazepam, lorazepam,
temazepam
long-lasting benzodiazepines: diazepam,
clorazepate, chlordiazepoxide, etc.
withdrawal state can be accomplished with
epileptic seizures
interaction with alcohol may induce
qualitative changes of consciousness
F14.x,15.x Mental Disorders
Due to Use of Stimulants
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Cocaine, amphetamine, metamphetamine
(pervitine), phenmetrazine, methyphenidate,
MDMA (ecstasy,
methylenedioxymetamphetamine)
Positive mood, activity, planning, diminished need
of sleep
Tachycardia, arrhythmia, hypertension,
hyperthermia, intracerebral haemorrhage
Withdrawal symptoms: severe craving,
depression, decreased energy, fatigue, sleep
disturbance
Prolonged use can trigger paranoid psychoses,
impulsivity, aggressivity, irritability,
suspiciousness and anxiety states
F16.x Mental Disorders Due to
Use of Hallucinogens
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Lysergid acid diethylamide (LSD),
psilocybin, mescaline, phencyclidine
Acute intoxication: distorted perception
(optic hallucinations and illusions);
unpredictable and dangerous behaviour
Withdrawal syndrome has not been
described
F18.x Mental Disorders Due to
Use of Volatile Solvents
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Toluene, acetone, adhesives, petrol,
cleaning fluids, etc.
Acute intoxication: euphoria,
disorientation, incoordination, slurred
speech; optic hallucinations
The way of use is very dangerous
Drug Addiction Treatment
HEALTH SERVICE:
 acute states (detox program, tox. psychosis)
 weaning treatment
 after-treatment care
 substitution (maintainance) treatment
OUT OF HEALTH SERVICE:
 contact centers
 daily static centers
 therapeutic communities
 after-treatment centers
 protected workshops and habitations
 mutual help groups – Alcoholics Anonymous,
Narcotics Anonymous
Links
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Czech National Focal Point for Drugs
and Drug Addiction:
www.drogy-info.cz
European Monitoring Centre for
Drugs and Drug Addiction:
http://www.emcdda.eu.int/