Substance –Related disorders Dr. Raafat Alowesie,MD,Msc Consultant Psychiatrist

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

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

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

10 Broad Principles of Drug Use and Problems Drug use is a chosen behavior Drug problems emerge gradually and occur along a continuum of severity Once well-established, drug problems tend to become self- perpetuating Motivation is central to prevention and intervention Drug use responds to reinforcement Drug problems do not occur in isolation, but as part of behavior clusters There are identifiable and modifiable risk and protective factors for problem drug use Drug problems occur within a family context Drug problems are affected by a larger social context Relationship matters

What is Addiction? Addiction is A Brain Disease Charaterized by: ⁻ Compulsive Behavior ⁻ Continued abuse of drugs despite negative consequences ⁻ Persistent changes in the brain’s structure and function

What Environment Factors Contribute to Addiction? Stress Early physical or sexual abuse Witnessing violeance Peers who use drugs Drug availability

Drugs and Brain Reinforcement Systems

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

Dependence Syndrome (Addiction) a)A strong desire or sense of compulsion to take the substance („craving“) b)Difficulties in controlling substance-taking c)Withdrawal sy characteristic for the substance d)Evidence of tolerance e)Progressive neglect of pleasures and interests f)Persisting with substance use despite clear evidence of overtly harmful consequences Physical dependence Psychic (psychological) dependence

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)

How Alcohol Attacks the Brain A guide to the sequential damage alcohol inflicts on neural tissue 1.First, alcohol affects the forebrain and assaults motor coordination and decision making 2. Then, Alcohol knocks out the midbrain, and you lose control over emotions and increase chances of a blackout. 3. Finally, alcohol batters the brainstem as it affects heart rate, body temperature, appetite and consciousness, a dangerous and potentially fatal condition.

Mild to moderate psychological symptoms: Feeling of jumpiness or nervousness Feeling of shakiness Anxiety Irritability or easily excited Emotional volatility, rapid emotional changes Depression Fatigue Difficulty with thinking clearly

Mild to moderate physical symptoms: Headache – general, pulsating Sweating, especially the palms of the hands or the face Nausea and vomiting Loss of appetite Insomnia, sleeping difficulty Paleness Rapid heart rate (palpitation) Eyes, pupils different size ( enlarged, dilated pupils) Skin, clammy Abnormal movements Tremor of the hands Involuntary, abnormal movements of the eyelids

Severe Symptoms: A state of confusion and hallucinations (visual) – known as delirium tremens Agitation Fever Convulsions (which may result in death) “Black outs”- when the person forgets what happened during the drinking episode

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 (Korsakov’s psychosis or syndrome)

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

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

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

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

Inhalants (withdrawal symptoms)

Cannabinoids

Mechanism of Action

Effects

Withdrawal

Effects of Abuse

Withdrawal symptoms

Tobacco

Amphetamines Amphetamines and amphetamine-related drugs are central nervous system stimulants. The past decade has seen a marked increase in the popularity of amphetamines use. Types: Amphetamines – group subtances including predominantly amphetamine and methamphetamine. Ecstacy- group substances- including MDMA (3,4- Methylenedioxymethamphetamine) and its analogues.

Amphetamines Effects of abuse 1.Short term Loss of appetite, rapid breathing and heartbeat, high blood pressure, and dilated pupils Fever, sweating, headache, blurred vision, and dizziness (high dose) Flushing, pallor, very rapid or irregular heartbeat, tremors, loss of coordination, and collapse (very high dose) death

2. Long term effects Short-term effects are exaggerated Various illness related to vitamin deficiencies and malnutrition More prone to illness Amphetamine psychosis – a mental disturbance similar to paranoid schizophrenia Kidney damage, lung problems, strokes, or other tissue injury may result

Withdrawal symptoms Due to tolerance to some effects Become psychologically or physically dependent Fatigue, long but troubled sleep, irritability, intense hunger, and moderate to serve depression, which may lead to suicidal behaviour Fits of violence may also occur These disturbances can be temporarily reversed if the drug is taken again