SEDATIVE, HYPNOTIC AND ANXIOLYTIC - 3 groups of drugs associated with this class of substance-related disorders Associated with physical and psychological dependence also withdrawal symptoms

1. MANAGEMENT OF SUBSTANCE RELATED
PSYCHIATRIC DISORDER
SEDATIVE, HYPNOTIC AND ANXIOLYTIC
DRUGS AND INHALANTS

2. SEDATIVE, HYPNOTIC AND
ANXIOLYTIC
3 groups of drugs associated with this class of substance-
related disorders
Benzodiazepines (diazepam, flurazepam, oxazepam)
Barbiturates (secobarbital, pentobarbital, secobarbital-
amobarbital combination)
Barbiturate-like substances (methqualone, meprobamate)
Can be used as antiepileptic, muscle relaxants, and
anaesthetics
Associated with physical and psychological dependence
also withdrawal symptoms

3. EPIDEMIOLOGY
• About 6% of individuals have used either sedatives or
tranquilizers illicitly
• Highest prevalence was 26- to 34- years of age
• Slight male predominance
• About one quarter to one third of all substance-related
emergency room visits involve substances of this class

4. ROUTES OF
ADMINISTRATION
• Oral
 Occasionally to achieve a time-limited specific effect
(young people)
 Regularly to obtain a constant usually, mild intoxication
(middle age people)
• Intravenous
 Young people intimately involved with illegal substances
 Highly associated with rapid and profound tolerance,
dependence and a severe withdrawal syndrome

5. DIAGNOSIS DSM-IV TR

6. DIAGNOSIS DSM-IV TR

7. FACTORS INFLUENCING
DEVELOPMENT OF WITHDRAWAL
• DOSAGE
• DURATION OF TREATMENT
• RATE OF TAPERING

8. MANAGEMENT
• According to bio psycho-social & spiritual model

9. MANAGEMENT WITHDRAWAL

10. MANAGEMENT OVERDOSE
• Gastric lavage
• Activated charcoal
• Careful monitoring of vital signs, CNS activity
• Benzodiazepine antagonist: Flumazenil

11. INHALANT DRUGS
 Are volatile hydrocarbon that are inhaled for psychotropic
effects.
 Eg : Toluene, n-hexane, methyl butyl ketone,
tricholoroethylene, trichloroethane, dichloromethane, gasoline,
butane.
 Sold in 4 commercial classes:
o Solvents for glue & adhesives
o Propellants for aerosol paint sprays, hair sprays, frying pan sprays,
shaving cream
o Thinners (paint products, typing correction fluids)
o Fuels

12. DIAGNOSIS DSM-IV TR

13. • Symptoms of mild intoxication similar to intoxication with alcohol or sedative-
hypnotics
• Possible toxic effects:
- Brain damage - Liver damage
- BM depression - Peripheral neuropathies
- Immunosuppression
Psychological effects Physical effects
Euphoria Ataxia
Belligerence Confusion
Assaultiveness Disorientation
Impaired judgment Slurred speech
Impulsiveness Dizziness
Depressed reflexes
Nystagmus

14. • Withdrawal rarely developed
• Characterized by:
Irritability
Sleep disturbances
Jitters
Sweats
Nausea, vomiting
Tachycardia
Hallucination & delusion (sometimes)

15. MANAGEMENT
• According to bio psycho-social & spiritual model
Investigations
Biology Psychosocial
Get information from family
members

16. MANAGEMENT

17. REFERENCES
• Kaplan & Sadock’s Pocket Handbook of Clinical
Psychiatry, 5th Edition
• Kaplan & Sadock’s Synopsis of Clinical Psychiatry, 10th
Edition