Substance use disorders in children and adolescents Flashcards
How big is the problem?
Incidence increased from 3.4 to 5.8 per 1000 live births
Geographical variation
East South Central Division (Kentucky, Tennessee, Mississippi and Alabama) showed 16.2 per 1000 live births
West South Central Division (Oklahoma, Texas, Arkansas and Louisiana) showed 2.6 per 1000 live births
Drugs Causing Withdrawal
Classic NAS due to opiates
Nicotine withdrawal from maternal tobacco exposure
Irritability associated with marijuana
Alcohol withdrawal and birth defects
Delayed withdrawal secondary to maternal benzodiazepine or psychotropic medications
Drugs in WV
Buprenorphine now very prominent
Methadone decreasing in frequency
Marijuana still continues to be used at high rates
Prescription opiates decreasing at time of delivery
Heroin use on the rise, Fentanyl increasing
Other psychotropic medications
Neonatal Abstinence Syndrome
Passive exposure of the newborn occurs when a mother uses a neuroactive drug during her pregnancy
When the infant is deprived of these substances through the birthing process, a withdrawal syndrome may develop
Classic NAS consists of a wide variety of CNS signs of irritability, GI problems, autonomic signs of dysfunction, and respiratory symptoms
The hallmark of neonatal withdrawal is a striking disorder of movement, most aptly termed “jitteriness”
Autonomic over-reactivity is typically exhibited by yawning, sneezing, mottling and fever
Cerebral irritation results in an irritable and hypertonic infant
Pathogenesis of NAS
Endogenous opiates (endorphins, enkephalins and dynorphins)
Complex interactions between endogenous opiates and their receptors are important in the developing brain
Locus coeruleus is a nucleus in the brain stem (pons) where norepinephrine is synthesized and involved with physiological response to stress and panic
When the opiate is withdrawn, the inhibiting effect gone
This results in a supranormal increase in norepinephrine levels, which are the likely cause of the signs and symptoms of NAS
Disuse Hypersensitivity
A drug may depress certain neural systems
Render the targets hypersensitive to their usual stimuli
Removal of the depressing drug results in a rebound hypersensitivity of the affected targets
May be caused in part by an increase in synthesis of certain receptors
Alternate Pathways
Drug may depress a primary neural pathway
An alternate pathway, usually of minor activity, may become more prominent in attempt to compensate
When the drug is removed, both pathways may operate in an additive fashion
