Disorders Due to Psychoactive
Substances
as. MUDr. Olga Pecinovská
Department of Psychiatry,
First Faculty of Medicine,
Charles University and General University Hospital in Prague
Disorders Due to Psychoactive
Substances
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Mental disorders due to substance
abuse
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Intoxication
Abuse
Addiction
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Withdrawal syndrom
Psychotic disorders due to addiction
Physical complications of substance
abuse
Abused Psychoactive Substances
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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
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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
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Tremor, hyperreflexia
Anxiety
Increased heart rate and blood presure
Sweating
Nausea, vomiting
insomnia
Alcohol withdrawal seizure
Alcohol Withdrawal Delirium
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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
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Alcoholic paranoid psychosis
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Alcoholic hallucinosis
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Auditory hallucinations without clouding of
sensorium
Alcohol amnestic disorder (Korsakoff‘s
psychosis)
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Heresy jealous, persecute
Memory defect, confabulations, intellectual
function is preserved
Alcoholic dementia
Physical Complications of Alcohol
Abuse/dependence
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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
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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
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Parotid gland enlargement
Neglected teeth, early loss of teeth
Gingivitis, parodontitis
Stomatitis, glossitis, cheilitis
Cancer of the mouth
Carcinoma of the pharynx
Sedatives/hypnotics/benzodiazepins
Addiction
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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
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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
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Alnagon, Korylan, Spasmoveralgin, Spasmopan
Pleumolysin, Talvosilen
Opioid Intoxication
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Euphoria immediately after use, then
apathy and psychomotor retardation
Miosis
Slow regular respiration
Slurred speech
Impairment of judgment, attention,
concentration, memory
analgesia
Opioid Withdrawal
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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:
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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
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Cocaine, pervitin, phentermine, ephedrine
Intoxication
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Withdrawal
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Anxiety, irritability, agitation, paranoia, confusion,
hallucinations, sympathomimetic effects
(dizziness, tremor, mydriasis, tachycardia,
hypertension, hyperpyrexia)
Dysphoria, insomnia/hypersomnia, hyperphagia
Risks
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Convulsions, heart attack, psychosis, accidents
Marihuana
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Intoxication:
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Withdrawal:
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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:
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Bronchitis, impaired sexual function, chromosomal
damage
Panic attacks, amotivational syndrome, cannabis
psychosis, dementia
Inhalants
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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 Doctor´s
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Abstining addicts
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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 Doctor´s
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Active addicts
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Poor collaboration, not valid anamnesis
Come in intoxication or withdrawal syndrome
Often come even with inflammatory complications
Irritability, manipulative
Asking for psychoactive substances
CAVE:
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alcohol: vomiting reflex, seizure
IUD: infection!!, analgesia or hypersensitivity
Cave combination therapy with abused substances
Cave high tolerance to psychoactive substances