disorders due to psychoactive substance use department of psychiatry 1 st faculty of medicine...
TRANSCRIPT
Disorders Due to Psychoactive Disorders Due to Psychoactive Substance UseSubstance Use
Department of PsychiatryDepartment of Psychiatry
11stst Faculty of Medicine Faculty of Medicine
Charles University, PragueCharles University, Prague
Head: Prof. MUDr. Jiří Raboch, DrSc.Head: Prof. MUDr. Jiří Raboch, DrSc.
Psychoactive SubstancePsychoactive Substance
Psychoactive (psychotropic)Psychoactive (psychotropic) substancesubstance is any substance which after is any substance which after absorption has influence on mental absorption has influence on mental processes both cognitive and processes both cognitive and affectiveaffective..
1.1. stimulativestimulative
2.2. suppressivesuppressive
3.3. hallucinogenichallucinogenic
Mental and Behavioural Disorders Mental and Behavioural Disorders Due to Psychoactive Substance UseDue to Psychoactive Substance Use
Disorders due to use ofDisorders due to use of::
F10.F10.x x alcoholalcohol
F11.F11.xx opioidsopioids
F12.F12.x x cannabinoidscannabinoids
F13.F13.xx sedatives or hypnoticssedatives or hypnotics
F14.F14.x x cocainecocaine
F15.F15.x x other stimulants (caffeine)other stimulants (caffeine)
F16.F16.x x hallucinogenshallucinogens
F17.F17.x x tobaccotobacco
F18.F18.xx volatile solventsvolatile solvents
F19.F19.xx multiple drugs and othermultiple drugs and other
psychoactive drugspsychoactive drugs
Mental and Behavioural Disorders Mental and Behavioural Disorders Due to Psychoactive Substance UseDue to Psychoactive Substance Use
Specific Clinical ConditionsSpecific Clinical Conditions::F1x.0 Acute intoxicationsF1x.0 Acute intoxicationsF1x.1 Harmful useF1x.1 Harmful useF1x.2 Dependence syndromeF1x.2 Dependence syndromeF1x.3 Withdrawal stateF1x.3 Withdrawal stateF1x.4 Withdrawal state with deliriumF1x.4 Withdrawal state with deliriumF1x.5 Psychotic disorderF1x.5 Psychotic disorderF1x.6 Amnesic syndromeF1x.6 Amnesic syndromeF1x.7 Residual state, late-onset psychotic F1x.7 Residual state, late-onset psychotic
disorderdisorderF1x.8 Other mental and behavioural disordersF1x.8 Other mental and behavioural disordersF1x.9F1x.9 Unspecified mental and behavioural Unspecified mental and behavioural
disorderdisorder
F1x.0 Acute IntoxicationF1x.0 Acute IntoxicationDf.: Df.: A transient condition following the administration A transient condition following the administration
of psychoactive substance resulting in of psychoactive substance resulting in disturbances in level of consciousness, cognition, disturbances in level of consciousness, cognition, perception, affect or behaviour, or other perception, affect or behaviour, or other psychophysiological functions and responsespsychophysiological functions and responses
Closely related to dose levelsClosely related to dose levels
UncomplicatedUncomplicated With trauma or other medical complicationsWith trauma or other medical complications With deliriumWith delirium With comaWith coma With convulsionsWith convulsions Pathological intoxicationPathological intoxication (applies only to (applies only to
alcohol)alcohol)
F1x.1 Harmful UseF1x.1 Harmful Use
The damage may be physical and/or mental.The damage may be physical and/or mental. Socially negative consequences are not Socially negative consequences are not
evidence (neither acute intoxication or evidence (neither acute intoxication or hangover).hangover).
F1x.2 Dependence Syndrome F1x.2 Dependence Syndrome (Addiction)(Addiction)
a)a) A strong desire or sense of compulsion to A strong desire or sense of compulsion to take the substance („craving“)take the substance („craving“)
b)b) Difficulties in controlling substance-takingDifficulties in controlling substance-takingc)c) Withdrawal sy characteristic for the Withdrawal sy characteristic for the
substancesubstanced)d) Evidence of toleranceEvidence of tolerancee)e) Progressive neglect of pleasures and Progressive neglect of pleasures and
interestsinterestsf)f) Persisting with substance use despite clear Persisting with substance use despite clear
evidence of overtly harmful consequencesevidence of overtly harmful consequences
Physical dependencePhysical dependence Psychic (psychological) dependencePsychic (psychological) dependence
F1x.2 The Course of Dependence F1x.2 The Course of Dependence SyndromeSyndrome
F1x.20F1x.20 currently abstinent (remission) currently abstinent (remission)
F1x.21 F1x.21 currently abstinent in a protected currently abstinent in a protected environmentenvironment
F1x.22 F1x.22 currently abstinent on a maintenance currently abstinent on a maintenance regimeregime
F1x.23 F1x.23 currently abstinent - receiving treatment currently abstinent - receiving treatment with aversive or blocking drugs with aversive or blocking drugs (naltrexone, disulfiram)(naltrexone, disulfiram)
F1x.24 F1x.24 currently active dependencecurrently active dependence
F1x.25F1x.25 continuous (chronic) use continuous (chronic) use
F1x.26 F1x.26 episodic use (dipsomania)episodic use (dipsomania)
F1x.3 Withdrawal StateF1x.3 Withdrawal State
Symptoms occurring on absolute or Symptoms occurring on absolute or relative withdrawal of a substance relative withdrawal of a substance after repeated and prolonged use of after repeated and prolonged use of the substancethe substance
• UncomplicatedUncomplicated• With convulsionsWith convulsions
F1x.4 Withdrawal State with F1x.4 Withdrawal State with DeliriumDelirium
Delirium tremensDelirium tremens - in severely - in severely dependent users with a long history of dependent users with a long history of use of alcoholuse of alcohol
Prodromal symptomsProdromal symptoms: insomnia, : insomnia, tremor, fears followed by illusions, tremor, fears followed by illusions, hallucinations, clouding of hallucinations, clouding of consciousness and marked tremorconsciousness and marked tremor
F1x.5 Psychotic DisorderF1x.5 Psychotic Disorder
Psychotic phenomena occurring during or Psychotic phenomena occurring during or immediately after psychoactive substance immediately after psychoactive substance useuse
Schizophrenia-likeSchizophrenia-like Predominantly delusional, hallucinatory, Predominantly delusional, hallucinatory,
depressive, manicdepressive, manic (alcoholic hallucinosis, (alcoholic hallucinosis, jealousy) jealousy)
Persistence for more than 48 hoursPersistence for more than 48 hours
F1x.6 Amnesic SyndromeF1x.6 Amnesic Syndrome Impairment of recent memoryImpairment of recent memory (learning of new (learning of new
material)material) Absence of defect in immediate recall, of Absence of defect in immediate recall, of
impairment of consciousness, and of impairment of consciousness, and of generalized cognitive impairmentgeneralized cognitive impairment
History of chronic use of psychoactive History of chronic use of psychoactive substancesubstance (Korsakov’s psychosis or syndrome) (Korsakov’s psychosis or syndrome)
F1x.7 F1x.7 Residual and late-onset Residual and late-onset psychotic disorder psychotic disorder
Onset related to the use of psychoactOnset related to the use of psychoactiveive substance, the disorder should persist beyond substance, the disorder should persist beyond any period of time during which direct effects any period of time during which direct effects of the psychoactive substance might be of the psychoactive substance might be assumedassumed
FlashbacksFlashbacks - duration in seconds or minutes, - duration in seconds or minutes, duplication of previous drug-related duplication of previous drug-related experiencesexperiences
Personality disorderPersonality disorder DementiaDementia
F10.x Mental Disorders Due to F10.x Mental Disorders Due to Use of AlcoholUse of Alcohol
Acute intoxicationAcute intoxication::• euphoria, flushed face, ataxia, slowed reaction euphoria, flushed face, ataxia, slowed reaction
time, impaired motor performance, slurred time, impaired motor performance, slurred speech, poor concentration; in higher doses speech, poor concentration; in higher doses behavioural changes – disinhibition of sexual and behavioural changes – disinhibition of sexual and aggressive impulses, increased suicidal and aggressive impulses, increased suicidal and homicidal behaviourhomicidal behaviour
Pathological intoxicationPathological intoxication::• sudden change of consciousness with aggressive sudden change of consciousness with aggressive
behaviour and amnesiabehaviour and amnesia Harmful useHarmful use::
• physical complications – hypertension, physical complications – hypertension, arteriosclerosis, heart infarction, cardiomyopathy, arteriosclerosis, heart infarction, cardiomyopathy, brain stroke, liver cirrhosis, fatty liver, gastritis, brain stroke, liver cirrhosis, fatty liver, gastritis, etc.etc.
• psychic complications - depressionpsychic complications - depression
F10.x Mental Disorders Due to F10.x Mental Disorders Due to Use of AlcoholUse of Alcohol
Dependence syndrome:Dependence syndrome:• increased tolerance to alcohol, morning increased tolerance to alcohol, morning
drinking, alcohol bouts, blackouts, drinking, alcohol bouts, blackouts, deterioration in occupational and marital life, deterioration in occupational and marital life, behavioural changes, withdrawal symptomsbehavioural changes, withdrawal symptoms
Withdrawal state:Withdrawal state:• tremor, anxiety, easy getting startled, tremor, anxiety, easy getting startled,
agitation, insomnia, nausea, sweating, agitation, insomnia, nausea, sweating, epileptic seizures and delirium tremensepileptic seizures and delirium tremens
Delirium tremens:Delirium tremens:• usually starts in evening hours – growing usually starts in evening hours – growing
tremulousness, severe agitation, anxiety and tremulousness, severe agitation, anxiety and perceptual distortionperceptual distortion
• a state seriously endangering patient's lifea state seriously endangering patient's life• recovery after several days, retrograde recovery after several days, retrograde
amnesiaamnesia
F10.x Mental Disorders Due to F10.x Mental Disorders Due to Use of AlcoholUse of Alcohol
Other psychotic disorders:Other psychotic disorders:• alcoholic hallucinosisalcoholic hallucinosis• pathological jealousypathological jealousy• Korsakov's psychosisKorsakov's psychosis• Wernicke encephalopathyWernicke encephalopathy• alcoholic dementiaalcoholic dementia
Treatment of alcoholismTreatment of alcoholism• Withdrawal from alcohol, benzodiazepines, Withdrawal from alcohol, benzodiazepines,
clomethiazolclomethiazol• Aversion therapyAversion therapy• Alcohol-Antabuse (disulfiram) Reaction (AAR)Alcohol-Antabuse (disulfiram) Reaction (AAR)• PsychotherapyPsychotherapy
F11.x Mental Disorders Due to F11.x Mental Disorders Due to Use of OpioidsUse of Opioids
Morphine, heroin (diacetylmorphine), Morphine, heroin (diacetylmorphine), codeine, pethidine, methadonecodeine, pethidine, methadone
HeroinHeroin::• dependence develops within two weeks of dependence develops within two weeks of
daily usedaily use• overdose may lead to deathoverdose may lead to death• withdrawal symptoms are extremely withdrawal symptoms are extremely
unpleasantunpleasant• needle-sharing represents a serious risk of needle-sharing represents a serious risk of
transmission of HIV and hepatitransmission of HIV and hepatititis B + C virusess B + C viruses• treatment of the withdrawal state – treatment of the withdrawal state –
buprenorphine, benzodiazepines, spasmolytics; buprenorphine, benzodiazepines, spasmolytics; in serious cases of dependence heroin is in serious cases of dependence heroin is replaced by methadone replaced by methadone
F1F122.x Mental Disorders Due to .x Mental Disorders Due to Use of Use of CannabinoidsCannabinoids
MarijuanaMarijuana (marihuana) is a colloquial term for dried leaves and (marihuana) is a colloquial term for dried leaves and flowers of cannabis plant (flowers of cannabis plant (Cannabis sativaCannabis sativa L.) L.)
ΔΔ99-tetrahydrocannabinol (Δ-tetrahydrocannabinol (Δ99-THC)-THC) is responsible for the is responsible for the psychoactive properties of the cannabis plant psychoactive properties of the cannabis plant
Complex physiological functions of the cannabinoid system: Complex physiological functions of the cannabinoid system: motor coordination, memory procession, control of appetite, motor coordination, memory procession, control of appetite, pain modulation and neuroprotectionpain modulation and neuroprotection
Summary of adverse effects:Summary of adverse effects:• acuteacute: anxiety, panic, impaired attention, memory, reaction : anxiety, panic, impaired attention, memory, reaction
time and psychomotor performance and coordination, time and psychomotor performance and coordination, increased risk of road accident, and increased risk of increased risk of road accident, and increased risk of psychotic symptoms among vulnerable personspsychotic symptoms among vulnerable persons
• chronicchronic: chronic bronchitidis, a cannabis dependence : chronic bronchitidis, a cannabis dependence syndrome, subtle impairments of attention, short-term syndrome, subtle impairments of attention, short-term memory and ability to organize and integrate complex memory and ability to organize and integrate complex informationinformation
F1F122.x Mental Disorders Due to .x Mental Disorders Due to Use of Use of CannabinoidsCannabinoids
Effect of cannabinoids on central nervous system:Effect of cannabinoids on central nervous system: Euphoria, enhancement of sensory perception, tachycardia, Euphoria, enhancement of sensory perception, tachycardia,
antinociception, difficulties in concentration, impairment of antinociception, difficulties in concentration, impairment of memorymemory
Cannabis use may exacerbate symptoms of schizophrenia Cannabis use may exacerbate symptoms of schizophrenia and may precipitate disorders in persons who are and may precipitate disorders in persons who are vulnerable to developing psychosis; heavy cannabis use vulnerable to developing psychosis; heavy cannabis use may increase depressive symptoms among some usersmay increase depressive symptoms among some users
Tolerance develops; the relatively long half-life and Tolerance develops; the relatively long half-life and complex metabolism of cannabis may result in a low complex metabolism of cannabis may result in a low intense withdrawal syndrome intense withdrawal syndrome
Marijuana use tends to impair executive function in the Marijuana use tends to impair executive function in the brain, e.g. higher risk for all types of injuries is associated brain, e.g. higher risk for all types of injuries is associated with cannabis use with cannabis use
Cannabis abuse and dependence were highly associated Cannabis abuse and dependence were highly associated with increasing risks of other substance dependencewith increasing risks of other substance dependence
F13.x Mental Disorders Due to F13.x Mental Disorders Due to Use of Sedatives and HypnoticsUse of Sedatives and Hypnotics
benzodiazepinesbenzodiazepines – potentiate the action of – potentiate the action of GABAGABA
risk of dependencerisk of dependence short-acting benzodiazepines: alprazolam, short-acting benzodiazepines: alprazolam,
flunitrazepam, oxazepam, lorazepam, flunitrazepam, oxazepam, lorazepam, temazepamtemazepam
long-lasting benzodiazepines: diazepam, long-lasting benzodiazepines: diazepam, clorazepate, chlordiazepoxide, etc.clorazepate, chlordiazepoxide, etc.
withdrawal state can be accomplished with withdrawal state can be accomplished with epileptic seizuresepileptic seizures
interaction with alcohol may induce interaction with alcohol may induce qualitative changes of consciousnessqualitative changes of consciousness
F14.x,15.x Mental Disorders F14.x,15.x Mental Disorders Due to Use of StimulantsDue to Use of Stimulants
Cocaine, amphetamine, metamphetamine Cocaine, amphetamine, metamphetamine (pervitine), phenmetrazine, methyphenidate, (pervitine), phenmetrazine, methyphenidate, MDMA (ecstasy, MDMA (ecstasy, methylenedioxymetamphetamine)methylenedioxymetamphetamine)
Positive mood, activity, planning, diminished Positive mood, activity, planning, diminished need of sleepneed of sleep
Tachycardia, arrhythmia, hypertension, Tachycardia, arrhythmia, hypertension, hyperthermia, intracerebral haemorrhagehyperthermia, intracerebral haemorrhage
Withdrawal symptoms: severe craving, Withdrawal symptoms: severe craving, depression, decreased energy, fatigue, sleep depression, decreased energy, fatigue, sleep disturbancedisturbance
Prolonged use can trigger paranoid psychoses, Prolonged use can trigger paranoid psychoses, impulsivity, aggressivity, irritability, impulsivity, aggressivity, irritability, suspiciousness and anxiety statessuspiciousness and anxiety states
F16.x Mental Disorders Due to F16.x Mental Disorders Due to Use of HallucinogensUse of Hallucinogens
Lysergid acid diethylamide (LSD), Lysergid acid diethylamide (LSD), psilocybin, mescaline, phencyclidinepsilocybin, mescaline, phencyclidine
Acute intoxication: distorted perception Acute intoxication: distorted perception (optic hallucinations and illusions); (optic hallucinations and illusions); unpredictable and dangerous behaviourunpredictable and dangerous behaviour
Withdrawal syndrome has not been Withdrawal syndrome has not been describeddescribed
F18.x Mental Disorders Due to F18.x Mental Disorders Due to Use of Volatile SolventsUse of Volatile Solvents
Toluene, acetone, adhesives, petrol, Toluene, acetone, adhesives, petrol, cleaning fluids, etc.cleaning fluids, etc.
Acute intoxication: euphoria, Acute intoxication: euphoria, disorientation, incoordination, slurred disorientation, incoordination, slurred speech; optic hallucinationsspeech; optic hallucinations
The way of use is very dangerousThe way of use is very dangerous
Drug Addiction TreatmentDrug Addiction TreatmentHEALTH SERVICEHEALTH SERVICE:: acute states (detox program, tox. psychosis)acute states (detox program, tox. psychosis) weaning treatmentweaning treatment after-treatment care after-treatment care substitution (maintainance) treatmentsubstitution (maintainance) treatment
OUT OF HEALTH SERVICEOUT OF HEALTH SERVICE:: contact centerscontact centers daily static centers daily static centers therapeutic communitiestherapeutic communities after-treatment centersafter-treatment centers protected workshops and habitationsprotected workshops and habitations mutual help groups – Alcoholics Anonymous, mutual help groups – Alcoholics Anonymous,
Narcotics AnonymousNarcotics Anonymous
LinksLinks
Czech National Focal Point for Drugs Czech National Focal Point for Drugs and Drug Addiction:and Drug Addiction:
www.drogy-info.czwww.drogy-info.cz European Monitoring Centre for European Monitoring Centre for
Drugs and Drug Addiction:Drugs and Drug Addiction:
http://http://www.emcdda.eu.intwww.emcdda.eu.int//