Substance Related Disorders | Anatomy2Medicine
Substance Related Disorders,drug-addiction

Substance Related Disorders

    • The co-morbidities commonly associated with Substance Abuse are
      • Antisocial Personality Disorder
      • Phobias
      • Major Depressive Disorder

 

    • Substance Dependence refers to
      • A strong desire to take the substance
      • Progressive neglect of alternative sources of satisfaction
      • The development of tolerance and physical withdrawal state
    • Tolerance is a state in which, after repeated adminis-

tration, a drug produces a decreased effect, or increasing doses  are required to produce the same effect.

Alcohol

      • A withdrawal state is a group of symptoms and signs, occurring when a drug is reduced in amount or withdrawn, which last for a limited time.
      • The alcohol content of “Absolute Alcohol” is  99.95%

 

  • The fatal dose of “Absolute Alcohol” in an adult is 150 ml
  • “Widmark’s formula” is used to determine quantity of in the body Alcohol
  • “Heavy alcohol drinkers” are those who consume alcohol as 5 or more drinks per occasion on 5 or more days in the past 30 days
  • People consuming alcohol on 51 or more days during the past year are defined as “Frequent Users”.
  • Those consuming 5 or more drinks on atleast one occasion in the past month, are known as “Binge-Drinkers”.
  • “Macewan’s Sign” is associated with Alcohol poisoning

 

    • The features seen in acute intoxication due to alcohol
      • Aggression and argumentativeness
      • Impaired attention and judgement
      • Disinhibition
    • Signs of acute intoxication due to use of alcohol,
      • Nystagmus
      • Conjunctival injection
      • Decreased level of consciousness (e.g., stupor,coma)
    • A single drink of alcohol is usually considered to contain about 12 gm of ethanol
    • Mellanby Effects, i.e. the intoxicating effects of alcohol are greater when the blood alcohol concentration is rising

 

      • Alcohol is associated with

 

  • Decreased rapid eye movement sleep (REM or dream sleep)

 

        • Decreased deep sleep (stage 4)
        • Increased sleep fragmentation, with more and longer episodes of awakening
      • The diagnostic criteria for alcohol withdrawal includes
        • Autonomic hyperactivity, manifested as sweating or heart rate greater than 100.
        • Increased hand tremor

 

  • Insomnia

 

        • Transient visual, tactile, or auditory hallucinations or illusions
      • “Morbid – Jealousy” is a feature associated with abuse of Alcohol
      • A 37 years old presented  difficulty in sustaining attention, ram bling, tremulousness, hallucinations and disorien-tation to time, place and person. The most probable diagnosis will be . Delirium tremens
        • This person has characteristic symptoms of a delirium: difficulty sustaining attention and other cognitive deficits including disorganized thinking (rambling), percepteral disturbances (hallucinations), and disorientation.

 

  • Wernicke’s Encephalopathy

 

        • also called alcoholic encephalopathy
        • it is an acute and completely reversible (with Thiamine treatment) neurological disorder
        • characterized by ataxia (affecting primarily the gait), vestibular dysfunction, confusion, and a variety of ocular motility abnormalities, including horizontal nystagmus, bilateral rectal palsy, and gaze palsy
        • These eye signs are usually bilateral but not necessarily symmetrical.

 

  • Other eye signs may include a sluggish reaction to light and anisocoria.

 

        • It may clear within a few days/wks spontaneously, or may progress into Korsakoff’s Syndrome.

 

  • Korsakoff’s Syndrome

 

        • Syn. Polyneuritis Psychosis
        • Described by Sergei S. Korsakoff ,a Russian neurologist.
        • it is a chronic amnestic syndrome

 

  • it can follow Wernicke’s encephalopathy

 

      • The cardinal features of Korsakoff’s syndrome are impaired mental functions (especially recent memory) and anterograde amnesia in an alert and responsive patient.
      • The patient may or may not have the symptom of confabulation.
      • The personality is characterized by psychosis within polyneuri-tis, disorientation, muttering, delirium, insomnia, illusions, and hallucinations
      • Painful extremities, rarely a bilateral wrist drop, more frequently bilateral foot drop with pain or pressure over the long nerves.
      • Only about 20 percent of patients with Korsakoff’s syndrome recover with thiamine and nutritional support.
    • Withdrawal delirium, hallucinations, and amnestic disorder is seen with Alcohol
    • Thiamine deficiency is known to occur in
      • Food faddist
      • Homocystinemia
      • Chronic alcoholism
    • An alcoholic is brought to the emergency OPD with the complaint of irrelevant talking. He had stopped using alcohol three days back. On examination, he is found to be disoriented to time, place and person. He also has visual illusions and hallucinations. There is no history of head injury. The most likely diagnosis is Delirium tremens
    • Development of features of alcohol withdrawl: Tremu-

lousness develops 6 to 8 hours after the cessation of

drinking, the psychotic and perceptual symptoms begin

in 8 to 12 hours, seizures in 12 to 24 hours, and Delirium

Tremens during 72 hours.

 

  • “Alcoholic Blackout” is characterized by Anterograde amnesia, in association with alcohol intoxication, for events during and shortly after drinking
  • The periods of amnesia in “Alcoholic Blackouts” can be

 

particularly distressing when people fear that they have

unknowingly harmed someone or behaved imprudently

while intoxicated.

    • Because their other intellectual faculties are well preserved, they can perform complicated tasks and appear normal to casual observers.
    • The characteristic feature of “Alcohol Withdrawal Syndrome” is Hallucination-
    • Delirium and amnestic reaction may be seen in people abusing Alcohol
    • Drug of choice for treating delirium tremens is Chlordiazepoxide
    • Successful treatment of delirium tremens is done with
      • Intravenous Lorazepam
      • High calorie, high carbohydrate food
      • Multivitamin supplementation

 

  • Antipsychotic medications should be avoided in delirium tremen, because they may reduce the seizure threshold in patients.

 

    • Korsakoff syndrome, a sequel to chronic alcoholism, is characterized by
      • A reversible condition in 20% of patients
      • Impaired recent memory
      • Intellectual deterioration
      • Impaired insight

 

  • Babu and Kumar , both in their late teens were having drinks while watching a movie at cable. Babu made a comment, on which both laughed. Then Kumar made the same comment after some time, on which again both laughed. Then Babu again made similar comment and they laughed again. This is an example of Alcohol related blackouts
  • During an alcohol related blackout, people have relatively intact memory but experience a specific short-term memory deficit in which they are unable to recall events that happened in the previous 5 or 10 minutes.
  • Acamprosate (calcium acetyl homotaurinate)

 

      • drug used as an “Anti-Craving Agent” to help maintenance of abstinence from alcohol:

 

  • “Acamprosate” is believed to act by stimulating GABA inhibitory neurotransmission and decreasing the excitatory effects of glutamate.

 

 

Opiates

    • Cannabis does not produce physical withdrawal symptom
    • Drugs that produce physical withdrawal symptom
      • Alcohol
      • Morphine
      • Phenobarbitones
    • All are features of acute intoxication due to use of alcohol as well of opioids
      • Disinhibition
      • Impaired attention and judgement
      • Slurred speech

 

  • Acute intoxication due to use of opioids results in pupillary constriction; except in anoxia from severe overdose,when pupillary dilatation occurs.

 

    • Following are opiates
      • Hydromorphone
      • 3-Methoxy morphine (codeine)
      • Diacetylmorphine (Heroin)
    • “Opium” is derived from juice of the opium poppy, papaver somniferum”, which contains approximately 20 opium alkaloids, including morphine.
    • The word “opiate” encompasses any preparation or derivative of opium
    • “Hydromorphone” is a synthetic opiate.
    • opioid means opiates, as well as synthetic narcotic that resembles an opiate in action but not derived from opium.
    • Synthetic opioids

 

  • Meperidine
  • Methadone
  • Pentazocine

 

    • Heroin is about 2 times as potent as morphine

 

  • Drugs  used to treat “opioid overdose” and “opioid dependence”,
  • Naltrexone
  • Naloxone
  • Levallorphan  

 

 

 

  • Opioid receptors

 

      • The Mu-opioid receptors are involved

 

  • Regulation and mediation of analgesia
  • Respiratory depression
  • Constipation
  • dependence.

 

      • K-opioid receptors are associated with analgesia, diuresis, and sedation.
      • Delta-opioid receptors possibly with analgesia.
    • Most commonly abused opioid is Heroin
    • Buprenorphine is used for treatment of opioid depen-dence.

 

  • Characteristic symptoms of Brown-Sugar withdrawal,
  • Abdominal cramps
  • Rhinorrhoea
  • Diarrhoea

 

    • “Morphine” withdrawal symptoms can be successfully managed with: Clonidine
    • Heroin” withdrawal symptoms

 

  • Yawning
  • Muscle and joint pains
  • Hypertension

 

    • Non-addicting drug useful for suppressing symptoms of opioid withdrawal is  Clonidine
    • Methadone Hydrochloride.
      • A synthetic analgesic drug with potency equal to morphine, but the narcotic action is weaker than morphine.

 

  • Methadone is habit forming agent

 

      • used experimentally in treatment of drug dependence due to use of opium derivatives.
    • The pupil is constricted in intoxication with Methadone
    • Drugs used for treatment of “Morphine overdose”includes

 

  • Naloxone
  • Nalorphine
  • Levallorphan

 

    • Causes of  pupillary constriction

 

  • Morphine
  • Barbiturates
  • Organophosphorous compounds
  • Rapid and shallow Respiration is observed in opioid poisoning:

 

    • Acute intoxication due to cannabinoids is manifested by

 

  • Euphoria
  • Temporal slowing
  • Paranoid ideation

 

    • Temporal Slowing. A sense that time is passing very slowly, and/or the person is experiencing a rapid flow of ideas.

 

  • Acute Dhatura intoxication cause

 

    • Tachycardia
    • Conjunctival injection
    • Dry mouth
  • “Smack” is a street name for Heroin
  • Temporal slowing, depersonalization, and derealiza-tion are the features of intoxication with Bhang
  • Amotivational Syndrome” has been linked to longterm heavy use of Cannabis .People suffering from amotivational syndrome are described as becoming apathetic and anergic, usually

gaining weight, and appearing slothful.

      • Dilated pupils with dry mouth are the features of intoxication with Cannabis

 

  • LSD (Lysergic Acid Diethylamide).

 

        • A derivative of an alkaloid in ergot.
        • LSD is used legally only for experimental purposes.
        • It is used illegally for its hallucinogenic effects.
      • The active principles of Dhatura are
        • Atropine
        • Hyoscine
        • Hyoscyamine
      • “Run-Amok”, i.e. homicidal delusion are characteristically seen in intoxication with Cannabis
      • The therapeutic indications for cannabis are
        • Appetite stimulant in patients with Acquired Immune Deficiency Syndrome (AIDS)
        • Nausea secondary to cancer treatment drugs

 

  • Glaucoma

 

 

    • Pupillary dilatation is caused by intoxication with
      • Cannabis
      • Cocaine
      • LSD
    • Cocaine was introduced in psychiatry by Sigmund Freud
    • “Tactile Hallucinations” are suggestive of chronicabuse of Cocaine
    • “Ice” and “Speed” are the street names for Amphetamines
    • “Ecstasy” and “Adam” are the street names for .   MDMA

(MDMA-> 3,4-Methylenedioxy amphetamine)

 

  • “Snow” and “Girl” are street names for Cocaine

 

    • anti-craving agents for cocaine

 

  • Amantadine
  • Bromocriptine
  • Carbamazepine

 

    • features of Nicotine with drawal,
      • Bradycardia
      • Insomnia
      • Restlessness
    • Integral parts of smoking cessation programme

 

  • Systemic nicotine administration
  • Bupropion
  • Cognitive Behaviour Therapy
  • “Angel Dust” is Phencyclidine

 

  • The Benzodiazepine with least addictive liability is Chlordiazepoxide
  • “Knock-out drops” or “Micky Finn” stands for Chloral hydrate