LAST LECTURE OF YEAR 1 Flashcards
intoxication
The DSM-5 term referring to the diagnosis of a reversible substance-specific syndrome due to recent ingestion of a drug and its effects on the CNS
Syndrome consists of significant maladaptive behavioral, psychological, physical changes
can be determined by blood, urine, or tissue drug levels
withdrawal
The DSM-5 term referring to the diagnosis of a
substance-specific syndrome that develops following
cessation of a substance after heavy/prolonged use
Syndrome consists of significant maladaptive
behavioral, psychological, physical changes
symptoms are usually the opposite of intoxication
symptoms appear 72 hours after cession and may last for weeks
substance use disorder (SUD)
A maladaptive pattern of substance use as manifested by >2 of 11 symptoms in a 12-month period
impaired control (cravings and time consuming)
social impairment (failure to meet role duties)
risk use (using despite consequences)
pharm criteria (tolerance and withdraw symptoms) if only symptoms NOT SUD
Dependence
A term referring to compulsive drug use despite negative consequences (SUD)
with withdraw and dependence = physical depend
no withdraw and dependence = psychological depend
screening tools used for alcohol and drug use
CAGE = determine if it is clinically significant (2 or more yes)
AUDIT (alcohol related issues)
NIDA -modified ASSIST (drug/alcohol use in the last 3-12 months)
drug rehabilitation
in-patient setting
usually 90 days or more
recovery is lifetime
acute phase of drug rehab
detox
treat med and psych issues
recovery phase of drug rehab
preventing relapse
can use therapy (CBT, family therapy, med assist therapy, self-help groups)
schedule I drug
Drugs with a high harm risk and NO safe, accepted medical use
Ex: LSD, heroin
cannot prescribe
Schedule II drug
Drugs with a high harm risk but with safe and accepted medical use. These drugs are highly addictive
Ex: opioids, stimulant’s, barbiturate’s
Schedule III, IV, V drug
Drugs with a harm risk less than Schedule II drugs with safe and accepted medical uses
III: anabolic steroid, codeine, dronabinol
IV: benzos
V: liquid codeine (cough medicine)
initial cause of addition: psychosocial and biological reasons
psychosocial: age of first use method of administering other mental illnesses coping strategies
genetic:
account for 40-60% vulnerability
unknown reason
continued and compulsive use of drugs…why?
the effects of the drug on brain functioning
- stimulation of the reward pathway
overrides the punishing effects
greater release of Dopamine in the NA, thus positive effects of the drug - dysfunction of the prefrontal cortex
alter in self-control- due to reward pathway stimulation - acute withdraw symptoms
discomfort may lead to relapse - Protracted Abstinence Syndrome
less dopamine is available due to the drug
relapse may be triggered by anhedonia - classical conditioning effects
drug is paired with environmental cues
common features of sedative drug intoxication
sedation, sleepy, less anxiety, impaired judgement, slurred speech, incoordination
sedatives examples
alcohol
barbiturates
inhalants
benzos
withdraw symptoms from sedatives
agitation insomnia anxiety tachycardia or hypertension nausea vomiting hand tremors hallucinations
treatment for acute alcohol withdraw?
benzos (diazepam) for acute
Naltrexone
Opioid receptor antagonist that reduces the pleasurable effects of alcohol
reduce the amount of drinking
Acamprosate
Decreases the anhedonia of protracted abstinence → makes the person feel euthymic → decreases the cravings & helps to maintain abstinence
mechanism is not completely known (NMDA antagonist maybe)
reduce alcohol intake
Disulfiram
Inhibits aldehyde dehydrogenase → acetaldehyde accumulates and causes a toxic reaction (e.g. nausea) for 30-60 min.
alcohol aversion agent
used short term due to compliance
treatment for benzodiazepine overdose/toxicity
Flumazenil
competitive antagonist
high affinity for the benzo GABAa receptor
inhalants
substances with psychoactive vapors
(paint, glue)
signs: rash, red and runny nose, chemical smell, face discoloration
intoxication is similar to sedative
intoxication features of simulants
psych:
paranoia / hallucinations
psychomotor acceleration
euphoria
physical: loss of appetite chest chain seizure dilated pupils tachy / hypertension
drug screen is needed to differentiate from schizo and bipolar I
common features of simulant withdraw
dysphoric mood fatigue slowing of psychomotor increased appetite hypersomnia
sounds like MDD, but its not
Methamphetamine vs Cocaine
both are addictive
direct action on the reward pathway
produce a rush due to euphoria
effects of cocaine are shorter
meth: meth mouth ( dry mouth and dental carries)
meth face = repetitive motor movements
Ecstasy (simulant)
empathy inducing perceptual changes (things are more interesting, time and sensory distortion)
increased thirst
increased temp
neurotoxic
caffeine
DSM-5 does not recognize caffeine use disorder
effects on sleep, anxiety, mood,
caffeine intoxication
more than 250mg
increased energy insomnia nervous rambling thoughts tachy GI disturbance
caffeine withdraw
headache
dysphoria
fatigue
less concentration
nicotine
DSM 5 does not recognize nicotine intoxication
stimulant
nicotine withdraw
dysphoric mood restless, anxious irritable less concentration less HR
treatment for nicotine abstinence
nicotine replacement therapy
medications
hallucinogens
sympathomimetic drugs
visual distortions
auditory distortions
distorted thinking, trouble concentrating, working memory impairment
classic hallucinogens
LSD, mescaline, psilocybin (mushroom)
high potency
effects last 8-12 hours
no withdraw symptoms
low addiction rates
intoxication: increased HR, increased BP, sweating, pupil dilation, dehydration, euphoria, hallucination
side affects of classic hallucinogens
irrational fears anxiety panic paranoia rapid mood swings hopelessness intrusive thoughts of harming others or self
psychoactive affects of cannabis
relaxation and slight euphoria
introspection and metacognition
increased appetite and HR
cannabis intoxication
dry mouth, increased appetite, poor muscle coordination, delayed reaction time,
can have bad trips similar to LSD
cannabis withdraw
irritability and nervous
dysphoric mood
sleep disturbance
decreased appetite
headache, shakiness
Dissociative Anesthetics intoxication
PCP and ketamine
depersonalization agitation and confusion impulsivity ataxia decreased pain response
rapid eye movements
increased HR, BP, and RR
no withdraw syndrome
treatment for PCP intoxication
benzo/ antipsychotic
opioids
analgesics to reduce pain
side effects / intoxication: euphoria decreased RR Low BP constipation drowsiness miosis impaired cognition
opioid withdraw
dysphoria nausea, vomiting, diarrhea muscle aches pupil dilation sweating / fever
Naloxone
used for acute overdose
not used at treatment
reverses CNS depression
treatment for opioid addiction
- abstinence based therapy
Naltrexone (blocks affects of opioid) - replacement therapy
methadone (opioid agonist) addictive
buprenorphine (partial opioid agonist) less addictive
gambling disorder
Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting 4+ symptoms over 1 year
preoccupation with gambling unable to control, stop, or cut back lying used as an escape losing relationships or reliant on others to pay debt
treatment for gambling disorder
SSRI
CBT
support group
family therapy
