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Páleníček,2002. Drug abuse & addiction. T. Páleníček Psychiatrické centrum Praha 3. Lékařská fakulta Univerzity Karlovy. Páleníček,2002. History. „Primitive cultures“ – Egypt, indians, chinese ….. Medical indications, raw material, shamanic use Old continent – canabis, opiats, mushrooms,

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drug abuse addiction

Páleníček,2002

Drug abuse & addiction

T. Páleníček

Psychiatrické centrum Praha

3. Lékařská fakulta Univerzity Karlovy

history

Páleníček,2002

History
  • „Primitive cultures“ – Egypt, indians, chinese …..
  • Medical indications, raw material, shamanic use
  • Old continent – canabis, opiats, mushrooms,
  • New continent – mushrooms, coca, peyotl, ayahuasca
today

Páleníček,2002

Today
  • Illicit substances (most of them) in most countries arround the world
  • Many new drugs – chemistry
  • Purity
  • Lost of the traditional consequences of use – misuse
  • New ways of application
definitions

Páleníček,2002

Definitions
  • Affects the perception of the reality – psychotropic effect & addictive Potential (Presl)
  • Any substance, that if gets into the organism, affects one or more of its function (pharmacological def.)
  • Drug (substance) abuse – psychological or physical state of servility vis-a-vis the drug
terms

Páleníček,2002

Terms
  • Use
  • Abuse
  • Tolerance
  • Dependence - physical & psychic
  • Whitdrawal syndrom
addiction
Addiction
  • First experience
  • Recreational use
  • Abuse
  • Dependece
  • Based on the reward
  • – drug seeking – aplication of the drug – effect(reward) – reinforcing effect –
  • Neurobiological substrate – DA system (NAC)

Páleníček,2002

general risks of drug use
General risks of drug use
  • Toxic effects
  • Form of application – i.v. - infections
  • Loss of control – addiction
  • Social consequences - loss of work, living place, friends
  • Changes in mood, personality

Páleníček,2002

classification

Páleníček,2002

Classification
  • Natural versus synthetic
  • Through the effect
      • Sedatives, tranqulisers, hypnotics
      • Stimulants
      • Halucinogens
      • Entactogens
      • Inhallants
  • Legal versus illegal
opiats

Páleníček,2002

Opiats
  • Morfin, heroin, kodein, buprenorfin …
      • Acts through own receptors (µ, κ, σ)
      • Analgesic effect, euphoria, sedation
      • Vagotonic effect
      • Supression of breathing
      • High addictive potential – physical and psychological
      • Tolerance – overdose
other sedatives tranqulisers hypnotics

Páleníček,2002

Other sedatives, tranqulisers, hypnotics
  • Benzodiazepines
  • Barbiturates
  • Toluen
  • Alcohol

High addictive potential, physical dependence (often mixed with others), live threatening withdrawal

stimulants

Páleníček,2002

Stimulants
  • Kokain, crack
      • inhibitor of DA and NA reuptake
      • euphoria, state of high, increased speach, feeling „ I am the best“
      • increased locomotion
      • elevates heart rate, blood presure
      • snorted, smoked, injected, on genitals
      • psychological dependece
      • heart attack, stroke
stimulants1

Páleníček,2002

Stimulants
  • Amphetamine, methamphetamine (speed, ice, meth)
      • Release of DA
      • Speed feeling, insomnia, anorexia, increased speach, stereotyped behaviour
      • Increased heart rate, blood presure
      • Snorted, injected, smoked, per os
      • Psychological dependence
      • Heart attack, stroke, toxic hepatitis, neurotoxic, toxic psychosis
halucinogens

Páleníček,2002

Halucinogens
  • Natural – (cannabis), psylocin, mezcal, ayahuasca, ibogain, muscarin
  • Synthetic – LSD, DOB, DOM (STP), TMA, DMT, Ketamine (Special K), PCP (Angel dust)
      • Most affect 5-HT system - 5HT2a receptors
      • Cannabis – CB1 & CB2 receptors
      • Ketamine, PCP – NMDA antagonists
halucinogens1

Páleníček,2002

Halucinogens
  • Halucinations - tripping
  • Most are not addictive
  • Bad trip, flashbacks, risk of injury, psychosis
      • LSD (acid, trip) – trips, crystal, liquid
      • DOM, DOB – trips, pills
      • Ketamine, PCP – white powder
cannabis

Páleníček,2002

Cannabis
  • Marijuana, hashish…
    • many states of being, often upside-down – stimulation, sedation, anxiosity, anxiolytic effect, laugh, halucinations, euforia, taste to eat
    • anxiety disorders, memory deficits, insulted spermatogenesis
    • a lot of terapeutical indications (CB – recptor agonists, antagonists, natural medicine)
entactogens

Páleníček,2002

Entactogens
  • MDMA, MDEA, MDA
  • PMA, PMMA, 4-MTA, 2C-B, 2C-T-7, MBDB

Entactogen = „the touch within“

producing state of well being, empathy, belonging to others, feeling of love, peace

slide18

Páleníček,2002

Ecstasy

E, madam, eve, pill, xtc…

  • Ecstasy - MDMA (MDA, MDEA)
  • Ecstasy - tablet (capsule)
slide19

Páleníček,2002

Use of MDMA

  • Young people (15 – 30 yrs)
  • All social groups
  • Connection with parties
  • polydrug users
  • „recreational users“
  • Per os, snorted
effects

Páleníček, 2002

effects
  • Metabolised by (CYP2D6) (cytochrom P450)
  • 5-9% white population is defficient
      • Poor metabolisers
      • Increased risk of acute toxicity
      • Drug-drug interactions (virostatics - ritonavir)
  • Acute effects – release of 5-HT and DA
  • Chronic effects – toxic effects
effects1

Páleníček,2002

effects
  • Chronic: neurotoxicity - cognitive defficit, sleep disorders, parkinsonism???, toxic hepatitis, teratogenic, imune dysfunction, flashbacks, psychosis
  • Risks: serotonin syndrom, stroke, rhabdomyolysis, acute liver failure
  • Neurotoxicity: selective degeneration of 5-HT and DA axons
treatment of addiction
Treatment of addiction
  • Motivation
  • Decission to stop
  • First contact with proffesionals (K-centre, hospital …)
  • Again motivation and testing the decision to stop
  • Detoxification
  • Therapy – ambulant, in hospital, in community
  • Susequent care – getting back to society
  • Relaps

Páleníček,2002

prevence
Prevence
  • Primární – vzdělávání cílové populace
  • Sekundární – práce s vyléčenými (abstinujícími) závislými
  • Terciární – minimalizace rizik (harm reduction, substituční léčba, testování drog)

Páleníček,2002

d kuji v m za pozornost
Děkuji vám za pozornost

Páleníček,2002

slide25

5-HT vlákna vycházejí zejména z mediálních a dorsálních rapheálních jader a projikují se do řady podkorových i korových oblastí mozku

  • rapheální jádra
  • neocortex
  • caudatum, putamen
  • thalamus
  • hypothalamus
  • amygdala, hipocampus
  • substantia nigra
  • neurovaskulární orgány komor
  • mozeček
  • mícha

(upraveno podle Manter and Gatz´s essentials of clinical Neuroanathomy and Neurofysiology, 1992)

Serotonergní dráhy

Páleníček,2002

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