Substance use disorders

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  • 1. SUBSTANCE USEDISORDERSNiharika ThakkarChild Guidance Centre andDepartment of Behavioural Sciences and MentalHealth,Sahyadri Hospitals ltd, Pune
  • 2. What are Substances??•Alcohol•Opioids•Cannabinoids•Sedatives/Hypnotics•Cocaine•Caffeine•Hallucinogens•Tobacco•Volatile solvents
  • 3. How to identify? Self report data Analysis of blood, urine etc Presence of drug samples Clinical signs and symptoms (Disturbances in levels of consciousness, perception, affect, behavior, psycho-physiological functions and responses) Informant history Comorbidity with other psychotic disorders
  • 4. AcuteIntoxication Small doses of substance produce disproportionately severe intoxication effect Causes behavioural disinhibition ►Recovery is usually complete ..Funny Anti Smoking Commercial - EPIC SPOOF.flv
  • 5. Harmful Use Pattern of Use Abusing the Substance Binging
  • 6. Dependence Syndrome Strong desire or compulsion Difficulty in controlling in terms of onset, termination or levels of use Withdrawal state Evidence of tolerance Neglect of alternative pleasures Persistent use inspite ofconsequences
  • 7. Tolerance Increased doses required- Alcohol and opiate- dependent individuals take daily doses sufficient to incapacitate or kill non- tolerant users
  • 8. Withdrawal State Indicator of Dependence Syndrome Repeated prolonged high dose Onset and Course is time limited Physical symptoms Psychological disturbances: Anxiety, Depression & Sleep disorders
  • 9. Withdrawal State with Delirium Delirium tremens: Short lived Occasionally life threatening Toxic-confusional state with accompanying somatic disturbances: Insomnia, tremulousness and fear Clouding of consciousness, vivid hallucinations and illusions affecting any sensory modality, delusions, agitation, automatic over activity.
  • 10. Psychotic Disorder During or immediately after psychoactive substance use Vivid hallucinations Misidentifications Delusions or ideas of reference Psychomotor disturbances Abnormal affect : Fear to ecstasy Immediately or in 48 hours (or late onset) Resolves within a month and fully within 6 months
  • 11. Amnesic Syndrome Chronic impairment in memory Remote memory lost, immediate memory preserved Disorientation Confabulation Personality changesKorsakov’s syndrome ..Requiem for a Dream.flv
  • 12. Residual and Late onset PsychoticDisorder Beyond the period during which psychoactive substance related effect might reasonably be assumed to be operating Not always reversible: Dementia Not to be confused with Withdrawal state Negative history: Rule out acute and transient psychotic disorders Flashbacks
  • 13. Guess the Celebrity??
  • 14. Articles SUBSTANCE ABUSE IN INDIA, Ahmad Nadeem, Bano Rubeena, Agarwal V.K., Kalakoti Piyush Tobacco use in India: prevalence and predictors of smokingand chewing in a national cross sectional household surveyM Rani, S Bonu, P Jha, S N Nguyen, L Jamjoum