disorders due to psychoactive substances (psychoactive drugs)

8/3/2019 Disorders Due to Psychoactive Substances (Psychoactive Drugs)

1/23

Disorders Due to PsychoactiveSubstances


2/23

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


3/23

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)


4/23

Mental Disorders due to

Substance (ab)useF 1x.0 Intoxication

F 1x.1 Substance abuse

F 1x.2 Addiction (syndrome ofdependence)

F 1x.3 Withdrawal syndrome

F 1x.4 DeliriumF 1x.5 Psychosis

F 1x.6 Amnestic disorder

F 1x.7 Residual psychotic disorder


5/23

Psychoactive Substance AbuseContinuing to use substance even though

the person knows there are reoccurring

physical or psychological problemsbeing caused by using the substance


6/23

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 (increasingtime for drug)

Withdrawal symptoms Persisting with drug use despite clear

evidence of harmful consequences


7/23

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 effect

0,5g/l cognitive deficits, motor coordination problem2,5g/l significant confusion, decreased state ofconsciousness

4g/l coma, death


8/23

Alcohol Withdrawal Syndrome

Uncomplicated Tremor, hyperreflexia

Anxiety

Increased heart rate and blood presure

Sweating

Nausea, vomiting insomnia

Alcohol withdrawal seizure


9/23

Alcohol Withdrawal Delirium Disorientation

Fluctuating consciousness

Vivid hallucinationsAgitation

Mild hyperpyrexia

Onset 48-72hours after the last drink(up to 7 days)

Mortality: 10-15% (untreated)


10/23

Alcohol Psychotic Disorders Alcoholic paranoid psychosis

Heresy jealous, persecute

Alcoholic hallucinosis Auditory hallucinations without clouding of

sensorium

Alcohol amnestic disorder (Korsakoffspsychosis) Memory defect, confabulations, intellectual

function is preserved

Alcoholic dementia


11/23

Physical Complications of Alcohol

Abuse/dependence Alcoholic peripheral neuropathy

Alcoholic encephalopathy

Alcoholic liver disease (steatosis, hepatitis,cirrhosis)

Cardiovascular disorders (dilatedcardiomyopathy, hypertension, hemorrhagic

stroke, holiday heart syndrome) Hematological disorders (anemia,

macrocytosis, leukopenia, thrombocytopenia,abnormalities of homeostasis)


12/23

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, abdominaldistension, neuropathy, tetany)

Endocrinological Disease (amenorrhoea,hypogonadism, virilisation/feminization)

Acute or chronic alcoholic myopathy Osteoporosis

FAS


13/23

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


14/23

Sedatives/hypnotics/benzodiazepins

Addiction Most often: Alprazolam, bromazepam,

clonazepam, diazepam, zolpidem

High doses (multiple LD) Signs of intoxication and withdrawal as

alcohol addiction, withdrawal oftencomplicated by seizure or delirium

Consequences: seizures, memory impairment,dementia, accidents!

Combinations with alcohol or replacement ofalcohol


15/23

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


16/23

Opioid Intoxication

Euphoria immediately after use, thenapathy and psychomotor retardation

Miosis

Slow regular respiration

Slurred speech

Impairment of judgment, attention,concentration, memory

analgesia


17/23

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


18/23

Medical Complications of OpioidAbuse/addiction

Mental: depression, dementia, personality dis.Physical:

illness of dirty needles: abscesses,lymphadenopathy, osteomyelitis, endocarditis,glomerulonephritis, septicemia, memingitis, septicemboli

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)


19/23

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


20/23

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


21/23

Inhalants

Abused inhalants: alkyl-nitrites, toluene andtoluene mixtures glues, paints, thinners,gasoline, ketones nail polish remover,printing ink, halogenated hydrocarbonshalothane, trichloroethylene, ethylene glycol

Clinic similar to alcohol, high toxicity!!, highrisk of overdoses!!

Consequences: hepatopathia, neuropathia,nefropathia, cardiopathia, pneumonia,organic mental syndrome, pulmonary andbrain oedema


22/23

Addicts at the Doctors

Abstining addicts

Good collaboration

Valid anamnesis including informationabout addiction in an.

Carefully asking for used medication

CAVE: no psychoactive substancesexcluding vital indication (benzodiazepines,tramadol etc.)


23/23

Addicts at the Doctors

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

disorders due to psychoactive substances (psychoactive drugs)

Documents