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Substance -related and Addictive Disorders

Substance -related and Addictive Disorders. Substance -related and Addictive Disorders. The substances include ten classes of drugs; Alcohol Sedatives Caffeine Hypnotics and anxiolytics Cannabis Stimulants Hallucinogens Tobacco and unknown substances Inhalants Opioids.

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Substance -related and Addictive Disorders

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  1. Substance -related and Addictive Disorders

  2. Substance -related and Addictive Disorders The substances include ten classes of drugs; Alcohol Sedatives Caffeine Hypnotics and anxiolytics Cannabis Stimulants Hallucinogens Tobacco and unknown substances Inhalants Opioids

  3. Substance -related and Addictive Disorders The substance related disorders are divided into two main groups: Substance use disorders Substance induced disorders

  4. Substance -related and Addictive Disorders Substance induced include: Intoxication Withdrawal Other substance/medication induced mental disorders including psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive complusive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders.

  5. Substance -related and Addictive Disorders Substance induced include: Intoxication Withdrawal Other substance/medication induced mental disorders including psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive complusive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders.

  6. Substance -related and Addictive Disorders Substance Intoxication: Is the development of a reversible substance syndrome due to the recent ingestion of a substance. The clinically significant problematic behavioural or psychological changes associated with intoxication ( e.g. belligerence, mood lability, impaired judgment ) are attributable to the physiological effects of the substance on the central nervous system and develop during or shortly after use of the substance.

  7. Substance -related and Addictive Disorders Substance Intoxication: Intoxication is common among patients with substance use disorders but could occur in patients without a substance use disorder. The symptoms are not attributable to another medical condition and are not better explained by another mental disorder.

  8. Substance -related and Addictive Disorders Abuse Is maladaptive patterns of substance use that impairs health. Misuse could be used to refer to the same issue. The Impairment in health includes social, psychological and physical aspects of health.

  9. Substance -related and Addictive Disorders Dependence Psychological and physiological phenomena that are induced by repeated intake of substance. Strong desire to take the substance The substance becomes the sole source of satisfaction and neglect of other sources. Development of tolerance Physical withdrawal state

  10. Substance -related and Addictive Disorders Tolerance Is the state in which with repeated administration of a drug , its effect is reduced and larger doses are required to produce the same effect.

  11. Substance -related and Addictive Disorders Withdrawal Refers to the problematic behavioural change with physiological and cognitive concomitants, that is due to the cessation of or reduction in, heavy and prolonged substance use. It causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  12. Substance -related and Addictive Disorders Withdrawal It is not due to another medical condition and are not better explained by mental disorder. Individuals have an urge to readminister the substance to reduce the symptoms.

  13. Substance -related and Addictive Disorders Intoxication and withdrawal frequently involve more than one substance sequentially or simultaneously. The highest prevalence rate is around 18-24 years. Substance induced mental disorders develop in the context of intoxication or withdrawal from substances of abuse, and medication-induced mental disorders are seen with the prescribed or over the counter medications that are taken at the suggested doses.

  14. Substance -related and Addictive DisordersAlcohol Related Disorders Alcohol is used by ordinary people socially or on occasions without causing harm to those who drink it . However alcohol drinking behaviour might become abnormal and problematic.

  15. Substance -related and Addictive DisordersAlcohol Related Disorders We can divide them into the following: Excessive consumption of alcohol Alcohol misuse Alcohol dependence Problem drinking

  16. Substance -related and Addictive DisordersAlcohol Related Disorders Excessive alcohol consumption Also called harmful drinking or hazardous drinking This depends on the normal pattern of drinking in different countries. A unit of alcohol is equal to half a pint of beer, one glass of table wine, one conventional glass of sherry or port and one single bar measure of spirits. Each unit is about 8 g of alcohol.

  17. Substance -related and Addictive DisordersAlcohol Related Disorders Excessive alcohol consumption The problem is different in different countries. It is more in men than women, more in unmarried, seperated or divorced. In the UK it is less in Muslims, Hindus and followers of the Baptist church.

  18. Substance -related and Addictive DisordersAlcohol Related Disorders Alcohol misuse Occupations liable for harmful use of alcohol include chefs, kitchen porters, barmen and brewery workers, who have easy access to alcohol, executives and salesmen who entertain on expense accounts, actors and entertainers, seamen, and journalists.

  19. Substance -related and Addictive DisordersAlcohol Related Disorders Alcohol dependence The same features of depedence on substances are applied her. Strong desire to take the substance The substance becomes the sole source of satisfaction and neglect of other sources. Development of tolerance Physical withdrawal state and this is not a must for the diagnosis of dependence.

  20. Substance -related and Addictive DisordersAlcohol Related Disorders Alcohol dependence The patient gives up all social, recreational and occupational activities are decreased because of drinking. He continues to drink despite the knowledge that that the drinking is harmful to his physical and psychological health.

  21. Substance -related and Addictive DisordersAlcohol Related Disorders Alcohol dependence The person starts in the early twenties and increase the amount of alcohol intake and looses control despite all the harm in all the social, physical, psychological and occupational harm.

  22. Substance -related and Addictive DisordersAlcohol Related Disorders The alcohol withdrawal syndrome Occurs with various severity depending on the amount and duration of drinking. The symptoms appear when the patient reduces or stops drinking. They appear early in the morning therefore they have early morning drinking.

  23. Substance -related and Addictive DisordersAlcohol Related Disorders The alcohol withdrawal syndrome He becomes more secretive about drinking, hides bottles and does not declare the amount he drinks. They develop tremor ‘ the shakes’, restlessness, startle and avoids facing people. Nausea, retching, and sweating are common. Insomnia is common and all those symptoms disappear when he drinks.

  24. Substance -related and Addictive DisordersAlcohol Related Disorders The alcohol withdrawal syndrome The withdrawal continues and if the patient is not treated or he drinks so he develops misperception and hallucinations. Perceptions are distorted and things become distorted, frightening or funny and sounds become louder. The patient might develop withdrawal seizures and if lasted 48 hours develop delirium tremens.

  25. Substance -related and Addictive DisordersAlcohol Related Disorders Complications related to alcohol: There are many complication including : Physical complications: Gastritis, peptic ulcer, esophageal varices and acute and chronic pancreatitis. Fatty infiltration of the liver, hepatitis, cirrhosis and hepatoma.

  26. Substance -related and Addictive DisordersAlcohol Related Disorders Complications related to alcohol: There are many complication including : Physical complications: Peripheral neuropathy, epilepsy, and cerebellar degeneration. Dementia and head injuries.

  27. Substance -related and Addictive DisordersAlcohol Related Disorders Complications related to alcohol: There are many complication including : Physical complications: Misuse is associated with hypertension and increased risk of stroke. The association with ischemic heart disease is controversial.

  28. Substance -related and Addictive DisordersAlcohol Related Disorders Complications related to alcohol: There are many complication including : Physical complications: Misuse is also linked to the development of cancers of mouth, pharynx, esophagus, liver, and breast. It might lead to amenorrhea, anovulation and menopause. Fetal alcohol syndrome: facial abnormality, small stature, low birth weight, low intelligence and overactivity.

  29. Substance -related and Addictive DisordersAlcohol Related Disorders Complications related to alcohol: There are many complication including : Psychiatric complications: Idiosyncratic alcohol intoxication occurs with a small amount of alcohol consumption and marked by aggression. Memory blackouts and short term amnesia Delirium tremens.

  30. Substance -related and Addictive DisordersAlcohol Related Disorders Delirium tremens Occurs in people after prolonged and heavy drinking. The patient stops drinking or reduces the amount and develops this condition. Clouding of consciousness, disorientation, impairment of recent memory, illusions and hallucinations, agitation, restlessness,

  31. Substance -related and Addictive DisordersAlcohol Related Disorders Delirium tremens insomnia, tremor and fumbling with things, sweating, tachycardia, fever, and raised blood pressure, dilated pupils, electrolyte disturbance, leucocytosis and impaired liver function. It is worse at night and there is high risk of mortality. The patient forgets all the condition after recovery.

  32. Substance -related and Addictive DisordersAlcohol Related Disorders Complications related to alcohol: Other psychiatric complications : Alcoholic dementia Personality deterioration Mood and anxiety disorders Suicidal behaviour ( more in young men, impulsivity, negative affect, and hopelessness) Morbid jealousy Alcoholic hallucinosis

  33. Substance -related and Addictive DisordersAlcohol Related Disorders Complications related to alcohol: There are many complication including : Social complications: Marital and family problems Occupational difficulties Road traffic accidents Violation of law

  34. Substance -related and Addictive DisordersAlcohol Related Disorders Etiology There are many theories regarding etiology and could be divided into individual and society factors. Individual factors: Genetic factors The condition runs in families, more in monozygotic twins than dizygotic twins, and adoption studies. Genes for alcohol dependence are controversial and it is believed that those with genetically impaired activity of alcohol metabolizing enzyme are at lower risk of becoming dependents.

  35. Substance -related and Addictive DisordersAlcohol Related Disorders Etiology There are many theories regarding etiology and could be divided into individual and society factors. Individual factors: Genetic factors Mutations in the aldehyde dehydrogenase gene is another theory rendering the enzyme inactive. Other suggestions included dopamine D2 receptor and GABA receptor association.

  36. Substance -related and Addictive DisordersAlcohol Related Disorders Etiology There are many theories regarding etiology and could be divided into individual and society factors. Individual factors: Other biological factors Abnormalities that antedate and predict the development of alcohol dependence including impaired performance on cognitive tasks especially executive function. Sons of alcohol dependent men are less sensitive to the acute intoxicating effect of alcohol.

  37. Substance -related and Addictive DisordersAlcohol Related Disorders Etiology There are many theories regarding etiology and could be divided into individual and society factors. Individual factors: Learning factors Modelling has been proposed but is not always true. Reward dependence: the ability of alcohol to give pleasure and reduce anxiety and release of dopamine in the mesolimbic pathways Personality factors Those with chronic anxiety, antisocial personality and those with traits that lead to risk taking and novelty seeking. Psychiatric disorders Chronic anxiety, social phobia , panic disorder , major depressive disorder , bipolar disorder and schizophrenia.

  38. Substance -related and Addictive DisordersAlcohol Related Disorders Etiology There are many theories regarding etiology and could be divided into individual and society factors. Societal factors This is related to general consumption of the people in the society, economic control , formal and informal control

  39. Substance -related and Addictive DisordersAlcohol Related Disorders Treatment There are tests to detect alcohol dependence: Gamma-glutamyl-transpeptidase GGT Mean corpuscular volume (MCV) Carbohydrate-deficient- transferrin Blood alcohol concentration

  40. Substance -related and Addictive DisordersAlcohol Related Disorders Treatment Approach to treatment of alcohol misuse: Raise awareness of the problem Increase motivation to change Support and advice. Withdraw alcohol ( or controlled drinking) (controversial) High intensity psychological treatments. Alcoholic Anonymous Medication (disulfiram, acomprosate)

  41. Substance -related and Addictive DisordersAlcohol Related Disorders Treatment Drinking history is taken properly Assessment of the physical, psychological and social problems. Assess factors that precipitate and maintain excessive drinking Avoid confrontation Involve partners in the assessment

  42. Substance -related and Addictive DisordersAlcohol Related Disorders Treatment Hospitalization is necessary : Medications used for detoxification: Chlordizepoxide and lorazepam Carbamazepine Chlormethiazole Antipsychotics with benzodiazepines Vitamin supplements

  43. Substance -related and Addictive DisordersAlcohol Related Disorders Treatment Hospitalization is necessary : History of DTs Very high alcohol consumption Concomitant benzodiazepine misuse Medical or psychiatric comorbidity

  44. Substance -related and Addictive Disordersother substance related disorders The etiology is multifactorial: Availability of drugs: Legally without prescription Prescription from doctors Illicit sources Personal factors: Broken homes, poor schools record, truancy or delinquency, traits as sensation seeking and impulsivity. History of mental illness or personality disorder in the family. Genetic factors to develop harmful use or dependence.

  45. Substance -related and Addictive Disordersother substance related disorders The etiology is multifactorial: Social environment: Substance use by peers or parents, social deprivation, unemployment and homelessness. Pharmacological factors: Drugs have a positive reinforcing property by inducing euphoria or reduce anxiety. They act on the dopamine pathway in the midbrain. These pathways form part of the physiological reward system.

  46. Substance -related and Addictive Disordersother substance related disorders The etiology is multifactorial: Dependence occurs when the patient develop tolerance or has withdrawal symptoms. Patient has desire to drink and a drug seeking behaviour Craving and dysphoria is associated with altered brain function. Continued use of drugs lead to adaptive changes in GABA neurotransmission and this explains the need to increase the intake to produce the same pharmacological effect.

  47. Substance -related and Addictive Disordersother substance related disorders complications of drug misuse The direct physical complications include intravenous drug might lead to HIV infection and hepatitis and death from heroin overdose. There are risks of fetal abnormalities and become dependent on the drugs. Infants develop withdrawal symptoms and are usually neglected.

  48. Substance -related and Addictive Disordersother substance related disorders complications of drug misuse Psychiatric disorders might be comorbid with substance related disorder such as personality disorder , depression, anxiety disorders. The symptoms of those disorders might be result of drug misuse or the misuse could be secondary to those disorders as self medication.

  49. Substance -related and Addictive Disordersother substance related disorders complications of drug misuse Social complications include Unemployment, motoring offences, traffic accidents, family problems and neglect of children. They commit offences to obtain drugs, solicit it by prostitution or create gangs to obtain the drugs illegally.

  50. Substance -related and Addictive Disordersother substance related disorders Diagnosis It is necessary to take a proper drug history from the patient with external verification whenever possible. We should look for signs of needle tracks, thrombosed veins and scars. We must observe job decline, social isolation and new friends from drug culture. 50

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