Disorders Due to

Psychoactive Substances
as. MUDr. Olga Pecinovsk
Department of Psychiatry,
First Faculty of Medicine,
Charles University and General University Hospital
in Prague

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

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)

Mental Disorders due to

Substance (ab)use
F 1x.0 Intoxication
F 1x.1 Substance abuse
F 1x.2 Addiction (syndrome of
dependence)
F 1x.3 Withdrawal syndrome
F 1x.4 Delirium
F 1x.5 Psychosis
F 1x.6 Amnestic disorder
F 1x.7 Residual psychotic disorder

Psychoactive Substance
Abuse
Continuing to use substance even
though the person knows there are
reoccurring physical or
psychological problems being
caused by using the substance

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
(increasing time for drug)
Withdrawal symptoms
Persisting with drug use despite clear
evidence of harmful consequences

Alcohol Intoxication
Alteration 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
problem
2,5g/l significant confusion, decreased state of
consciousness
4g/l coma, death

Alcohol Withdrawal
Syndrome Uncomplicated

Tremor, hyperreflexia
Anxiety
Increased heart rate and blood presure
Sweating
Nausea, vomiting
insomnia
Alcohol withdrawal seizure

Alcohol Withdrawal
Delirium

Disorientation
Fluctuating consciousness
Vivid hallucinations
Agitation
Mild hyperpyrexia
Onset 48-72hours after the last
drink (up to 7 days)
Mortality: 10-15% (untreated)

Alcohol Psychotic
Disorders

Alcoholic paranoid psychosis

Alcoholic hallucinosis

Auditory hallucinations without clouding of

sensorium

Alcohol amnestic disorder (Korsakoffs

psychosis)

Heresy jealous, persecute

Memory defect, confabulations, intellectual

function is preserved

Alcoholic dementia

Physical Complications of
Alcohol Abuse/dependence

Alcoholic peripheral neuropathy

Alcoholic encephalopathy
Alcoholic liver disease (steatosis, hepatitis,
cirrhosis)
Cardiovascular disorders (dilated
cardiomyopathy, hypertension, hemorrhagic
stroke, holiday heart syndrome)
Hematological disorders (anemia,
macrocytosis, leukopenia, thrombocytopenia,
abnormalities of homeostasis)

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,
abdominal distension, neuropathy, tetany)
Endocrinological Disease (amenorrhoea,
hypogonadism, virilisation/feminization)
Acute or chronic alcoholic myopathy
Osteoporosis
FAS

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

Sedatives/hypnotics/benzodiaze
pins Addiction

Most often: Alprazolam, bromazepam,

clonazepam, diazepam, zolpidem
High doses (multiple LD)
Signs of intoxication and withdrawal as
alcohol addiction, withdrawal often
complicated by seizure or delirium
Consequences: seizures, memory
impairment, dementia, accidents!
Combinations with alcohol or
replacement of alcohol

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

Opioid Intoxication

Euphoria immediately after use, then

apathy and psychomotor retardation
Miosis
Slow regular respiration
Slurred speech
Impairment of judgment, attention,
concentration, memory
analgesia

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

Medical Complications of
Opioid Abuse/addiction
Mental: depression, dementia, personality
dis.
Physical:

illness of dirty needles: abscesses,

lymphadenopathy, osteomyelitis, endocarditis,
glomerulonephritis, septicemia, memingitis,
septic emboli
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)

Stimulants

Cocaine, pervitin, phentermine, ephedrine

Intoxication

Withdrawal

Anxiety, irritability, agitation, paranoia,

confusion, hallucinations, sympathomimetic
effects (dizziness, tremor, mydriasis,
tachycardia, hypertension, hyperpyrexia)
Dysphoria, insomnia/hypersomnia, hyperphagia

Risks

Convulsions, heart attack, psychosis, accidents

Marihuana

Intoxication:

Withdrawal:

Tachycardia, conjunctival injection, dry mouth,

increased appetite,
Impaired short-term memory, labile affect,
altered time perception, enhanced sociability
Craving, insomnia, dysphoria, irritability

Medical and psychological consequences:

Bronchitis, impaired sexual function,

chromosomal damage
Panic attacks, amotivational syndrome,
cannabis psychosis, dementia

Inhalants

Abused inhalants: alkyl-nitrites, toluene and

toluene mixtures glues, paints, thinners,
gasoline, ketones nail polish remover,
printing ink, halogenated hydrocarbons
halothane, trichloroethylene, ethylene
glycol
Clinic similar to alcohol, high toxicity!!, high
risk of overdoses!!
Consequences: hepatopathia, neuropathia,
nefropathia, cardiopathia, pneumonia,
organic mental syndrome, pulmonary and
brain oedema

Addicts at the Doctors

Abstining addicts

Good collaboration
Valid anamnesis including information
about addiction in an.
Carefully asking for used medication
CAVE: no psychoactive substances
excluding vital indication
(benzodiazepines, tramadol etc.)

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