Disorders Due to Psychoactive Substance Use

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Disorders Due to Psychoactive Substance Use

• Department of Psychiatry
• 1st Faculty of Medicine
• Charles University, Prague
• Head Prof. MUDr. Jirí Raboch, DrSc.

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Psychoactive Substance

• Psychoactive (psychotropic) substance is any
  substance which after absorption has influence on
  mental processes both cognitive and affective.
• stimulative
• suppressive
• hallucinogenic

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Mental and Behavioural Disorders Due to
Psychoactive Substance Use

• Disorders due to use of
• F10.x alcohol
• F11.x opioids
• F12.x cannabinoids
• F13.x sedatives or hypnotics
• F14.x cocaine
• F15.x other stimulants (caffeine)
• F16.x hallucinogens
• F17.x tobacco
• F18.x volatile solvents
• F19.x multiple drugs and other
• psychoactive drugs

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Mental and Behavioural Disorders Due to
Psychoactive Substance Use

• Specific Clinical Conditions
• F1x.0 Acute intoxications
• F1x.1 Harmful use
• F1x.2 Dependence syndrome
• F1x.3 Withdrawal state
• F1x.4 Withdrawal state with delirium
• F1x.5 Psychotic disorder
• F1x.6 Amnesic syndrome
• F1x.7 Residual state, late-onset psychotic
  disorder
• F1x.8 Other mental and behavioural disorders
• F1x.9 Unspecified mental and behavioural disorder

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F1x.0 Acute Intoxication

• Df.
• A transient condition following the
  administration of psychoactive substance
  resulting in disturbances in level of
  consciousness, cognition, perception, affect or
  behaviour, or other psychophysiological functions
  and responses
• Closely related to dose levels
• Uncomplicated
• With trauma or other medical complications
• With delirium
• With coma
• With convulsions
• Pathological intoxication (applies only to
  alcohol)

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F1x.1 Harmful Use

• The damage may be physical and/or mental.
• Socially negative consequences are not evidence
  (neither acute intoxication or hangover).

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F1x.2 Dependence Syndrome (Addiction)

• A strong desire or sense of compulsion to take
  the substance (craving)
• Difficulties in controlling substance-taking
• Withdrawal sy characteristic for the substance
• Evidence of tolerance
• Progressive neglect of pleasures and interests
• Persisting with substance use despite clear
  evidence of overtly harmful consequences
• Physical dependence
• Psychic (psychological) dependence

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F1x.2 The Course of Dependence Syndrome

• F1x.20 currently abstinent (remission)
• F1x.21 currently abstinent in a protected
  environment
• F1x.22 currently abstinent on a maintenance
  regime
• F1x.23 currently abstinent - receiving treatment
  with aversive or blocking drugs (naltrexone,
  disulfiram)
• F1x.24 currently active dependence
• F1x.25 continuous (chronic) use
• F1x.26 episodic use (dipsomania)

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F1x.3 Withdrawal State

• Symptoms occurring on absolute or relative
  withdrawal of a substance after repeated and
  prolonged use of the substance
• Uncomplicated
• With convulsions

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F1x.4 Withdrawal State with Delirium

• Delirium tremens - in severely dependent users
  with a long history of use of alcohol
• Prodromal symptoms insomnia, tremor, fears
  followed by illusions, hallucinations, clouding
  of consciousness and marked tremor

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F1x.5 Psychotic Disorder

• Psychotic phenomena occurring during or
  immediately after psychoactive substance use
• Schizophrenia-like
• Predominantly delusional, hallucinatory,
  depressive, manic (alcoholic hallucinosis,
  jealousy)
• Persistence for more than 48 hours

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F1x.6 Amnesic Syndrome

• Impairment of recent memory (learning of new
  material)
• Absence of defect in immediate recall, of
  impairment of consciousness, and of generalized
  cognitive impairment
• History of chronic use of psychoactive substance
  (Korsakovs psychosis or syndrome)

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F1x.7 Residual and late-onset psychotic disorder

• Onset related to the use of psychoactive
  substance, the disorder should persist beyond any
  period of time during which direct effects of the
  psychoactive substance might be assumed
• Flashbacks - duration in seconds or minutes,
  duplication of previous drug-related experiences
• Personality disorder
• Dementia

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F10.x Mental Disorders Due to Use of Alcohol

• Acute intoxication
• euphoria, flushed face, ataxia, slowed reaction
  time, impaired motor performance, slurred speech,
  poor concentration in higher doses behavioural
  changes disinhibition of sexual and aggressive
  impulses, increased suicidal and homicidal
  behaviour
• Pathological intoxication
• sudden change of consciousness with aggressive
  behaviour and amnesia
• Harmful use
• physical complications hypertension,
  arteriosclerosis, heart infarction,
  cardiomyopathy, brain stroke, liver cirrhosis,
  fatty liver, gastritis, etc.
• psychic complications - depression

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F10.x Mental Disorders Due to Use of Alcohol

• Dependence syndrome
• increased tolerance to alcohol, morning drinking,
  alcohol bouts, blackouts, deterioration in
  occupational and marital life, behavioural
  changes, withdrawal symptoms
• Withdrawal state
• tremor, anxiety, easy getting startled,
  agitation, insomnia, nausea, sweating, epileptic
  seizures and delirium tremens
• Delirium tremens
• usually starts in evening hours growing
  tremulousness, severe agitation, anxiety and
  perceptual distortion
• a state seriously endangering patient's life
• recovery after several days, retrograde amnesia

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F10.x Mental Disorders Due to Use of Alcohol

• Other psychotic disorders
• alcoholic hallucinosis
• pathological jealousy
• Korsakov's psychosis
• Wernicke encephalopathy
• alcoholic dementia
• Treatment of alcoholism
• Withdrawal from alcohol, benzodiazepines,
  clomethiazol
• Aversion therapy
• Alcohol-Antabuse (disulfiram) Reaction (AAR)
• Psychotherapy

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F11.x Mental Disorders Due to Use of Opioids

• Morphine, heroin (diacetylmorphine), codeine,
  pethidine, methadone
• Heroin
• dependence develops within two weeks of daily use
• overdose may lead to death
• withdrawal symptoms are extremely unpleasant
• needle-sharing represents a serious risk of
  transmission of HIV and hepatitis B C viruses
• treatment of the withdrawal state
  buprenorphine, benzodiazepines, spasmolytics in
  serious cases of dependence heroin is replaced by
  methadone

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F12.x Mental Disorders Due to Use of Cannabinoids

• Marijuana (marihuana) is a colloquial term for
  dried leaves and flowers of cannabis plant
  (Cannabis sativa L.)
• ?9-tetrahydrocannabinol (?9-THC) is responsible
  for the psychoactive properties of the cannabis
  plant
• Complex physiological functions of the
  cannabinoid system motor coordination, memory
  procession, control of appetite, pain modulation
  and neuroprotection
• Summary of adverse effects
• acute anxiety, panic, impaired attention,
  memory, reaction time and psychomotor performance
  and coordination, increased risk of road
  accident, and increased risk of psychotic
  symptoms among vulnerable persons
• chronic chronic bronchitidis, a cannabis
  dependence syndrome, subtle impairments of
  attention, short-term memory and ability to
  organize and integrate complex information

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F12.x Mental Disorders Due to Use of Cannabinoids

• Effect of cannabinoids on central nervous system
• Euphoria, enhancement of sensory perception,
  tachycardia, antinociception, difficulties in
  concentration, impairment of memory
• Cannabis use may exacerbate symptoms of
  schizophrenia and may precipitate disorders in
  persons who are vulnerable to developing
  psychosis heavy cannabis use may increase
  depressive symptoms among some users
• Tolerance develops the relatively long half-life
  and complex metabolism of cannabis may result in
  a low intense withdrawal syndrome
• Marijuana use tends to impair executive function
  in the brain, e.g. higher risk for all types of
  injuries is associated with cannabis use
• Cannabis abuse and dependence were highly
  associated with increasing risks of other
  substance dependence

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F13.x Mental Disorders Due to Use of Sedatives
and Hypnotics

• benzodiazepines potentiate the action of GABA
• risk of dependence
• short-acting benzodiazepines alprazolam,
  flunitrazepam, oxazepam, lorazepam, temazepam
• long-lasting benzodiazepines diazepam,
  clorazepate, chlordiazepoxide, etc.
• withdrawal state can be accomplished with
  epileptic seizures
• interaction with alcohol may induce qualitative
  changes of consciousness

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F14.x,15.x Mental Disorders Due to Use of
Stimulants

• Cocaine, amphetamine, metamphetamine (pervitine),
  phenmetrazine, methyphenidate, MDMA (ecstasy,
  methylenedioxymetamphetamine)
• Positive mood, activity, planning, diminished
  need of sleep
• Tachycardia, arrhythmia, hypertension,
  hyperthermia, intracerebral haemorrhage
• Withdrawal symptoms severe craving, depression,
  decreased energy, fatigue, sleep disturbance
• Prolonged use can trigger paranoid psychoses,
  impulsivity, aggressivity, irritability,
  suspiciousness and anxiety states

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F16.x Mental Disorders Due to Use of Hallucinogens

• Lysergid acid diethylamide (LSD), psilocybin,
  mescaline, phencyclidine
• Acute intoxication distorted perception (optic
  hallucinations and illusions) unpredictable and
  dangerous behaviour
• Withdrawal syndrome has not been described

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F18.x Mental Disorders Due to Use of Volatile
Solvents

• Toluene, acetone, adhesives, petrol, cleaning
  fluids, etc.
• Acute intoxication euphoria, disorientation,
  incoordination, slurred speech optic
  hallucinations
• The way of use is very dangerous

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Drug Addiction Treatment

• HEALTH SERVICE
• acute states (detox program, tox. psychosis)
• weaning treatment
• after-treatment care
• substitution (maintainance) treatment
• OUT OF HEALTH SERVICE
• contact centers
• daily static centers
• therapeutic communities
• after-treatment centers
• protected workshops and habitations
• mutual help groups Alcoholics Anonymous,
  Narcotics Anonymous

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Links

• Czech National Focal Point for Drugs and Drug
  Addiction
• www.drogy-info.cz
• European Monitoring Centre for Drugs and Drug
  Addiction
• http//www.emcdda.eu.int/