The document discusses the biological, psychological, and social complications that can arise from substance misuse. Biologically, substances can cause acute intoxication, chronic health effects, withdrawal symptoms, and interactions with pre-existing medical conditions. Psychologically, substances may lead to dependence and addiction as well as substance-induced disorders. Socially, substance misuse can result in failure to meet obligations, hazardous behaviors, legal problems, and interpersonal issues. The most common substances that are misused are alcohol, opiates, depressants, stimulants, hallucinogens, cannabis, and volatile substances. Clinically significant withdrawal symptoms typically occur with alcohol, opiates, nicotine, benzodiazepines, amphetamines
In this presentation I have tried to discuss in brief about obsessive compulsive disorder and its treatment both pharmacological and non pharmacological.
In this presentation I have tried to discuss in brief about obsessive compulsive disorder and its treatment both pharmacological and non pharmacological.
This a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
Mania is a facet of type I bipolar disorder in which the mood state is abnormally heightened and accompanied by hyperactivity and a reduced need for sleep.
A phobia is defined as the unrelenting fear of a situation, activity, or thing. These are largely under reported, probably because many phobia sufferers find ways to avoid the situations to which they are phobic. Statistics that estimate how many people suffer from phobias vary widely.
This a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
Mania is a facet of type I bipolar disorder in which the mood state is abnormally heightened and accompanied by hyperactivity and a reduced need for sleep.
A phobia is defined as the unrelenting fear of a situation, activity, or thing. These are largely under reported, probably because many phobia sufferers find ways to avoid the situations to which they are phobic. Statistics that estimate how many people suffer from phobias vary widely.
SUBSTANCE USE DISORDER
The term substance is used in reference to any drug, medication or toxin that shares the potential for abuse.
Addiction is a physiological and psychological dependence on alcohol or other drugs of abuse that affects the central nervous system in such a way that withdrawal symptoms are experienced when the substance is discontinued.
Abuse – refers to maladaptive pattern of substance use that impairs health.
Dependence – refers to certain physiological & psychological phenomena induced by repeated taking of a substance.
Tolerance – state in which after repeated administration, a drug produces a decreased effect or increasing doses are required to produce the same effect.
Withdrawal state – group of signs & symptoms recurring when a drug is reduced in amount or withdrawn, which last for a limited time.
CLASSIFICATION
F 10-19 Mental and behavioral disorders due to psychoactive substance use
F10 Mental and behavioral disorders due to use of Alcohol
F11 Mental and behavioral disorders due to use of Opiods
F12 Mental and behavioral disorders due to use of Cannabinoids
F13 Mental and behavioral disorders due to use of Sedatives or Hypnotics
F14 Mental and behavioral disorders due to use of Cocaine
F10 Mental and behavioral disorders due to use of Hallucinogens
COMMONLY USED PSYCHOTROPHC SUBSTANCES
Alcohol
Opiods
Cannabis
Cocaine
Amphetamines
Hallucinogens – LSD, Phencyclidine
Sedatives & Hypnotics –Barbiturates
Inhalants
Nicotine
Other stimulants-Caffeine
ETIOLOGY
Biological factors
Genetic vulnerability-family H/O substance use disorder
Biochemical factors- role of Dopamine & Nor epinephrine in cocaine, ethanol & opiod dependence, abnormalities in alcohol dehydrogenase play a role in alcohol dependence
Neurobiological theories- inborn deficiency of Endomorphins
Co-morbid medical disorder- to control chronic pain.
Behavioral Theories
Result of conditioning, reinforcement from drug use
Drug use causes euphoric experience perceived as rewarding, thereby motivating user to keep taking the drug
Psychological Factors
General Rebelliousness
Sense of Inferiority
Poor impulse control
Low self esteem
Inability to cope with the pressures of living and society
Loneliness, unmet needs
Desire to escape from reality
Desire to experiment, a sense of adventure
Pleasure seeking
Machoism
Sexual immaturity
Social Factors
Religious reasons
Peer pressure
Urbanization
Extended periods of education
Unemployment
Overcrowding
Poor social support
Effects of TV & other mass media
Occupation – more common in chefs, barmen, executives, salesman, actors, entertainers, army personnel, journalists, medical personnel etc
Easy availability of drugs
Taking drugs prescribed by doctors (diazepam)
Taking drugs that can be bought legally without prescription (Opiods, nicotine)
Taking drugs that can be obtained from illicit sources (street drugs)
Psychiatric disorders
Depression
Anxiety disorders
Personality disorders
Organic brain diseases
Schizophrenia
Alcohol is a CNS depressant drug that is used socially in our society for many reasons (e.g., to
enhance the flavor of food, to encourage relaxation and conviviality, for feelings of celebration, and as a
sacred ritual in some religious ceremonies). Therapeutically, it is the major ingredient in many
OTC/prescription medications. It can be harmless, enjoyable, and sometimes beneficial when used
responsibly and in moderation. Like other mind-altering drugs, however, it has the potential for abuse and,
in fact, is the most widely abused drug in the United States (research suggests 5% to 10% of the adult
population) and is potentially fatal. Frequently, the client in a residential care setting has been using alcohol
in conjunction with other drugs. It is believed that alcohol is often used by clients who have other mental
illnesses to assuage the pain they feel. The term “dual diagnosis” is used to mean an association between
the use/abuse of drugs (including alcohol) and other psychiatric diagnoses. It may be difficult to determine
cause and effect in any given situation to determine an accurate diagnosis. However, it is important to
recognize when both conditions are present so that the often-overwhelming problems of treatment are
instituted for both conditions.
This plan of care addresses acute intoxication/withdrawal and is to be used in conjunction with CP:
Substance Dependence/Abuse Rehabilitation.
1. Complications of Substance Misuse
Substance misuse is a maladaptive pattern of substance use, resulting
in significant complications, using the Bio-Psycho-Social model:
Biological Complications:
Acute Intoxication = Reversible abnormalities caused by the direct effects of the substance
Chronic effects:
o Exacerbation of Pre-existing disorders e.g. Anabolic Steroids and Hypertension
o Cognitive Impairment Syndromes e.g. ↓Thiamine Wernicke’s Encephalopathy
o Residual Disorders = Continuing symptoms, even when drug has been stopped
E.g. LSD Flashbacks
Withdrawal = Where there is Physical dependence on a drug, stopping it Symptoms.
o Clinically significant withdrawal is seen in:
Alcohol / Opiates / Nicotine / Benzodiazepines / Amphetamines and Cocaine.
Psychological Complications
Dependence = ‘Addiction’:
o Physical adaptations e.g. ↑No of Nicotine receptors in Smoking, need more to get the
same effects.
o Behavioural adaptations e.g. won’t have fun / escape feelings without having the drug.
Substance Induced Psychotic Disorder e.g. Cannabis Relapsing Schizophrenia
Socially Complications
Failure to fulfil usual obligations at Home / School / Work
o Home Children taken into Social Services
o School Expulsion, unable to complete education for
qualifications
o Work Unemployment and subsequent reliance on Benefits
Hazardous Behaviour = Dangerous driving / Criminal activity
Legal Problems = Arrest for: Possession of drugs, Disorderly conduct or
loss of Children
Interpersonal problems = Arguments and fights with Spouse
Alcohol
Acute: ↓LOC↑Risk of accidents + Aspiration; Hypoglycaemia; Acute renal failure and Coma.
Chronic:
o Hepatic Fatty Liver / Alcoholic Hepatitis / Cirrhosis / Hepatocellular Cancer
o GI Gastritis / Barrett’s / Mallory Weiss / Peptic Ulcers / Diarrohea / Pancreatitis
o CVS HTN / Dilated Cardiomyopathy / AF / CVA
o Resp TB / Klebsiella and Pneumococcal Pneumonia
2° to: Poor nutrition and self-neglect
o Neuro Peripheral Neuropathy / Cerebellar Degeneration / Optic
Atrophy
o GUM Erectile Dysfunction and Hypogonadism (Men)
o Others Fetal Alcohol Syndrome / Osteoporosis
Withdrawal Sweating; Nausea; Delirium Tremens and Seizures
Psychiatric: Amnesia; Hallucinations; Delusions; Dementia; Pathological
jealousy and Wernicke’s leading to Korsakoff’s.
o Also exacerbates existing Anxiety and
Depression.
2. Drugs
Opiates:
= Heroin / Dihydrocodeine / Methadone / Codeine / Buprenorphine / Pethidine
Acute Nausea; Vomiting; Constipation; Respiratory Depression and ↓LOC Aspiration
Injecting Local Abscesses; Cellulitis; Osteomyelitis; Bacterial Endocarditis; Septicaemia
and the transmission of Blood Bourne Viruses (BBV’s)
Withdrawal Sweating / Dilated pupils / Tachycardia /
HTN / Piloerection / Watering Eyes and Nose / Yawning
/ Abdominal Cramping / Nausea, Vomiting and
Diarrohea / Tremor.
o NB: Opiate withdrawal is unpleasant, but
generally not medically dangerous
Heroin is one of the most addictive drugs on the planet –
alongside smoking and alcohol
Depressants:
= Benzodiazepines / Barbituates / GHB (Gamma-Hydroxybutyrate) / Rohypnol
NB: Often used to counteract the unpleasant side effects of other drugs
of abuse
Acute Forgetfulness / Drowsiness/ ↓Consciousness and Co-ordination
o Rohypnol (Date Rape) can cause Anteroretrograde Amnesia
o Barbiturates can cause Respiratory Depression
Injecting Limb Ischemia and risks of Blood Bourne Viruses / Abscesses
Withdrawal Anxiety / Insomnia / Tremor / Agitation / Headache / Nausea /
Sweating / Depersonalisation / Seizures and Delirium
Stimulants:
= Ecstasy / Amphetamines / Cocaine
Acute Arrythmias; Intense Anxiety; HTN ( CVA); Impulsivity and
Impaired judgement
o Ecstasy and Amphetamines Hyperpyrexia and ↑Sweating
o Ecstasy in particular has been the cause of many
dehydration deaths.
Chronic:
o Ecstasy Neurotoxicity; Hepatotoxicity and Cognitive impairment
o Amphetamines Anxiety and depressive symptoms
o Cocaine Nasal Septum necrosis; fetal damage; panic and
anxiety disorders; persecutory delusions and Psychosis.
Dependency:
o ↓ Dependency for Ecstasy or Amphetamines – other than
psychological addiction e.g. Will have more fun at the party tonight if I take it.
o Cocaine is associated with Classical dependence – with a compulsive pattern
Hallucinogens:
= LSD / Magic Mushrooms / Ketamine
Acute Behavioural Toxicity (“I can fly”) and Bad Trips
Dissociation, fear, incipient madness and frightening perceptions.
o Mushrooms can also GI Symptoms + Risk of consuming
toxic fungi!
o Ketamine can also Nausea/ Ataxia and Slurred Speech
Chronic Flashbacks; Persistent Psychosis; Persistent Anxiety /
Depressive symptoms
NB: There is no risk of overdose, physiological dependence or withdrawal
3. Cannabis:
Acute Mild Paranoia / Panic attacks / Accidents and ↓Reaction times
Chronic Dysthymia / Anxiety and Depression / ‘Amotivational syndrome’
and it can precipitate or cause a relapse of Schizophrenia.
Withdrawal May occur in a heavy user, symptoms: Insomnia, anxiety
and irritability
NB: There are no reports of fatal overdose and there is little physical
dependency.
Anabolic Steroids
= Nandrolone and Stanozolol
o Prescription medication – legitimately used to Rx: Aplastic
Anaemia and Osteoporosis, but abused by Body Builders
and Athletes Enhance performance
Medically Hypertension; Hypogonadism; Gynaecomastia;
Amenorrhoea; Liver Damage; Impotence and Male pattern
baldness
Psychiatric Acute emotional instability (‘Roid Rage’);
↑Aggressiveness; Persecutory/ Grandiose delusions; Depression and Chronic Fatigue.
NB: There is no withdrawal syndrome, but injecting Steroids can lead to infections.
Other drugs misused by Athletes = Thyroxine / GH / Diuretics / Epo / Amphetamines
Volatile Substances
= Glue / Solvents / Lighter fuel / Paint Stripper / Fire Extinguishers / Aerosols / Paints/
Petrol / Correction fluid and Nail Varnish Remover
All contain simple hydrocarbons:
Acetone, Toluene, Xylene and Butane
Acute Local irritation; Headache; Cardiac Arrhythmias;
Suffocation (Bag or Laryngeal Oedema); LOC; Aspiration
and Sudden Death.
Chronic Liver and Kidney damage and Cognitive
impairment
Withdrawal Similar to Alcohol e.g. Sweating / Nausea /
Tremors
Patients can become psychologically dependent upon it.
Key Points:
1. Use of any drugs can have Biological, Psychological and Social Complications
2. The most common drugs of abuse include:
o Alcohol / Opiates / Depressants / Stimulants / Hallucinogens / Cannabis and Volatile
Substances
3. Clinically Significant withdrawal is only seen in:
o Alcohol / Opiates / Nicotine / Benzodiazepines / Amphetamines and Cocaine.
o This is what makes these the most addictive drugs.
4. Other drugs can also become addictive because of their ability to:
a. Create associations with: Friends and Pleasurable experiences
b. Allow a degree of Escapism from reality
c. Allow the user to achieve a previously unreachable goal e.g. Anabolic Steroids
5. Always ask if a drug is being injected – because this creates an additional risk of Blood
Bourne Viruses, Infections e.g. Abscesses and Endocarditis and Blood clots.
References:
Semple, D. Oxford Handbook of Psychiatry: 2nd
Edition. Oxford University Press; 2009
Bourke, Castle and Cameron. Crash Course Psychiatry. 3rd
Edition. Mosby Elsevier; 2008