Chapter 12: Substance-Related Disorders Flashcards
Define dual diagnosis.
Having both a mental illness and a substance abuse disorder
How is the relationship between drugs and mental illness difficult to determine?
- Drugs may be an attempt to “self medicate” for a mental disorder
- Psychiatric probs may be caused by drugs in the first place
- There may be an interaction of the mental disorder and drug
List examples of how drugs may be an attempt to “self medicate” for a mental disorder.
- Alcohol abuse in a social phobic to face social situations
- Cigarette smoking to calm down schizophrenic voices
- Caffein to help focus w/ ADHD
- Smoking marijuana to reduce OCD symptoms
List examples of how psychiatric probs may be caused by drugs in the first place.
- Mania caused by cocaine intoxication in a person who isn’t bipolar
- Intense anxiety during withdrawal from benzodiazepine dependence
- Depression in a chronic alcoholic (subsides after quitting drinking)
- Permanent psychosis caused by brain damage from meth or PCP abuse
List examples of how there may be an interaction of mental disorder and drug.
- Stimulants and marijuana make a paranoid individual more paranoid
- Drinking alcohol makes a depressed person even more depressed
- Caffeine abuse can drive hypomania into mania
- Hallucinogens can trigger the onset of schizophrenia in a predisposed individual
Explain physical dependence on drugs.
- Psychological need for drug
- Drug discontinued –> unpleasant withdrawal symptoms develop
- Physical dependence goes along w/ tolerance
What characteristics of a drug make it more addictive? What does addiction speed depend on?
- Fast acting
- Shorter half-life
- Depends on way of consumption (injecting, smoking, eating)
Explain psychological dependence on drugs.
- Psychological need to use drug
- Not being able to relax w/o using the drug
- Not daring to be sociable w/o the drug
- Psychological dependence may or may not go along w/ physical dependence
What is the DSM-V criteria for substance-related disorders?
- Recurrent use of a drug
- Drug has caused probs in important areas of life (work, relationships, health, endangering self or others, legal probs)
- User has made unsuccessful efforts to control drug use
- User continues to use drug despite of knowledge of its harmful effects
- Typically includes physical dependence w/ tolerance and withdrawal
What are the classes of drugs?
- Depressants
- Stimulants
- Hallucinogens
What do depressants do?
Slow down activity of CNS
List depressant drugs.
- Alcohol
- Barbiturates
- Benzodiazepines
- Opiates
What are the effects of alcohol on the brain?
- Primarily facilitating the GABA system
- Inhibits frontal inhibitory synapses first
- Blocks actions of glutamate
- Secondary effect = release of dopamine’s pleasure pathway
- Genetic vulnerability to addiction
What are the effects of light alcohol intoxication?
- More relaxed
- Increased sociability
- Reduced self-awareness
- Release of inhibitions, slowed reaction times
What are the effects of increased amounts of alcohol intoxication?
- Motor coordination impaired
- Slurred speech
- Repeating oneself
- Double vision
- Memory probs, black outs
What does the speed of alcohol intoxication depend on?
- Body weight
- Food consumed
- Rate of drinking
- Sex = women absorb alcohol faster into bloodstream
- Genetics
- Simultaneous consumption of other depressants
- One’s history of drinking
Why do women absorb alcohol faster into the bloodstream?
- Less body water content
- Interaction w/ hormone cycle
- Less enzymes (in liver and stomach) that break down alcohol
What are the warning signs for alcoholism?
- Probs at work or home b/c of drinking
- DUI
- Lying about drinking
- Isolating in order to drink
- Feeling guilty after drinking
- Becoming angry or violent on alcohol
- Drinking to change one’s emotional state
Binge drinker vs. maintenane drinker
LOOKUP
Describe Fetal Alcohol Syndrome
- Fetal growth retardation
- Cognitive deficits
- Behavioral probs
- Learning difficulties
- Characteristic facial features (thin upper lip, short nose, etc.)
What is Korsakoff’s Syndrome?
-Persistent alcohol amnestic disorder due to vitamin B1 deficiency
What is Delirium Tremens?
During alcohol withdrawal
What are barbiturates? Characteristics? Med of choice for? NTs?
- Sedatives
- Work first on GABA system in reticular formation
- Med of choice for insomnia and anxiety prior to benzodiazepines
- Highly physically addictive
- High OD potential, especially if combined w/ alcohol
What are benzodiazepines? NTs? Characteristics? What does it treat?
- Tranquilizers, anti-anxiety pills
- Works on GABA system
- Treatment of anxiety and insomnia
- High tolerance and physical dependence
- Psychologically addictive
List the opiates?
- Opium
- Morphine
- Codeine
- Heroin
- Methadone
- Oxycodone
What are the effects of opiates in early users?
- Pleasant sensations
- Eliminates all anxiety and pain
- No hallucinations or delusions
- Cognitive functions largely intact except for memory probs
What are the effects of opiates in chronic users?
- Positive effects wear off w/ rapid tolerance
- Main reason for using is to avoid withdrawal symptoms
What are the visible signs of opiate intoxication?
- Constricted pupils
- Drooling
- Apathetic look
- Speech is slowed or slurred
What are the opiate withdrawal symptoms? When do they start and end?
- Start 3 days after last use
- Subside after one week
- Similar to bad flu = diarrhea, stomach cramps, body aches, fever, chills, runny nose
- High anxiety
What makes opiates highly physically addictive? Effects?
- Opiate molecules vary similar to endorphins
- Opiates attached themselves to endorphin receptor sites
- Signals brain to stop endorphin production
- Prolonged opiate abuse can cause permanent depletion of endorphins
- Results in chronic pain, anxiety, depression
- Opiates work on both pain path and pleasure path
What are the societal problems associated w/ heroin use?
Increase in crimes as opiates are expensive
-Spread of HIV and hepatitis C through shared needles
How is methadone a treatment for heroin addiction? Target users?
- Methadone similar to heron, but has longer half-life
- For chronic heron addicts who failed other treatments?
Which narcotic is abused through being prescribed?
Oxycodone
What do stimulants do?
- Speed up brain activity
- Increase heart rate and breathing, decrease appetite, give burst of energy
List the stimulants.
- Caffeine
- Nicotine
- Cocaine
- Crack
- Ephedra
- Amphetamines
- Methamphetamines
Where does cocaine come from? Origin?
- Occurs naturally in the leaves of the coca plant
- Used in western world for at least 100 years
What is crack? Why is it named that? Vs. cocaine?
- Flammable compound that can be smoked
- Comes from cracking sounds the rocks make when smoked in a pipe
- Cheaper than cocaine
Where do amphetamines and methamphetamines come from? Uses?
- Synthetic drugs
- Medicinal and military uses
- Lab production of milder amphetamines for medical use –> Ritalin for ADHD, appetite suppressant
- Meth cooked in illegal labs
What are the intoxication of cocaine and methamphetamines in mild doses?
- Decreases boredom, fatigue, need for sleep, appetite
- Better concentration for monotonous tasks
- Increased physical strength
What are the intoxication of cocaine and methamphetamines in moderate doses?
- Sense of elation, freedom, energy
- Pleasant but unrealistic overestimation of one’s abilities
- Feeling witty, self-confident
- Increased sexual arousal
- Euphoric rush
What are the intoxication of cocaine and methamphetamines in heavy doses?
- Manic activity level, rapid speech, restless, on the go
- Impairment of mental abilities; can produce erratic thoughts & behaviors
- Psychotic states (paranoid delusions and hallucinations)
- Hallucinations may be auditory, visual, tactile
- Aggressive behaviors
- Weight loss
- Body sores from scratching
- Bizarre repetitive movements
- Dilated pupils
- Can cause seizures and heart arrhythmia
What are the intoxication of cocaine and methamphetamines with chronic users?
- Less and less euphoria
- Need to use stimulant drug simply to get out of bed and do ordinary things
What are the withdrawal symptoms of cocaine and methamphetamines?
- Fatigue
- Depression
- Suicide thoughts
- Anxiety
- Hunger, weight gain
- Bizarre dreams
What are the effects of cocaine and methamphetamines on the brain?
- Work directly on dopamine and norepinephrine system
- Dopamine reuptake inhibitor
- Stimulate release of dopamine
- Overstimulate reward system circuitry of brain
- Possibility of permanent depression due to permanent alteration of the dopamine systems and damage to receptor sites
- Cause permanent cognitive deficits (short term memory, concentration, problem solving)
What is the addiction potential of cocaine and methamphetamines?
- Highly psychologically and physiologically addictive
- Tolerance builds up fast
What are the differences between cocaine and methamphetamines?
METH:
-more aggressive behavior
-longer lasting high (6-12 hrs vs. 20 mins-3 hrs)
-paranoia lasts longer after cessation of drug (7-14 days vs. 4-8 hrs)
-possibility of permanent paranoia and psychosis
-greater risk of brain damage b/c meth alters structure of neurons while cocaine generally stays more on neuron’s outside
COCAINE
-has stronger effects on cardiovascular system w/ possibility of permanent heart damage
What do hallucinogens do? What conditions can it trigger?
- Have strongest effect on altering consciousness
- Usually change a user’s perception of both the internal and external world
- Mind expansion vs. potential triggering of psychosis in vulnerable individuals
- Can trigger onset of schizophrenia and depersonalization
List hallucinogens.
- Mescaline
- Psilocybin
- LSD
- Cannabis
- PCP
What is mescaline derived from? What does it do?
- Derived from the Peyote Cactus
- Strong sensual and perceptual experiences
What is an example of a psilocybin? What do they do?
- Shrooms
- Intense visual hallucinations
What are the intoxication symptoms of LSD?
- Visual hallucinations and perceptual distortions
- Heightened aesthetic experiences
- Time perception may be altered
- Synesthesia
- Magnification of feelings –> “horror trip”
- Depersonalization, out of body experiences
- Thoughts can become incoherent
- Loss of reality contact
What is the addiction potential of LSD?
- May be psychologically addictive
- No tolerance or withdrawal symptoms
What is the danger of LSD?
Can trigger schizophrenia in predisposed individuals
What are the short term effects of cannabis?
- Slowed reaction times even at low doses
- Sensitivity to colors, music, smells, touch
- Silly mood
- Red watery eyes, dead head look
- Memory probs
- Increased appetite
- Reduced pain
What are the long term effects of cannabis?
- Lung disease
- Decrease of male sperm count
- Lack of motivation
- Depression
- Paranoia
- Weight gain
What are the withdrawal symptoms of cannabis? How long can they last?
- Insomnia
- Restlessness
- Irritability
- Loss of appetite
- Nausea
- Diarrhea
- Can last up to 90 days
What is PCP? Other names?
- “Angel dust” “super acid”
- Hallucinogen and a stimulant
- Has some analgesic properties
What are the behavioral intoxication symptoms of PCP?
- Energy, increased strength
- Psychosis, paranoid thoughts and delusions
- Bizarre, violent behaviors
- Dissociation, disorientation
- Impaired memory
What are the psychological intoxication symptoms of PCP?
- Increased blood pressure and HR
- Sweating
- Numbness
- Floating sensations
- Slowed reflexes
- Sometimes coma and immobility
What makes PCP a very dangerous drug?
- Danger of heart attacks and strokes
- High potential of permanent brain damage
- Cognitive deficits are virtually always apparent in habitual users
- Often added to marijuana, ecstasy, meth, or cocaine w/o user’s knowledge
What is ecstasy?
Mostly a stimulant but also has some psychedelic properties
What are the intoxication symptoms of ecstasy?
- Creates calm, pleasurable orgastic, peaceful feelings
- Outpourings of empathy
- Hallucinations only in higher doses
- Teeth clenching, grinding
What are the dangers of ecstasy?
- Hyperthermia –> kidney failure, stroke, etc.
- Reduced sweat production –> danger of hyponatremia
- Being mixed w/ other drugs –> causes brain and organ damage
What NT systems does ecstasy work on?
Dopamine and serotonin
What is the effect of ecstasy on long term users?
- Addiction w/ withdrawal symptoms
- Reduction in serotonin receptors and damage to nerve endings
- Permanent depression, sleep disturbance, irritability, anxiety
- Short term memory impairments
- Chronic users = ecstasy works more and more like methamphetamine
