Addictions Psychiatry Flashcards
What type of illicit drugs are stimulants?
Cocaine
Amphetamine
How is cocaine consumed?
Coca leaves chewed or brewed
Cocaine hydrochloride is snorted or injected
Cocaine freebase or crack cocaine is snorted
What are the effects of cocaine?
Stimulant and euphoriant
Increased alertness and energy
Increased confidence and impaired judgement
Lessens apetite and desire for sleep
What are the complications of cocaine?
Damage to nose and airway Convulsions with respiratory failure Cardia arrhythmias and MI Hypertension and CVA Toxic confusion Paranoid psychosis
What are the effects of cocaine withdrawal?
Depression Irritability Agitation Craving Hyperphagia Hypersomnia
How is amphetamine consumed?
Sniffed, swallowed or injected
What illicit drugs are classed in the opiates group?
Opium Morphine Heroin (diamorphine) Methadone Codeine and dihydrocodeine
How is heroin consumed?
Snorting
Smoking
Injection
What is the complications of heroin?
Analgesia Drowsiness and sleep Mood change (euphoria, intense pleasure) Respiratory depression Cough reflex depression Sensitisation of the labyrinth with nausea and vomiting Decreased sympathetic flow (bradycardia and hypotension) Lowering of body temperature Pupillary constriction Constipation Respiratory arrest with a pulse Pinpoint pupils unreactive to light
What are the side effects of medium term opiate use?
Phlebitis
Anorexia
Constipation
What are the side effects of ling term opiate use?
Tolerance
Withdrawal
Social and health problems
What are the clinical features of opiate withdrawal syndrome?
Craving Insomnia Yawning Muscle pain and cramps Increased salivary, nasal and lacrimal secretions Dilated pupils Piloerection
What are the pros of methadone maintenance?
Decriminalises drug use
Allows normalisation of lifestyle
Reduces IV misuse
What is the con of methadone maintenance?
Leakage on to the illicit market
What is the chemical name of ecstasy/
3,4-methylenedioxymethamphetamine
How is ecstasy consumed?
Orally
What are the effects of ecstasy?
Euphoria followed by feeling of calm
Increased sociability
Inability to distinguish between what is an isn’t desirable
What are the side of ecstasy?
Nausea and dry mouth Increased blood pressure and temperature Club users risk dehydration Large dose can cause anxiety and panic Drug induced psychosis
What is the psychoactive agent in cannabis?
Tetrahydrocannabinol
How is cannabis consumed?
Smoked, but can be eaten
What are the psychological effects of cannabis?
Relaxing or stimulatory Euphoriant Increased sociability and hilarity Increases appetite Changes in time perception Synaesthesia Anxiety Panic Persecutory ideation Hallucinatory activity
What are the ill effects of cannabis?
Respiratory problems as with tobacco
Toxic confusion
Exacerbation of major mental illness
What are anabolic steroids legitimately prescribed for?
Hypogonadism
Muscular dystrophy
Various anaemias
Wasting in AIDS
What is the effect of anabolic steroid use?
Muscle hypertrophy particularly marked in he upper body (pectoralis, deltoid, trapezius, biceps)
What are the side effects of anabolic steroid use?
Skin - acne, stretch marks, baldness
Feminisation in males with hypogonadism and gynaecomastia
Visualisation in females with hirsutism, deep voice, clitoral enlargement, menstrual irregularities, hair thinning
Increased cholesterol and hypertension
Growth deficits due to premature epiphyseal closure
Cholestatic jaundice, liver tumours
What are the psychological side effects of anabolic steroid use?
Irritability and anger
Hypomania and mania
Depression and suicidality on withdrawal
What is drug tolerance?
Reduced responsiveness to a drug caused by previous administration
What is the mechanism of tolerance?
Less drug absorbed
Drug metabolised faster to inactive metabolites
Drug metabolised slower to active metabolites
More drug excreted
Fewer drug receptors
Less efficient drug receptors
What is the reward centre?
Neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex
When VTA neurones are stimulated they release dopamine is released
This causes a sensation of pleasure/reward
How do drugs affect the reward centre?
Heroin increases firing rate of dopaminergic neurones
Amphetamine increases dopamine release
Cocaine inhibits dopamine uptake
Alcohol
