Disorders Due to Psychoactive Substances

as. MUDr. Olga PecinovskáDepartment 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 abuseF 1x.2 Addiction (syndrome of

dependence)F 1x.3 Withdrawal syndromeF 1x.4 DeliriumF 1x.5 PsychosisF 1x.6 Amnestic disorderF 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 effect0,5g/l cognitive deficits, motor coordination

problem2,5g/l significant confusion, decreased state of

consciousness4g/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

Heresy jealous, persecute Alcoholic hallucinosis

Auditory hallucinations without clouding of sensorium

Alcohol amnestic disorder (Korsakoff‘s psychosis) 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/benzodiazepins 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

Anxiety, irritability, agitation, paranoia, confusion, hallucinations, sympathomimetic effects (dizziness, tremor, mydriasis, tachycardia, hypertension, hyperpyrexia)

Withdrawal Dysphoria, insomnia/hypersomnia,

hyperphagia Risks

Convulsions, heart attack, psychosis, accidents

Marihuana Intoxication:

Tachycardia, conjunctival injection, dry mouth, increased appetite,

Impaired short-term memory, labile affect, altered time perception, enhanced sociability

Withdrawal: 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 Doctor´s

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 Doctor´s 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