MANAGEMENT OF SUBSTANCE RELATED

PSYCHIATRIC DISORDERSEDATIVE, HYPNOTIC AND ANXIOLYTIC DRUGS AND

INHALANTS

SEDATIVE, HYPNOTIC AND ANXIOLYTIC

3 groups of drugs associated with this class of substance-related disordersBenzodiazepines (diazepam, flurazepam, oxazepam)Barbiturates (secobarbital, pentobarbital, secobarbital-

amobarbital combination)Barbiturate-like substances (methqualone, meprobamate)

Can be used as antiepileptic, muscle relaxants, and anaesthetics

Associated with physical and psychological dependence also withdrawal symptoms

EPIDEMIOLOGY

• About 6% of individuals have used either sedatives or tranquilizers illicitly

• Highest prevalence was 26- to 34- years of age• Slight male predominance• About one quarter to one third of all substance-related

emergency room visits involve substances of this class

ROUTES OF ADMINISTRATION

• Oral Occasionally to achieve a time-limited specific effect

(young people) Regularly to obtain a constant usually, mild intoxication

(middle age people)• Intravenous

Young people intimately involved with illegal substances Highly associated with rapid and profound tolerance,

dependence and a severe withdrawal syndrome

DIAGNOSIS DSM-IV TR

DIAGNOSIS DSM-IV TR

FACTORS INFLUENCING DEVELOPMENT OF WITHDRAWAL

• DOSAGE• DURATION OF TREATMENT• RATE OF TAPERING

MANAGEMENT

• According to bio psycho-social & spiritual model

MANAGEMENT WITHDRAWAL

MANAGEMENT OVERDOSE

• Gastric lavage• Activated charcoal• Careful monitoring of vital signs, CNS activity• Benzodiazepine antagonist: Flumazenil

INHALANT DRUGS

Are volatile hydrocarbon that are inhaled for psychotropic effects. Eg : Toluene, n-hexane, methyl butyl ketone, tricholoroethylene,

trichloroethane, dichloromethane, gasoline, butane. Sold in 4 commercial classes:

o Solvents for glue & adhesiveso Propellants for aerosol paint sprays, hair sprays, frying pan sprays,

shaving creamo Thinners (paint products, typing correction fluids)o Fuels

DIAGNOSIS DSM-IV TR

• Symptoms of mild intoxication similar to intoxication with alcohol or sedative-hypnotics

• Possible toxic effects: - Brain damage - Liver damage- BM depression - Peripheral neuropathies- Immunosuppression

Psychological effects Physical effectsEuphoria Ataxia

Belligerence ConfusionAssaultiveness Disorientation

Impaired judgment Slurred speechImpulsiveness Dizziness

Depressed reflexesNystagmus

• Withdrawal rarely developed • Characterized by:

IrritabilitySleep disturbancesJittersSweatsNausea, vomitingTachycardiaHallucination & delusion (sometimes)

MANAGEMENT

• According to bio psycho-social & spiritual modelInvestigations

Biology Psychosocial

Get information from family members

MANAGEMENT

REFERENCES

• Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry, 5th Edition

• Kaplan & Sadock’s Synopsis of Clinical Psychiatry, 10th Edition