MINISTRY OF HEALTH OF UKRAINE
BUKOVYNIAN STATE MEDICAL UNIVERSITY
“Approved”
on the methodical meeting
of the Department of neurology, psychiatry
and medical psychology nm. S.M.Savenko
“____” ___________ 2009 (Report № __).
Chief of the Department
_______________________
Professor V.M. Pashkovsky
METHODICAL INSTRUCTION
for 4-th year students of medical faculty №2
(the speciality “medical affair”)
for independent work during preparing to practical class
Theme 19: ABUSE OF NON-DEPENDANCE-PRODUCING
SUBSTANCES.
MODULE 2. SPECIAL (NOSOLOGY) PSYCHIATRY
TOPICAL MODULE 4. MENTAL AND BEHAVIOURAL DISODERS DUE TO
PSYCHOACTIVE SUBSTANCES USE.
Сhernivtsi, 2009
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1. Actuality of theme:
A lot of people use toxic substances in over world. Their amount constantly increases.
To the student, future doctor, which begins to obtain knowledge, practical skills and abilities
in clinics, it is necessary to master the basic forms of mental and behavioural disorders due to use of
non-dependance-producing substances, able them to diagnose, to treatment.
2. Duration of practical classes - 2 hours.
3. EDUCATIONAL PURPOSE
3.1. To know:
1. Medical and social problems using toxic substances.
2. Etiological and pathogenesis factors due to dependence from toxic substances.
3. Mental and behavioural disorders due to abuse tranquilisers.
4. Mental and behavioural disorders due to abuse soporific.
5. Mental and behavioural disorders due to abuse cholinolitic.
6. Mental and behavioural disorders due to abuse products with coffeine.
7. Mental and behavioural disorders due to use inhalant and solvents.
8. Smoking as form of toxicomania.
9. Age peculiarities toxicomanies.
10. Principles and methodic of treatment toxicomanies.
11. Prophylactic of toxicomanies.
12. Expertise of toxicomanies.
3.2.Able:
1. Diagnose poisoning of tranquilisers, soporific, cholinolitic, inhalant.
2. To give urgent help at the extreme states (poisons).
3. Make up medical rehabilitation programs for patients with toxicomanies.
3.3.To capture practical skills:
1. To collect subjective and objective anamnesis.
2. To help about abstinence syndrome.
3. To give urgent help at the poisons toxic substances.
4. INTERSUBJECT INTEGRATION (base level of preparation).
Names of previous disciplines
1. Medical chemic.
2. Clinical pharmacology.
3. Internal therapy.
Skills are got
1.To know basic chemical features toxic substances.
2. Pharmacology toxic substances.
3. To describe features of diseases of organs and systems
due to using toxic substances.
5. ADVICES TO STUDENTS.
5.1. CONTENTS OF THEME.
Addictions. The harm that addiction to chemicals has on the body, the physical damage it
does isn't the only reason for quitting addiction but also the harm it does to a person's mental health
should also be taken into account too, as well as that of partners and relations living in the same
house.
One of the worlds most widely used legal drugs is nicotine; millions of people all over the
world use it on a daily basis and spend billions every year by doing so. People use it for its calming,
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tranquillising and mildly mood enhancing properties; despite this it is highly addictive and has
prolonged withdrawal effects such as causing anxiety, mood swings and cravings for those wishing
to give up.
Glues and some household products that give off fumes are increasingly becoming a form
of abuse particularly in youngsters and teenagers due to them being readily available and
inexpensive. Solvents are usually sniffed and inhalation of the fumes produces feelings of
inebriation, confusion, stupor and unconsciousness. A high number of young people die each year
accidentally due to experimentation with solvents but very few people actually continue using
solvents but move onto using other drugs.
All sedatives can be misused and abused, but barbiturates and benzodiazepines are
responsible for most of the problems with sedative abuse due to their widespread "recreational" or
non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may
overuse or become dependent on sedatives. Heroin users take them either to supplement their drug
or to substitute for it. Stimulant users frequently take sedatives to calm excessive jitteriness. Others
take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in
nearly one-third of all reported drug-related deaths. These include suicides and accidental drug
poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or
when sedatives are taken with alcohol. In the U.S., in 1998, a total of 70,982 sedative exposures
were reported to U.S. poison control centers, of which 2310 (3.2%) resulted in major toxicity and
89 (0.1%) resulted in death. About half of all the people admitted to emergency rooms in the U.S. as
a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an
excessive dose or combined it with alcohol or other drugs.
People often say that caffeine makes them feel more capable for intellectual and physical
activity and less tired and drowsy. But, expects have shown that caffeine abuse has slowed reaction
time to visual and auditory stimuli; it can also lead to diminishing your intellectual and physical
performances. The symptoms of caffeine abuse called caffenism, are tiredness, craving, confusion,
lethargy, and headaches.
Belladonna is one of the most toxic plants found in the Western hemisphere. Children have
been poisoned by eating as few as three berries. Ingestion of a leaf of the Belladonna can be fatal to
an adult. The root of the plant is generally the most toxic part, though this can vary from one
specimen to another.
All parts of the plant contain tropane alkaloids. The berries pose the greatest danger to
children because they look attractive and have a somewhat sweet taste. Symptoms of belladonna
poisoning are the same as those for atropine (the best-known of the tropane alkaloids), and include
dilated pupils, tachycardia, hallucinations, blurred vision, loss of balance, a feeling of flight,
staggering, a sense of suffocation, paleness followed by a red rash, flushing, husky voice, extremely
dry throat, constipation, urinary retention, and confusion. The skin can completely dry out and
slough off. Fatal cases have a rapid pulse that turns feeble. The antidote is physostigmine or
pilocarpine, the same as for atropine. The reason for most of these symptoms is because of
atropine's effect on the parasympathetic nervous system. Atropine competitively inhibits the action
of acetylcholine (ACh) at the acetylcholine receptor in the nerve synapse, thereby preventing the
parasympathetic nervous system from sending out electrical nerve impulses. Since the
parasympathetic nervous system regulates non-volitional/subconcious activities (such as sweating,
breathing, and heart rate) when it is prevented from sending out signals, the heartbeat and breathing
become extremely irregular.
The Belladonna is toxic to many domestic animals and livestock; Belladonna poisoning can
lead to colic, depression, weakness, and lack of coordination in horses, with fatalities reported even
for small amounts from 1 to 10 pounds (0.5 to 5 kg).
A. General Treatment Principles
1. Goals of Treatment
2. Assessment
3. Treatment Settings
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4.
5.
6.
7.
Formulation and Implementation of a Treatment Plan
Pharmacological Treatments
Psychosocial Treatments
Clinical Features Influencing Treatment
Treatments for Other Co-occurring Psychiatric Disorders in Patients With Substance Use
Disorders
Anticonvulsants The anticonvulsants carbamazepine, gabapentin, and valproate have been
used to treat alcohol withdrawal and might work especially well in patients with co-occurring
psychiatric disorders. Valproate has shown promise in stabilizing mood and reducing drinking
in patients with bipolar disorder. Drug-drug interactions can occur between anticonvulsants
(e.g., valproate and either lamotrigine or carbamazepine) or with other psychotropic
medications, as a result of displacement from plasma protein binding sites and metabolism
through UDP-glucuronosyltransferase and the cytochrome P450 2C9 enzyme.
Antidepressants Monoamine oxidase inhibitors (MAOIs) may have interactions (e.g., with
alcohol, cocaine and other stimulants, meperidine, dextromethorphan). Tricyclic antidepressants
and MAOIs may be toxic in overdosage. Simultaneous use of antidepressants and substances of
abuse may increase sedation or cardiovascular effects. Bupropion may theoretically increase the
risk of psychosis in psychotic patients, but concomitant treatment with antipsychotic medication
will reduce this risk. Drug-drug interactions mediated through the cytochrome P450 system are
common (e.g., methadone and antidepressants metabolized via cytochrome P450 2D6 or 3A4).
Antipsychotics Clozapine may have benefits in decreasing substance use among individuals
for whom it is otherwise indicated. Smoking decreases blood levels of some antipsychotics
(e.g., clozapine, olanzapine, haloperidol, fluphenazine, thioridazine, chlorpromazine) via the
cytochrome P450 1A2 enzyme. Simultaneous use of some antipsychotics and substances of
abuse may increase sedation or cardiovascular effects.
Anxiolytics and Anxiolytics and sedative-hypnotics with abuse potential should be
sedative- prescribed cautiously (e.g., dispense in limited quantities, keep hypnotics track of
prescription refills, and monitor ongoing medical necessity and response to medication). These
medications may have increased sedative and respiratory effects in combination with specific
substances (e.g., alcohol, other sedatives, opioids). Drug-drug interactions may be mediated
through the cytochrome P450 system (e.g., CYP 3A4, CYP 2C19).
Stimulants Evidence suggests that appropriate use of stimulants in attentiondeficit/hyperactivity disorder does not augment later risk of substance use disorders. Limit
abuse potential by prescribing these medications cautiously (e.g., dispense in limited quantities,
keep track of prescription refills, and monitor ongoing medical necessity and response to
medication).
8. Confidentiality
B. Psychiatric Management
5.2. THEORETIC QUESTIONS:
1. Definition of notion narcology and toxicomania.
2. Medical and social problems using toxic substances.
3.Etiological and pathogenesis factors due to dependence from toxic substances.
4. Mental and behavioural disorders due to abuse tranquilisers.
5.Mental and behavioural disorders due to abuse soporific.
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6.Mental and behavioural disorders due to abuse cholinolitic.
7.Mental and behavioural disorders due to abuse products with coffeine.
8.Mental and behavioural disorders due to use inhalant and solvents.
9.Smoking as form of toxicomania.
10.Age peculiarities toxicomanies.
11.Principles and methodic of treatment toxicomanies.
12. Urgent help at the poisons toxic substances.
13.Prophylactic of toxicomanies.
14.Expertise of toxicomanies.
5.3. Practical tasks on the class:
1. To collect anamnesis, clinical psychopathological examination of patients with
toxicomanies.
2.To help about abstinence syndrome.
3.Make up of plan. Diagnose and treatment of patient with toxicomanies.
5.4.Material for self-contrrol.
A. Questions of self-controls:
1.Definition of notion narcology and toxicomania.
2. Medical and social problems using toxic substances.
3.Etiological and pathogenesis factors due to dependence from toxic substances.
4. Mental and behavioural disorders due to abuse tranquilisers.
5.Mental and behavioural disorders due to abuse soporific.
6.Mental and behavioural disorders due to abuse cholinolitic.
7.Mental and behavioural disorders due to abuse products with coffeine.
8.Mental and behavioural disorders due to use inhalant and solvents.
9.Smoking as form of toxicomania.
10.Age peculiarities toxicomanies.
11.Principles and methodic of treatment toxicomanies.
12. Urgent help at the poisons toxic substances.
13.Prophylactic of toxicomanies.
14.Expertise of toxicomanies.
B. TESTS:
1. The condition of dependence from toxic substances named:
A. Asthenic syndrome
B. Narcotic syndrome
C. Hypochondriac syndrome
D. Abstinential syndrome
E. Depressive syndrome
2. What is cholinolitic of central action, which using with purpose toxicomania:
A. Phenobarbital
B. Tincture of belladonna
C. Ephedrine
D. Heroine
E. Caffeine
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3. What is purpose abusing of tranquilisers:
A. Stimulation
B. Hypnotic effect
C. Anti depressive effect
D. Euphoria
E. General tonic effect
4. With purpose blocking of feel (inclination) to toxic substances using:
A. Sedatives
B. Anti depressants
C. General tonic remedies
D. Psychotherapy
E. Nootropics
B. SITUATIONAL TASKS
1. In hospital was convey patient K, 28 old year. Relatives told, that he using unknown pills
in last times.
Psychical status: patient excited, euphoric, has ataxia, reflexes reduced, bradycardia,
hypotonia.
Diagnose kinds of toxicomania.
2. Patient A., 63 old year used phenobarbital for good sleep during long time. He did not these pills
duration last week.
Psychical status: general weakness, breakness, tireness, insomnia, anxiety, muscle tics, pain
in abdomen, nausea, vomiting.
What syndrome in patient?
3. Patient has poison of cnolinolitics.
Psychical status: optical hallucinations, delusion of relation of erotic content. Pupils dilated,
non mobility, arterial pressure incresed.
Your tactic?
8. RECOMMENDED LITERATURE IS:
8.1. Basic:
1. Clinical Psychiatry from Synopsis of Psychiatry by H.I.Kaplan, B.J.Sadock. – New York:
Williams @ Wilkins. – 1997.
2. Psychiatry. Course of lectures. – Odessa: The Odessa State Medical University. – 2005. – 336
p.
3. Lectures.
4. Internet resource.
8.2. Additional:
1. Морозов Т.В., Шумский Н.Г. Введение в клиническую психиатрию. – Н.Новгород:
Изд-во НГМА, 1998.
2. Попов Ю.В., Вид В.Д. Современная клиническая психиатрия. – М., 1997.
3. Сонник Г.Т. Психіатрія: Підручник / Г.Т.Сонник, О.К.Напрєєнко, А.М.Скрипніков. –
К.: Здоров’я, 2006.
Prepared by assistant
S.D.Savka