1. DRUG ADDICTION AND ALCOHOLISM Yard. Doç. Dr. N. Berfu Akbaş Yeditepe Üniversitesi Psikiyatri Anabilim Dalı

2. DEPENDENCE: DEPENDENCE: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, manifested by TOLERANCE, WITHDRAWAL, PERSISTANT DESIRE, a great time and activity spent, social activities given up, use is continued despite knowledge of harms. A maladaptive pattern of substance use, leading to clinically significant impairment or distress, manifested by TOLERANCE, WITHDRAWAL, PERSISTANT DESIRE, a great time and activity spent, social activities given up, use is continued despite knowledge of harms. ABUSE: recurrent substance use in a failure to fulfill major role obligations, use in situations physically hazardous, recurrent legal problems, continued use despite social and interpersonal problems ABUSE: recurrent substance use in a failure to fulfill major role obligations, use in situations physically hazardous, recurrent legal problems, continued use despite social and interpersonal problems INTOXICATION: the development of a reversible substance-specific syndrome due to recent exposure ( clinicaly significant maladaptive behavioral or psychological changes on central nervous system ) INTOXICATION: the development of a reversible substance-specific syndrome due to recent exposure ( clinicaly significant maladaptive behavioral or psychological changes on central nervous system ) WITHDRAWAL: the development of a reversible substance-specific syndrome due to the cessation of substance WITHDRAWAL: the development of a reversible substance-specific syndrome due to the cessation of substance

3. ALCOHOL RELATED DISORDERS ALCOHOL RELATED DISORDERS %0.05 in blood: thought, judgment, restraint loosened % 0.1 : voluntary motor actions clumsy % 0.3 : confusion and stupor 0.5 promil: 0.5gr alcohol in 1lt blood: %0.063 alcohol Intoxication: inappropriate behaviour, mood lability, impaired judgement, slurred speech, incoordination, nystagmus, impaired attention amd memory, coma Withdrawal: autonomic hyperactivity, hand tremor, insomnia, nausea-vomitting, hallusinations, illusions, psychomotor agitation, anxiety, grand mal seizures Delirium Tremens: Alcohol ıntoxication delirium, mortal %20. ın 1 week after alcohol cessation. Hallusinations, delusions, tachycardia, diaphoresis, fever, hypertension, hyperexcitability or lethargy

4. Wernicke-Korsakoff Sydrome: alcohol-induced persisting amnestic disorder. Thiamine deficiency. Wernicke-Korsakoff Sydrome: alcohol-induced persisting amnestic disorder. Thiamine deficiency. Wernicke ’ s Encephalopaty: alcoholic encephalopaty, ataxia, confusion, nystagmus, gaze palsy, anisocoria. Reversible if treated, if not → Korsakoff ’ s Sydrome: chronic amnestic sydrome. Wernicke ’ s Encephalopaty: alcoholic encephalopaty, ataxia, confusion, nystagmus, gaze palsy, anisocoria. Reversible if treated, if not → Korsakoff ’ s Sydrome: chronic amnestic sydrome. Marciafava-Bignami Syndr: demyelination of corpus callosum, optic tracts, cerebellar peduncles. Marciafava-Bignami Syndr: demyelination of corpus callosum, optic tracts, cerebellar peduncles. Medical complications of alcohol use: Medical complications of alcohol use: Liver damage, peptic ulcer, pancreatitis Liver damage, peptic ulcer, pancreatitis Peripheral neuropathies, myopathy, hepatocerebral degeneration, cerebellar degeneration, gynecomastia Peripheral neuropathies, myopathy, hepatocerebral degeneration, cerebellar degeneration, gynecomastia HT, stroke cardiomyopathy, anemia, electrolyte imbalances HT, stroke cardiomyopathy, anemia, electrolyte imbalances Ca of mouth, pharynx, liver, breast Ca of mouth, pharynx, liver, breast

5. Idiosyncratic alcohol intoxication: small amounts, agression Idiosyncratic alcohol intoxication: small amounts, agression Pathological jealosy Pathological jealosy Alcoholic hallusinosis: auditory Alcoholic hallusinosis: auditory

6. AMPHETAMINE-RELATED DISORDERS Ice, crystal, speed, XTC, adam, eve...psychostimulants. Ice, crystal, speed, XTC, adam, eve...psychostimulants. Metamphetamine, ephedrine, pseudoephedrine, MDMA( ecstasy), methylphenidat Metamphetamine, ephedrine, pseudoephedrine, MDMA( ecstasy), methylphenidat A single dose ( 5mg): ıncrease the sense of well-being, elation, euphoria, friendliness, improve attention, increase performance, anorexia A single dose ( 5mg): ıncrease the sense of well-being, elation, euphoria, friendliness, improve attention, increase performance, anorexia Severe hypertension, myocardial infarction, cerebrovascular infarction, ischemic colitis, seizures, coma. Severe hypertension, myocardial infarction, cerebrovascular infarction, ischemic colitis, seizures, coma.

7. CAFFEINE RELATED DISORDERS A cup of coffee: 100-150mg. Caffeine ( methylxanthine) A cup of coffee: 100-150mg. Caffeine ( methylxanthine) Low doses: + reinforcer, doses > 300mg: increased anxiety and mild dysphoria. Low doses: + reinforcer, doses > 300mg: increased anxiety and mild dysphoria. Global cerebral vasoconstriction Global cerebral vasoconstriction Intoxication:restlessness,nervousness, excitement, muscle twitching, cardiac arrhytmia Intoxication:restlessness,nervousness, excitement, muscle twitching, cardiac arrhytmia Withdrawal: fatique, drowsiness, anxiety and depression, nausea and vomitting Withdrawal: fatique, drowsiness, anxiety and depression, nausea and vomitting

8. CANNABIS-RELATED DISORDERS Hashish ( flower), marijuana ( leaves) Hashish ( flower), marijuana ( leaves) (tetrahidrocannabiol- THC) - Physical dependance is not strong - No respiratory depression Euphoria, sensitivity to external stimuli, slows time, motor skill impairment may last 12 hrs, red eye, tachycardia, increased appetite, hypotension, long term use; cerebral atrophy, seizures, chromosomal damage, decreased testesterone, amotivational syndrome Euphoria, sensitivity to external stimuli, slows time, motor skill impairment may last 12 hrs, red eye, tachycardia, increased appetite, hypotension, long term use; cerebral atrophy, seizures, chromosomal damage, decreased testesterone, amotivational syndrome

9. COCAINE-RELATED DISORDERS Vasoconstrictive and topical anesthetic effects Vasoconstrictive and topical anesthetic effects Dopamine reuptake blockage Dopamine reuptake blockage Produces euphoria → personality changes, Produces euphoria → personality changes, impulsive behaviour, weight loss, insomnia,nasal congestion, impulsive behaviour, weight loss, insomnia,nasal congestion, cerebrovascular(infarcts) cerebrovascular(infarcts) cardiological disorders ( arritymia, MI, CMP ) cardiological disorders ( arritymia, MI, CMP ) seizures, seizures, crash syndrome ( post intoxication depression) crash syndrome ( post intoxication depression) formication ( cocaine bugs) formication ( cocaine bugs)

10. Hallucınogens mushrooms( psilocybin), mescaline( cactus),LSD mushrooms( psilocybin), mescaline( cactus),LSD Phencylidine (PCP) Phencylidine (PCP) “ hallucinogen persisting perception disorder ”- “flashbacks” “ hallucinogen persisting perception disorder ”- “flashbacks”

12. Opioid Related Disorders: morphine, heroin, fentanyl, codeine, hydrocodone Opioid Related Disorders: morphine, heroin, fentanyl, codeine, hydrocodone μ receptor *: analgesia, resp. depres., hypothermia, bradycardia, constip. μ receptor *: analgesia, resp. depres., hypothermia, bradycardia, constip. κ receptor: analgesia, diuresis, sedation κ receptor: analgesia, diuresis, sedation Σ receptor: analgesia Σ receptor: analgesia Euphoric high ( rush ) → sedation, Euphoric high ( rush ) → sedation, Dry mouth, ichy nose, red face, pinpoint pupils, constipation, smooth muscle contraction, respiratory depression,anaphylactic shock, arrythmia,hyptension, hypothermia...