LECTURE №1

THEME: Subject and narcology problems. The organization of the

narcological help. Actual problems of modern narcology from positions of

demonstrative medicine.

Aim:  To acquaint students with bases of the organization of the narcological help to the population; to give concept about a subject and narcology problems.

Actuality: Dear colleagues, the special course of Narcology in the Medical Academy has been working since 2001.

The subject was put into compulsory educational program as a result of acute actuality of the problem. Narcomania in the world and also in Kazakhstan has the tendency to steady rise.

The mass using of PAS leads to the increasing number of intoxication cases, traumatism, violence crimes and etc. And the most important of it that the drugs using is more typical for youth, teenagers and children. Alcohol using is also often noticed in childhood and adolescence. Undoubtedly that these factors greatly effect on the personality forming and its interests, social position and etc.

The intravenous drug using stimulates a rapid spread of the virus infectious diseases-AIDS, hepatitis and others. Most of opiomania patients die as a rule in their young age. In connection of the problem significance for the last 15-20 years all countries greatly liven up the scientific researches in this area.

1.Narcology- a scientific subject investigating theappearance conditions and some mechanisms of addictionforming from psychoactive substances, their toxic effectswith the aim to develop some adequate diagnostics'methods, treatment and prophylactics stipulated by theirdiseases.

One of the determining narcology tasks is a task of alcoholics and narcomaniacs treatment. When it is a question of treatment it means remission stabilization and prophylactics of disease recurrences. Other narcology task is prophylactics and disease prevention.

Nowadays there are more chemical substances that bring on the forming of addiction syndrome. That's why it was offered to unit all these specimens (alcohol, narcotics and others) in one group and called them as psychoactive substances (PAS).

1. The meaning of narcological service consists of cooperated narcological polyclinic's work, hospitals, the centers of medico-social rehabilitation of narcological patients and the scientific-practical centers of medico-social narcomania's problems.

1.The initial, the second and the third prophylaxis of PAS addiction.

2.Early detection, treatment and registration of people who are alcoholic, narcomaniac, and toxicomaniac.

3.Dynamic regular medical check-up.4.Research of disease among the

population.

5.Analysis of efficiency of the medical and the disease-prevention service.

6.Social service.7.Psychological and

psychoprophylactic work.8.Collaboration with other

organizations. 9.Alcoholic, narcological and

toxicological examination(twenty-four hour).

10.Statistical documents manipulation.

Registration office. District narcologist's room. Teenagers' room. service-room for narcological

patients. Anonymous treatment room. Other specialists' room:

therapeutist's,neuropathologist's and psychologist's.

Room of alcoholic, narcological, and toxicologicalintoxication examination.

Stationary department (female, male and adolescence).

Diagnosis department with laboratories. Hospital. Medical workroom. Rooms of active treatment methods:

procedure,physiotherapeutic, for psychotherapy, hypnosis.

Organizational methodological department.

District narcologists realize the reception of patients, visit them who are under dispensary registration, realize the prophylactic work at schools instructing pupils to prevent them from narcomania. The period of dispensary examination is of narcomania-for 5 years, of alcoholism-for 3 years, for people who use PAS-occasionally for 1 year.

There are 2 forms of treatment at the stationary-voluntary and compulsory. The compulsory is realized by the court decision, if a patient does not want to treat but he constitutes a menace for other people. The period of treatment in the stationary for alcoholism is for 45 days, for narcomania is for 60 days. The compulsory treatment is from 6 months till 2 years.

Speaking about the appearance conditions of narcological diseases should have in view some components such as social, psychological and of course biological factors.

In such way, the addiction from psychoactive substances is ethnologically compound multiple- factor disease stipulated by as genetic predisposition as the constellation of external and internal environmental factors.

Psychopathic structure of personality with dispositionto aggression, antisocial acts and risk.

Male sex. Hyperactivity syndrome in childhood. Low intellect, unwillingness to study. Emotional disconnection with parents.

Deflection in behavior (lessons missing, bad discipline).

Risk factors of addiction development from psychoactive

Substances found in families: Parents' alcoholism or narcomania. Other relatives' alcoholism or

narcomania. Conflicts in the families.

Absence of emotional connection between family's members.

Tolerant parents' attitude to using PAS.

Incomplete family (the absence of father in the family)

Messy family's lifestyle. Environmental factors leads to PAS

using: family traditions, culture and country traditions. - friends, classmates, neighbors, colleagues.

The influence of drugs, alcohol and others PAS on person's organism, his vital activity and functions becomes apparent in 3 different directions.

At first PAS specifically has effect on the definite brain's system and structure bringing on the development of addiction syndrome. This syndrome is the main in clinic view of narcological diseases.

Secondly, drugs and alcohol have toxic effect of psychoactive substances.

At last thirdly, today there is actually the influence of parents' narcological pathology on their children. Medico-genetic investigations have proved that alcoholics or narcomaniacs' children have assigned risk of these diseases development. Besides there are some character and behavior disorders: aggression, disposition of depression or risk.

The pregnant woman's alcohol using leads to fetus's alcoholic syndrome development and her drugs using can be a reason of a child with forming narcotic addiction. All modern scientific facts say that neurophysiological mechanisms of PAS addiction development are based in stem and limbic brain structures in those its regions where is so called a reinforcement system. The system takes part in supplying of the emotional state regulation, mood, psychophysical tonus, person's behavior, and his adaptation in the environment.

The results of many investigations can do the conclusion that the PAS effect on neurochemical processes of brain is the majority of addiction syndrome development. The mass effect of drugs leads to the dysfunction of nearly all neurochemical brain systems, however not all these disturbances have a connection with development of drugs addiction syndrome. Every substance has its own pharmacological spectrum of effect. However, all these substances can bring on addiction syndrome have common link of pharmacological effect what is typical influence on catechohaminic neuromediation in limbic brain structure, especially in "reinforcement system ".

The PAS effect leads to the intensive output of neutromediators from the group of catecholamine (CA) as dopamine (DA) at first in these brain departments and therefore to greatly stronger stimulation of reinforcement system. Such stimulation is often accompanied with positive emotional experience. Free CA is subjected to metabolism ferments activities and quickly ruin. Repeated PAS using leads to the running out of neuromediators that appears with not enough expressing excitement of the reinforcement system with appearing of "normal" impulse.

Psychophysically, it is expressed by falling mood, sluggish disposition, weakness, boredom, emotional discomfort and depressing symptoms. PAS using again stimulates in the case additional freedom for neuromediators from the shed that temporarily compensate their deficiency at the synaptic fissure and normalize the brain limbic structure. This process is accompanied with subjective senses of amelioration, emotional and psychic excitement. However free CA again ruins quickly and that leads to further their contents' rate falling, deterioration of psychoemotional state and accordingly to a wish to use drugs again.

This "vicious circle" underlies the forming of alcohol and drugs psychic addiction.

During the long alcohol and drugs using, the deficiency of neuromediators can develop moreover it is threaten for the vital activity of organism. As compensation mechanism of the occurrence is an intensive catecholamine synthesis and suppression of ferments activity of their metabolism, firstly monoaminoxidoses (MAO) and dopamine-betahydroxylazile (DBH), which control the transformation dopamine to noradrenaline.

Thus, stimulated PAS by other its using CA release and their rapid destroyment combine with compensatoryly intensive synthesis of these neuromediators. The rapid forming of CA circulation is going. Now when the drug using stops, in the period of abstinence, the intensive catecholamines freedom from the shed does not occur, but their rapid synthesis stays. In consequence of ferments' activity change in the brain, one of the С A-dopamine is accumulating. The process causes the development of the main clinic abstinent syndrome's symptoms: high alarm, tension, excitement, arterial pressure rise, increased pulse, appearing of the vegetative disorders, sleep disturbances and beginning of psychotic states.

Described above the change of brain neurochemical functions is a base of PAS physical addiction forming.

Dopamine rate in blood exactly correlates with clinic difficulty of abstinent syndrome (AS), increasing of its initial indicators in two times combines with heavy abstinent syndrome but the increasing in three times, acute psychic state-alcohol delirium develops.

In remission the patients with formed physical addiction are observed the typical dopamine rate hesitation: in the initial period it is risen, then it is lower than 'norma'. The DA deficiency in reinforcement brain structure is a base of heavy pathological desire to drugs and alcohol and high probability of recurrent disease.

 

Modern classifications of DSM-IV and accepted ICD-10 in Kazakhstan are for statistic analyses and they do not have dynamic approach.

In ICD-10 psychical and behavior disorders are coded as a letter "F". Psychical and behavior disorders of PAS using are coded as a figure "1". The third figure is a PAS group. So, for example, FlO-alcohol, Fll- opiats, F12-cannabiods, F13-sedative and soporific substances, F14-cocaine, F15-other stimulators including caffeine, F16-hallucinogenes, F17-tobacco, F18-volatile solvents, F19-combined PAS using. Also by this classification are pointed: complications, accompanied by disease, syndromes (for e.g. abstinence, intoxication and presence or absence of PAS using at the same moment for e.g. the recurrence that is active PAS using or remission that is abstinence PAS using. The doctor diagnoses with the help of ICD10.

In usual work doctors also use clinic-dynamic classification, which is based upon the disease -stage.

Narcomania (toxicomania) course has the common regularities. Addiction forming is preceded by the stage of episodic PAS using, which are used from time to time. There is no definite narcotization rhythm in the period and also there is no tolerance. As for psychic addiction, it can form after some periods of time, after the beginning of episodic drugs using and sometimes it forms after the first trials and promotes to go on narcotization.

Further the exact narcotization rhythm is producing and drugs are used regularly. Tolerance begins to grow. However, physical addiction has not formed yet. This period can be called as initial (10-stage) narcomania stage. Tolerance is growing in narcotization continuation and physical addiction is forming. By the period tolerance has reached maximum range and tolerance plateau is observed. In the phase the euphoria quality changes. The extensive disease stage (the second) is becoming.

The patients can't stand previous high drug dose during the long narcotization. Tolerance is decreasing, there is no euphoria. Drug using only supports the organism in more or less comfortable state. The character of abstinence syndrome changes. Somato- neurological disorders are expressed in the largest stage. This is a final (third) narcomania stage.

Actual problems of modern narcology from positions of demonstrative medicine.

Actual problems of modern narcology from positions of demonstrative medicine in the conditions of Kazakhstan are features genesis and a clinical picture of alcoholism, and also opium and cannabis narcotisms

Thank you for attention!!!