This ppt is suitable for lecturers who are dealing with B.Sc., nursing students..

1. GOOD
MORNI
NG

2. PREPAREDBY:
MS. MARUTHU. G,
M.Sc., (N),
DEPARTMENT OF PSYCHIATRY

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Alcohol &
drugs are a
Major Public
Health
Problem

5. ABUSE:
IT REFERS TO MALADAPTIVE
PATTERN OF SUBSTANCE USE THAT
IMPAIRS HEALTH IN A BROAD SENSE.

6. DEPENDENCE:
IT REFERS TO CERTAIN
PHYSILOGICAL AND
PSYCHOLOGICAL PHENOMENA
INDUCED BY THE REPEATED TAKING
OF SUBSTANCE.

7. TOLERANCE:
IT IS A STATE IN WHICH AFTER
REPEATED ADMINISTRATION, A DRUG
PRODUCES A DECREASED EFFECT,
ON INCREASING DOSES ARE
REQUIRED TO PRODUCE THE SAME
EFFECT.

8. INTOXICATION:
A PHYSICAL AND MENTAL
STATE OF EXHILARATION AND
EMOTIONAL FRENZY OR LETHARGY
AND STUPOR.

9. WITHDRAWAL STATE:
A GROUP OF SIGNS AND SYMPTOMS
RECURRING WHEN A ADDICTIVE
SUBSTANCES IS REDUCED IN AMOUNT
OR WITHDRAWN, WHICH LAST FOR A
LIMITED TIME. THE NATURE OF THE
WITHDRAWAL STATE IS RELATED TO THE
CLASS OF SUBSTANCE USED.

10. CO-DEPENDENCY:
CO-DEPENDENCY REFERS TO AN
UNCONSCIOUS ADDICTION TO ANOTHER
PERSON’S ABNORMAL BEHAVIOUR
- WEKESSER, 1994

11. SUBSTANCE – RELATED DISORDER :
“A substance – related disorder is a
condition ( such as intoxication, harmful
use / abuse , dependence, withdrawal, and
psychoses or amnesia associated with the
use of substance ) associated with
substance abuse, often involving
maladaptive behaviours over a long
period of time”.
- Wikipedia

12. CLASSIFICATION:
-- SUBSTANCE USE DISORDERS
(SUD)
-- SUBSTANCE - INDUCED
DISORDERS (SID)
-

14. It include
- substance abuse
- substance dependence

15.  “Substance abuse is a maladaptive
pattern of substance use manifested by
recurrent and significant adverse
consequences related to repeated use of
the substance”

16.  Substance dependence refers to
certain physiological and psychological
phenomena induced by the repeated
taking of a substance.

17.  Substance induced disorders
include medical conditions that can be
directly attributed to the use of a
substance.

18. Intoxication
Withdrawal
Delirium
Dementia
Amnesia
Psychosis
Mood disorders
Anxiety disorders
Sexual dysfunction
Sleep disorders

19. Alcohol
Amphetamines
and related
substances
Caffeine
Cannabis
Cocaine
Hallucinogens
Inhalants
Nicotine
Opioids
Phencyclidine
(PLP) and related
substances
Sedatives,
hypnotics, or
anxiolytics.

20. 20
ALCOHOL DEPENDENCE

21. Alcoholism refers to the
use of alcoholic beverages to
the point of causing damage to
the individual, society or both.

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23.  BIOLOGICAL FACTORS
 BEHAVIOURAL THEORIES
 PSYCHOLOGICAL & INTERPERSONAL
FACTORS
 SOCIAL FACTORS
 EASY AVAILABILITY
 PSYCHIATRIC DISORDER

25. I. EXPERIMENTAL
II. RECREATIONAL
III. RELAXATIONAL
IV. COMPULSIVE

26. I. PRE – ALCOHOLIC PHASE
II. THE EARLY ALCOHOLIC OR
PRODROMAL PHASE
III. THE CRUCIAL PHASE
IV. THE CHRONIC PHASE

28. ACUTE INTOXICATION

29. WITHDRAWAL SYNDROME

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Complications

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Family
 Marital disharmony, separations,
divorces, spouse abuse, child
abuse
 In wife- anxiety and depression
 In children- aggression, anxiety,
poor school performance.
Social
 unable to marry, Social isolation,
loss of hobbies, interests and
creativity

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Sexual dysfunction
 Infertility
 Impotence,  sexual desire
Work
Intoxication during work,
absences, sick leave, 
illnesses, arguments, aggression,
crime, sleeping at work, quarrels,
unreliability.

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Financial
 Debts, taking advances
Legal
 Murder, assaults, drunken driving,
shop lifting, sexual offences.
Accidents
 At home, office, work place, fire,
drowning, road traffic accidents.

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Medical Management for
alcoholism

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C A G E - for alcohol dependence
Cut down alcohol ?
Annoyed when discussed ?
Guilt about drinking ?
Eye opening drinking ?

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DIAGNOSIS:
Examination of the patient
History
Physical examination
Time last dose was taken
Lab tests for LFT, Blood picture,
Blood sugar
Examination for withdrawal
symptoms.

39. TREATMENT
DETOXIFICATION ALCOHOL
DEPENDANCE

40.  AIM : SYMPTOMATIC MANAGEMENT
 DRUG OF CHOICE : BENZODIAZEPINES
CHLORDIAZEPOXIDE
DIAZEPAM
VITAMIN SUPPLEMENT
(THIAMINE 100 mg)
 CARE OF DEHYDRATION

41.  ALCOHOL DETERRENT THERAPY
DISULFIRAM

42.  BEHAVIOUR THERAPY

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44. VENTLATION
INTERPRETATIONRE-EDUCATION

45.  GROUP THERAPY
ALCOHOLIC
ANONYMOUS -

46.  AVERSION THERAPY :
IT INVOLVES THE USE OF A DAILY DOSE
OF DISULFRUM TO PREVENT COMPULSIVE
DRINKING
 MECHANISM OF ACTION
 DOSE – 250 – 500 mg/day
 DURATION
 CONTRAINDICATION

48.  TAKE CONSENT
 ATLEAST 12 hrs
ELAPSED
 INSTRUCTIONS
 Pt. SHOULD BE
WARNED AGAINST
INGESTION
 ADVICES
 AVOID CNS
DEPRESSANTS

49.  AVOID DRIVING
 PATIENT SHOULD BR WARNED ABOUT
DISULFIRAM ALCOHOL REACTION
 CARRY IDENTIFICATION CARD
 FOLLOW – UP
 ANTI – CARVING AGENTS
 OTHER MEDICATIONS

51.  THREE MAJOR COMPONENTS OF
REHABILITATION :
a) Continued efforts to increase &
maintain high levels of motivation for
abstinence
b) Work to help patient readjust to a
lifestyle free of alcohol
c) Relapse prevention

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 Awareness among
professionals
 Early identification
 History taking- tactful,
confidential, in privacy,
without degrading patient

53. Distribution:
* Alcohol – 42%
* Opium – 20%
* Heroin – 13%
* Cannabis – 6.2%
* Others – 1.8%
the majority of drug addicts are aged
between 16 and 30 years.

56.  Prevalence low.
 Majority of Heavy Drug users
 Health and social problems are high

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 Heroin – Brown sugar, smack
 Morphine
 Pethidine
 Buprenorphine
 Fortwin – [Pentazocine]
 Dextropropoxyphene
 Codeine

58. Apathy
Bradycardia
Hypotension
Respiratory depression
Subnormal temperature
Pinpoint pupils
Delayed reflexes
Thready pulse and coma can occur

59.  Watery eyes
 Running nose
 Yawning
 Loss of appetite
 Irritability
 Tremors
 Sweating
 Nausea
 Diarrhoea
 Insomnia
 Raised body
temperature
 Piloerection
 Anorexia

60. Parkinsonism
Peripheral neuropathy
Transverse myelitis
Skin infection – IV use
Thrombophlebitis
Pulmonary embolism
Endocarditis
Septicemia
AIDS, viral hepatitiis, tetanus
Involvement in criminal activities

61. Overdose – narcotic antagonists ex-
naloxone, naltrexone
Detoxification – methadone, clonidine,
naltrexone, buprenorphine.
Maintenance – methadone, opioid
antagonists, psychological methods like
individual psychotherapy, behaviour
therapy, group therapy, family therapy

63. Derived from HEMP PLANT, CANNABIS
SATIVA
The dried leaves and flowering tops are
often referred as Ganja or Marijuna
The resin in the plant is referred as hashish
Bhang is a drink made from cannabis
Cannabis is either smoked or taken in
liquid form

64. Mild impairment of
consciousness and
orientation
Tachycardia
A sense of floating in
the air
Euphoria
Dream like states
Flashback
phenomena
Alteration in
psychomotor
activity
Tremors
Photophobia
Lacrimation
Dry mouth
Increased
appetite

65. Mostly found in the first 72-96 hours
Include :
* Incresed salivation
* Hyperthermia
* Insomnia
* Decreased appetite
* Loss of weight

66. Transient or short lasting psychiatric
disorders such as
# Acute anxiety
# Paranoid psychosis
# Hysteria
# Hypomania
# Schizophrenia
Amotivational syndrome
Memory impairment

67. Supportive and
symptomatic treatment

69. Common street name is ‘crack’
It can be administered orally, intranasally
by smoking, or parenterally.

70. Pupillary dialatation
Tachycardia
Hypertension
Sweating
Nausea
Hypo manic picture

71. Agitation
Depression
Anorexia
Fatigue
sleepiness

72. Acute anxiety reaction
Uncontrolled compulsive
behaviour
Seizures
Respiratory depression
Cardiac arrhythmias

73. Management of intoxication: amyl
nitrite is an antidote; diazepam or
propranolol is also used
Withdrawal symptoms:
antidepressants and psychotherapy.

75. Amphetamines are powerful CNS
stimulants with peripheral
sympathomimetic effects.
Commonly used Amphetamines are
pemoline and methylphenidate

76. Insomnia
Restlessness
Irritability
Paranoid
hallucinatory
syndrome
Amphetamine
induced
psychosis
Tachycardia
Hypertension
Cardiac failure
Seizures
Tremors
Hyperpyrexia
Pupillary dilatation
Panic

77. Depression
Apathy
Fatigue
Hypersomnia or
insomnia
Agitation
hyperphagia

78. Seisures
Delirium
Arrhythmias
Aggressive
behaviour
coma

79. LSD is a powerful
hallucinogen and was first
synthesized in 1938
It presumably produces is
effects by acting on 5-HT
levels in brain.
A common pattern of LSD
use is ‘trip’

80. Perceptual changes
occurring in clear
consciousness, for example,
Depersonalization
Derealisation
Illusions
Synaesthesia's
Autonomic hyperactivity
Marked anxiety
Paranoid ideation
Impairment of judgment

81. Flashbacks
Complications
Anxiety
Depression
Psychosis
Visual hallucinosis

82. Symptomatic treatment
Antianxiety
Antidepressants
Antipsychotic medications

84. Commonly abused
barbiturates are
* Secobarbital
* Pentobarbital
* Amobarbital

85. Irritability
Lability of mood
Disinhibited behaviour
Slurring of speech
Incoordination
Attention and memory
impairment

86. Skin abscesses
Cellulitis
Infection
Embolism
Hypersensivity reactions

87. Restlessness
Tremors
Seizures
Delirium tremens

88. Induce vomiting
Use of activated charcoal which reduce
absorption
Symptomatic treatment

91. Thank You