Psychoactive substance use disorder.addikt.ppt
- 1. Psychoactive substance use disorders Dr. Erika Szily 16. 10. 2013.
- 2. Basic conceptions Psychoactive substance: compound that can alter one’s state of mind Reinforcer: that causes pleasant or stops unpleasant conditions
- 3. Categories of drugs CNS Depressants Alcohol Sedatives, hypnotics, and anxiolytics Opiates Stimulants Heroin Amphetamines Meperidine Methylphenidate Codeine Cocaine Hydromorphone Cannabis Hallucinogens LSD Inhalants Designer drugs Synthetic cathinons and other amphetamine derivatives, opioids, THC-analogues
- 4. DSM-IV-TR substance-related mental disorders 1. Substance use disorders: - Substance abuse - Substance dependence 2. Substance -induced disorders: - Substance intoxication - Substance withdrawal with or without delirium - Substance -induced amnestic disorder / dementia - Substance -induced psychotic disorder (e.g. delusion of jealousy and hallucinations) - Substance -induced mood, personality, anxiety, sexual, and sleep disorder
- 5. Basic definitions: substance abuse Maladaptive pattern of substance use: – Failure to fulfill role obligations at work, school or home – Physically hazardous situations – Legal problems – Continued use despite serious social and interpersonal problems
- 6. Basic definitions: substance dependence (Heavy and prolonged substance use); Tolerance (need for increase amounts; diminished effect of the same amount) Withdrawal (certain symptoms when stop substance use, alcohol cures the syndrome) Persistent desire or unsuccessful efforts to cut down substance use Great amount of time is spent on activity related to the substance Social, work or recreational activities are given up Continued use despite of knowledge of serious social, psychological,and physical problems
- 7. Dependence When the substance use is reduced or ceased withdrawal symptoms develop lack of withdrawal symptoms Level of dependence ----------------------------- withdrawal symptoms Two types physiological dependence (Alcohol, BZDs, Opioids – drug-specific effects on certain receptors: e.g. GABA receptors) psychological dependence (Most of the psychoactive substances – dopaminergic effects, reward and motivation systems (striatum, n. accumbens)
- 8. Tolerance The dose of the drug has to be increased in order to reach the desired effect (pharmacokinetic (enzym induction) and pharmacodynamic (receptor downregulation) effect of drug develops Level of tolerance ------------------------- effect of drug doesn’t develop
- 9. Addiction Compulsive behavioural pattern of seeking drugs, consumption of drugs Characterized by strong dsesire towards the drugs, and strong tendency to the relapse after the withdrawal
- 10. Alcohol consumption in the World
- 11. Neuropsychiatric disorders due to alcohol consumption Withdrawal without or with delirium tremens Alcoholic hallucinatory state Alkoholic delusive disorder Alcoholic personality changes Alcohol-induced Persisting Dementia Wernicke’s encephalopathy Korsakoff syndrome
- 12. Alcohol withdrawal - clinical presentation Minor withdrawal (5-10 hours) – Autonomic hyperactivity: tremulousness, hyperhydrosis, tachycardia, hypertension, GI upset; – Anxiety, insomnia, and vivid dreams Major Withdrawal (12-72 hours) – Hallucinations (visual, tactile) – 10-25% – Seizures (generalized tonic-clonic seizures ) – 10% Delirium tremens (48-72 hours) – 5% – Disordered consciousness – Life threatening state – medical emergency!!!!
- 13. Delírium tremens Most severe form of alcohol withdrawal Untreated delirium has a mortality rate of 20 % Occurs after prolonged and heavy alcohol consumption at cease or reduction of alcohol use Provoking factors can often be seen (fever, internal disturbance)
- 14. Symptoms of delirium Psychopathological symptoms: - Disordered conscioussness, confusion - Impaired attention, distractibility - Disorientation in relation to time, place and person - Hallucinations and illusions (complex, visual, tactile, auditory) - Desorganised behaviour, agitation, violence Vegetative and somatic symptoms: Autonomic hyperactivity: tremulousness, hyperhydrosis, tachycardia, hypertension, fever GI upset Inversion of sleeping Convulsions
- 15. Treatment of delirium Prevention Benzodiazepines Thiamine Ensure fluid and electrolite ballance High calorie, high-carbohydrate diet suplemented by multivitamins Treatment of internal disorders, infections, etc.
- 16. Alcoholic hallucinatory state At prolonged and heavy alcohol- consumption, after alcohol-abuse or cease of alcohol consumption
- 17. Alcoholic hallucinatory state Symptoms: Hallucinations Clear conunsciousness, kept orientation Severe anxiety Persecutory delusions Delusions of reference Altered behaviour by the psychotic contents Suicidal danger
- 18. Alcoholic delusive disorder Delusions of jealousy (most often) persecutory reference
- 19. Alcoholic personality changes Slowly progressing chronic psychic distrubance involving all parts of personality after prolonged alcohol consumption
- 20. Symptoms Changeable mood, superficial emotions, bursts of anger Superficial attachment to the family Lack of inhibitions, lack of ethic Decreased critical sense, unconscientiousness Irritability, agressivity Decreased adapting to the society Decreased judgement Deterioration of intelelctual functions
- 21. Alcohol-induced Dementia Reason: Direct neurotoxic effect of alcohol and thiamine deficiency Symptoms: Deterioration of intelelctual functions Impaired memory, Impaired ability of abstraction Impaired judgement, Impaired problemsolving thinking Impaired orientation
- 22. Alcohol-related nutritional disorders Nutritional and absorption problems: thiamine (vitamin B1) deficiency in chronic alcohol dependence Lesions: mammilary body, fornix, thalamus, cerebellum and brainstem Korsakoff’s syndrome: short-term memory impairment, confusion, and confabulation Wernicke’s encephalopathy: gait ataxia, confusion, oculomotor problems - horizontal nystagmus and gaze palsy (Wernicke’s encephalopathy is reversible but can progress to Korsakoff’s syndrome, coma or death; avoid rapid glucose administration BEFORE thiamine) --- Lack of folic acid: macrocytaer anaemia Rare: pellagra and beri-beri-like conditions
- 23. Thiamine Reason of thiamine deficiency: Poor nutrition Malabsorption Thiamine is a cofactor for several important enzymes It’s involved in the conduction of the axon potential along the axon and in synaptic transmission
- 24. Effects and consequences of illegal drug use
- 25. Effects of opiate use - flushing - orgasmic sensation in the abdomen - euphoria - calmness
- 26. Withdrawal symptoms of opiates lacrimation rhinorrhea sweating yawning hot and cold flashes insomnia muscle and joint pain nausea vomiting abdominal cramps sever anxiety irritability
- 27. Effects of stimulants elevated mood increasd energy increased alertness transient psychosis decreased appetite autonomic hyperarousal: - tachicardia - elevated blood pressure
- 28. Effects of cocain euphoria disinhibition enhanced sense of mastery sexual alertness improved self esteem rush (rapid onset of euphoria) tactile hallucinations (coke bugs)
- 30. Hallucinogens Agents, that induce psychotic-like experiences, hallucinations, perceptual disturbances, feeling of unreality Hallucinogens LSD (lysergic acid diethylamide) peyotle mescaline MDMA
- 31. Effects of Hallucinogens Alterations in perception: hallucinations, illusions synthesias (e.g. colors are brighter and more intense or colors may be heared and sounds seen) Emotions become intense and labile Introspection Depersonalisation, Derealization
- 32. Bad trips Patient develop marked anxiety and paranoia Flashback: a brief reoccurrence of a drug induced experience that occurs in situations unrelated to taking the drug
- 33. Cannabis Cannabis derivatives are produced from the hemp Cannabis sativa. The active ingredient is the THC (delta- 9-tetrahydrocannabinol). The illicit psychoactive compound (marijuana) is probably the most widely used.
- 34. Effects - euphoria - drowsiness - feeling of calm - feeling that time has slowed - improved self coinfidence - perceptual distortions - paranoia (suspiciosness) - decreased motor coordinaton
- 35. Cosequences Amotivation syndrome Memory disturbance Marijuana impairs the transfer of material from mediate to long term memory
- 36. Inhalants Chemicals, that produces psychoactive vapours airplane glue paint thinner nail-polish remover gasoline many substances in aerosol cans Active substances: Toluane, acetone, benzene, other organic hydrocarbons
- 37. Effects excitation disinhibition euphoria dizziness slurred speech ataxia delirium hallucinations delusions nystagmus double vision At higher doses: stupor, coma
- 38. Consequences Neuromuscular and brain damage, damage to the kidneys, liver due to high concentrations of heavy metals
- 39. Therapy of addictive disorders Connected therapeutic chain from detixification to resocialisation and rehabilitation Aim of treatment: Improve ability to community and social functioning
- 40. Therapy of addictive disorders Different methods in treatment since drug abuse is a medical - a psychological and - sociological problem
- 41. Therapy Pharmacotherapy (Opioids - methadone, naltrexon Alcohol - nalmefene, disulfiram) Psychoterapy Relapse prevention
- 42. Long-term management of substance dependence: psyhosocial treatment and rehabilitation Confrontation with reality and motivating according to individual needs and capacity to change Focusing on and treatment of co-morbid mood and anxiety disorders (30-40%) Family-level intervention Counseling and community-level intervention: - motivation to maintain abstinence and prevent relapse – showing the consequences - cope with everyday stress - stimulus control and craving - build-up alternative lifestyle
- 43. Self-help groups Alcoholics Anonymous, Narcotics Anonymous - Sober peer group, 12-step treatment from confrontation to spiritual awakening - Role modeling of social functioning without drinking - Peer help available 24 hours - Strong group coherence („we-ness”) - Religion and spirituality potential problems: confrontation with the medical model, may be dogmatic, requires changes in view of life Other organizations: LifeRing Secular Recovery, Rational Recovery, SMART Recovery