Substance-related disorders Course Psychiatry Psychoactive substance

One whose administration can lead to relatively rapid effects on the CNS, including a
change in the level of consciousness or the state of mind.

Drugs
Illicit
Cocaine,

heroin

Licit
Alcohol,

solvents Psychoactive substance

Minor
Theism Cafeinism tabagism

Major
Drugs Alcohol Sedatives, hypnotics
Terms Acute intoxication= transient condition following the administration of a psycho-active drug resulting in disturbances in physiological, psychological or behavioral functions or responses Harmful use= pattern of psychoactive substance use which is causing damage to health Tolerance= takes place when the desired CNS effects diminish so that increasing doses need to be administered to achieve the same effects Dependence= cluster of physiological, behavioral and cognitive phenomena in which the use of pas takes on a much higher priority for the individual than other behaviors than once had higher value. The desire of consumption is very strong, overpowering; there is a psychological and a physical dependence Withdrawal states= group of physical and psychological symptoms occurring on an absolute or relative withdrawal from the pas; the acute state is time-limited. The severe complications are delirium, seizures. Epidemiology

5-7% prevalence ( 3-5% constitutes alcoholism) > men

1

20-45 years Dependence forms in 10 years Special backgrounds: underground Jobs: waiters, bartenders, doctors
Etiopathogeny Consequences of alcohol consumption or dependence Acute intoxication Simple pathological Dependence Withdrawal Noncomplicated Complicated (seizures, delirium tremens) Delusional forms Encephalopathy Dementia +dipsomania Alcoholism

Psychological- hypomnesia, black-outs, bradipsychia, seizures, illusions, hallucinations,

jealousy, paranoid delusions, dementia

Somatic-gastritis, esophagitis, ulcers, pancreatitis, cirrhosis, cardiomiopathy,

arteriopathy, polineuropathy, impotence, cortical atrophy, subdural haematoma

Relational-conflicts in family, violence, rape, separation Social status decline-job loss, the entire family becomes poorer, the global income
decreases, penal delicts Acute intoxication Simple The degree of drunkenness depends to the cerebral level of alcohol Belligerence, mood lability, cognitive impairment, hilarity, somnolence, coma Pathological The deep state of drunkenness occurs after small amounts of alcohol Heteroagression, violence, black-out Is dismissed of penal responsivity Is reproducible Chronic alcohol dependence 5-7 years of constant consume

The person makes great efforts to reduce the daily alcohol consume The interests narrow The drinking habits become more restrictive (towards distilled drinks) Neglect of family, job, various accidents Typical face, mouth smell, trembling, bradipsychia, paranoid ideation, general
hypoprosexia,sectorial hyperprosexia for drinks, personality change, illusions, hallucinations Withdrawal states Simple After alcohol cessation Morning worsening Trembling Perspiration Slight confusion dysphoria Complicated With seizures With delirium tremens Impressive tremor, Sweetening High fever Marked confusion Vivid hallucinations Critical general state Other forms

Delusional
Postoniric sequelae Alcoholic hallucinosis Amnesic syndrome Korsakov syndrome Gayet- Wernicke Alcoholic dementia Dipsomania Fetal embriopathy Therapy Acute intoxication- let the alcohol eliminate; eventually, hydric and vitaminic supplement Dependence- the patient has to be strongly motivated; he has to be abstinent for few months; aversive medication: carbamazepine,treatment of depressions, including in

psychotherapy, AA. Aversive drugs-disulfiram vitamins complex- milgamma, thiogamma Therapy of withdrawal states Attentive checking of somatic condition 2-3 l of sweet liquids Vitamins B1, B6, C (im, iv) Diazepam 100-150 mg/die Perfusion-serum, glucose Electrolytes, Hepatoprotection, cardiotonics, antithermics, antibiotics Further- substitution- carbamazepine, meprobamat, buspiron Opioid dependence

Heroin produces rapid tolerance

Acute intoxication- euphoria,detachment,myosis, constipation Supraacute intoxication- flush, happiness, warmth, somnolence. The overdose can lead to respiratory depletion,hT,colaps, aritmias, secretion aspiration, sudden deaths Dependence- hypoxic skin, impotence, weight loss, vomisments, abscesses Withdrawal- after 6-12 h of cessation being maximum at 24-48 h; craving, restlessness, rhinorrea, midriazis, muscle cramps, insomnia, fever, hypertension Treatment-acute intoxication benefits of antidot-Naltrexon, Naloxon Dependence- methadone+ psychotherapy Cannabinoids Marijuana is extracted from Cannabis sativa The most used drug especially as cigarettes (hashish, joint)- party drug Does not produce dependence Acute intoxication lasts 2-3 h: euphoria, lightness, depersonalization, special time experience Some experience horror trips, flash-backs Chronic use leads to demotivation, teratogenic and carcinogenetic effects Treatment-psychotherapy Drug dependence Drugs with addictive potential: Tranquilizers-Meprobamat, diazepam Sedative Hypnotics Analgesics Anticholinergics laxative 4

Is partly iatrogenic Acute intoxication Dependence Withdrawal Treatment Acute intoxication- agonist- Flumazenil Questioning of the quantity of drugs; choose drugs with longer T1/2 and with lower addictive potential; vitamins; psychotherapy Cocaine

Snuffed Crack= the combination with bicarbonate +heroine= speedball Great addictive potential Craving is deep and leads to promiscuity Acute intoxication produces euphoria, creativity, erotic desinhibition, talkativeness Treatment-craving is treated with amantadine, bromocriptine Inclusion in a therapeutic community
Stimulants Amphetamine- consumed as pills, smoked- ice, inhaled, injected Well known- ecstasy, designer drugs Acute intoxication- euphoria, high energy, omnipotence, talkative, various somatic signs Does not develop dependence but abstinence is responsible of anxiety, hallucinations. Phencyclidine- angel dust; produces beligerence,impulsivity Treatment- as cocaine dependence Other drugs

Hallucinogens LSD- intoxication produces anxiety, euphoria, reference ideas, perception disorders,
somatic complaints Treatment- antipsychotics Inhalants-volatile substances Adhesives, diluents, sprays Acute intoxication-inhalation narcosis-oniric state, confusion, beligerance,paranoid states Serious somatic complaints: respiratory, hepato-renal failure, polineuropaty, sudden death Treatment- social cleaning