opiods, nicotine and phencyclidine

1. Opioid, Nicotine
&
Phencyclidine Abuse
By: Ismah Haron
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2. Opioid
• Endogenous opioids peptides, natural opium alkaloids
(morphine & codeine), semi synthetic opioid (heroin) and fully
synthetic opioids (pethidine & methadone)
• Routes of administration: oral, IM, IV, SC, sniffed or inhaled
(chasing the dragon)
• Can be detected in urine:
 Heroin 36-72h
 Morphine 48-72h
 Methadone 72h
• Result of overdose; respiratory depression and DEATH
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3. DSM IV (DiagnosticCriteriaforOpioidIntoxication)
 Recent use of opioid
 Significant psychological changes, with initial euphoria
followed by:
• Apathy
• Dysphoria
• Psychomotor retardation
• Impaired judgment, social functioning
 Pupillary constriction/ dilation and one of the following:
• Drowsiness or coma
• Slurred speech
• Impairment in attention or memory
 Symptoms not due to general medicine 3

4. DSM IV (DiagnosticCriteriaforOpioidWithdrawal)
 Either one of the following:
• Cessation/ reduction of heavy/prolonged opioid
• Administration of antagonist after a period of use
 Three or more of the following:
• Dysphoric mood
• Nausea and vomiting
• Muscle aches
• Lacrimation and rhinorrhea
• Pupillary dilatation, sweating
• Diarrhea
• Yawning
• Fever
• Insomnia
 Symptoms above cause significant impairment.
 Symptoms not due to general medical condition.
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5. Nicotine
• Tobacco smoking
• Tolerance and dependence develop rapidly
• Toxicity and overdose are possible but occur infrequently
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6. Features of toxicity
• Abdominal pain
• Agitation
• Breathing difficulty
• Convulsions
• Diarrhea
• Dizziness
• Excessive salivation
• Headache
• Tremors
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7. DSM IV (DiagnosticCriteriaforNicotineWithdrawal)
• Abrupt cessation use/reduce in amount followed within 24
hours, >4 following signs:
 Dysphoric/depressed
 Insomnia
 Irritability, frustration/anger
 Anxiety
 Difficulty concentrating
 Restlessness
 Decreased heart rate
 Increase appetite/ weight gain
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8. Phencyclidine
• Street names; PCP, Hog, Angel Dust, Loveboat or Lovely
• Synthetic substance, commercially developed in the
1950s by the Parke-Davis pharmaceutical company
• Previously used as anesthetic drug
• Route of administration; oral, IV or smoked
• Exhibits both hallucinogenic and neurotoxic effects
• Detected in urine up to 48 hours after ingestion
• Complications; acute rhabdomyolysis, renal failure and
death due to hyperpyrexia
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9. DSM IV (DiagnosticCriteriaforPhencyclidineIntoxication)
• Recent use of PCP
• Significant behavioral changes like assaultiveness,
impulsiveness, unpredictability and impaired judgment.
• 2 of the following signs:
 Vertical and horizontal nystagmus
 Hypertension and tachycardia
 Numbness
 Ataxia
 Dysarthria
 Muscle rigidity
 Seizures or coma
 Hyperacusis
• Symptoms are not due general medical condition. 9

10. 10

11. THANK YOU
References:
1. Psychiatry 2nd edition by Neel Burton
2. http://www.psychtreatment.com/index.htm
3. http://www.mdguidelines.com/
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