This document provides information on substance-related disorders including substance abuse, dependence, withdrawal, and intoxication. It defines substance abuse and dependence based on DSM-IV criteria. It describes the epidemiology, categories, and effects of commonly abused substances like stimulants, depressants, opiates, hallucinogens, inhalants, and caffeine. For each substance or class, it summarizes intoxication, withdrawal, treatment approaches, and diagnostic evaluation.
Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. This overstimulation of the reward circuit causes the intensely pleasurable "high" that leads people to take a drug again and again.
Overview of substance abuse/addiction prevention principles including risk and protective factors. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. This overstimulation of the reward circuit causes the intensely pleasurable "high" that leads people to take a drug again and again.
Overview of substance abuse/addiction prevention principles including risk and protective factors. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
drug abuse- what is it? most common stimulants, cocaine abuse, aderall abuse, meth abuse, physiology of drug abuse, physical signs of drug abuse, treatment
Drug & substance abuse Marijuana, Cocaine, Heroine, alcohol and prescription...OrnellaRN
Risk Factors, Effects on the brain,Symptoms, Warning signs and treatment.
Drugs and substances such as marijuana, cocaine and heroine are not the only substances that can be abused. Alcohol, prescription drugs and over-the-counter medications, inhalant and solvents, sedatives, coffee and cigarettes.
A DSM 5 Update: Substance - Related And Addictive DisordersChat 2 Recovery
Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5.
Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City.
Includes:
Changes in the diagnostic criteria from the DSM–IV to the DSM-5
The distinction between Substance Use Disorders and the Substance - Induced Disorders
Recording procedures for Substance Related Disorders
Alcoholism has became the one of the leading cause for kidney and liver diseases. In India alcoholism is the root cause of poverty, unemployment, domestic conflicts, occupational disputes and deaths all together. Several Indian studies have shown the increased risk of suicide due to alcohol dependency. Thus it has became the global cause for depletion of human species all way round. Awareness, prevention, promotion, restoration and maintenance of health should be held up as essential base to work on for diverting the substance use/abuse and misuse and directing towards the sober community norms step by step to reduce intoxication, dependency, tolerance, conditioned learning and addiction as a whole.
This PPT is based on Drug Addiction & Abuse..Anyone who is interested to download this ppt ,can comment on the comment section with their email id. I can assure you that I will send this original ppt to your email.
life skills are the skills required for every human being in the universe by which they can make their life more easier. these are soft skills for the betterment of life. even though they are illiterate they need life skills.
drug abuse- what is it? most common stimulants, cocaine abuse, aderall abuse, meth abuse, physiology of drug abuse, physical signs of drug abuse, treatment
Drug & substance abuse Marijuana, Cocaine, Heroine, alcohol and prescription...OrnellaRN
Risk Factors, Effects on the brain,Symptoms, Warning signs and treatment.
Drugs and substances such as marijuana, cocaine and heroine are not the only substances that can be abused. Alcohol, prescription drugs and over-the-counter medications, inhalant and solvents, sedatives, coffee and cigarettes.
A DSM 5 Update: Substance - Related And Addictive DisordersChat 2 Recovery
Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5.
Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City.
Includes:
Changes in the diagnostic criteria from the DSM–IV to the DSM-5
The distinction between Substance Use Disorders and the Substance - Induced Disorders
Recording procedures for Substance Related Disorders
Alcoholism has became the one of the leading cause for kidney and liver diseases. In India alcoholism is the root cause of poverty, unemployment, domestic conflicts, occupational disputes and deaths all together. Several Indian studies have shown the increased risk of suicide due to alcohol dependency. Thus it has became the global cause for depletion of human species all way round. Awareness, prevention, promotion, restoration and maintenance of health should be held up as essential base to work on for diverting the substance use/abuse and misuse and directing towards the sober community norms step by step to reduce intoxication, dependency, tolerance, conditioned learning and addiction as a whole.
This PPT is based on Drug Addiction & Abuse..Anyone who is interested to download this ppt ,can comment on the comment section with their email id. I can assure you that I will send this original ppt to your email.
life skills are the skills required for every human being in the universe by which they can make their life more easier. these are soft skills for the betterment of life. even though they are illiterate they need life skills.
Internet Addiction , causes , symptoms and consequences Chetan Pandey
Now days new types of addiction is arising that is Internet addiction. This presentation clear all your doubts about internet addiction. Also this presentation will also tell you about different types of Internet addiction. Its harmful effects towards your health as well as to your surrounding people and this presentation will also tell you about how internet addiction can effect your relationships.
Porn industry including porn web sites overview. Includes: Main porn sites
Key porn facts
Porn content
Porn search keywords
Porn industry revenue
Top porn stars
Popular movies
How Pornography Affects Developing Brains - Dr. Jennifer Brownucap4utah
Dr. Jennifer Brown has done extensive research on the effects of pornography on children's developing brains. This PowerPoint presentation details some of the main points of her study. Dr. Brown presented this information to the Prevent Child Abuse Utah Joining Forces Conference in October 2014. This research was also instrumental in passing S.B. 227 in Utah to allow a judge to reduce or restrict custody if a parent has intentionally exposed their child to pornography.
DIET CLINIC, which provides unique, professionally supervised effective weight Loss & Therapeutic Diets programs to its clients.
NOW At Diet Clinic, Success can be Yours when you join the Diet Clinic with expert ‘tips’ and ‘advise’ from expert Dieticians. You can start losing weight and feeling better than you have, over the years, while you still eat your ‘favorites,’ whenever you feel. All these, can be achieved thru our ‘expert diet plan’ which takes all guess work out of dieting so you feel full and satisfied as you lose weight.
At Diet Clinic, we offer a different approach to weight loss. Our commitment is to help you regain a healthy and comfortable weight!
These slides are meant to educate parents and teenagers about key features of Attention-Deficit/Hyperactivity Disorder (ADHD) in adolescence. They present scientific facts and correct popular myths about ADHD symptoms, related personality and social characteristics and treatment options for teens
Presented by Nikola Sudijovski at SkopjeTechMeetup 8.
Looking back at all the progress humanity has made through the last few centuries, it's perfectly natural to feel a little bit moved by the power of human ingenuity and our thrive for constant improvement. It's natural, but also (for the most part) wrong. If we really looked into the history of our technological development, we'd notice а pretty intriguing pattern, often intentionally left unmentioned. Well, that is, until now.
Effective treatment for drug addiction in Mindheal Homeopathy clinic ,Chembur...Shewta shetty
"Drug Addiction- drug addiction is characterized by the use of narcotic drugs or alcohol excessively so that when its usage is stopped withdrawal symptoms are manifested in the body. Drug addiction is a complex but treatable condition. It can be treated by proper rehabilitation of the patient along with mindheal therapy."/>
Psycotropics, anti psycotics 1st and second generation,anti parkinsons, anti depressants mood stabilizers, sedative hypnotics side effects, management of side effects
Quality use of medicines in geriatric patients with their Physiological changes with aging, altered Pharmacokinetics and Pharmacodynamics with ADR's, Guidelines for prescribing the older people and the role of clinical pharmacist in geriatric prescribing.
Homeopathic Doctor - Dr. Anita Salunke homeopathic clinic for Drug Addiction ...Shewta shetty
Homeopathic Doctor Anita Salunke practices in Chembur, Mumbai, India in her homeopathic clinic Mindheal. Find more information about homeopathic treatment at Mindheal. Welcome to safe, sure and effective homeopathic treatment Drug Addiction
Introduction
Substance misuse disorders
Stages of change and harm reduction
Alcohol: diagnostic criteria, assessment, complications and treatment
Terms related to drugs, ‘street names’
Assessment of drug user, treatment plan
Opiates: detox and maintenance
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. SUBSTANCE ABUSE
• Substance abuse is significant problem for
the society and healthcare system all over
the world .
• Substance abuse is a patterned use of a
substance (drug) in which the user consumes
the substance in amounts or with methods
neither approved nor supervised by medical
professionals
3. SUBSTANCE ABUSE
DIAGNOSIS AND DSM-IV CRITERIA
Abuse is a pattern of substance use leading to impairment
or distress for at least 1 year with one or more of the
following manifestations :
1. Failure to fulfill obligations at work, school, or home
2. Use in dangerous situations (i.e., driving a car)
3. Recurrent substance-related legal problems
4. Continued use despite social or interpersonal problems
due to the substance use
5. SUBSTANCE DEPENDENCE
DIAGNOSIS AND DSM-IV CRITERIA
Dependence is substance use leading to impairment or
distress manifested by at least three of the following within a
12-month period :
1. Tolerance
2. Withdrawal
3. Using substance more than originally intended
4. Persistent desire or unsuccessful efforts to cut down on use
5. Significant time spent in getting, using, or recovering from
substance
6. Decreased social, occupational, or recreational activities
because of substance use
7. Continued use despite subsequent physical or psychological
problem (e.g., drinking despite worsening liver problems)
6. Cont …
• Psychological dependence:
Crave for taking the drug or substance is
progressive :
need → mild desire → craving → compulsion.
• Physical dependence
It is adaptation at the cellular level to drugs such
that when the drug is abruptly stopped , there is
a characteristic withdrawal or abstinence
syndrome
7. Cont …
A diagnosis of substance
dependence supersedes a
diagnosis of substance abuse.
8. Cont …
Withdrawal
The development of a substance-specific
syndrome due to the cessation of
substance use that has been heavy and
prolonged
Tolerance
The need for increased amounts of the
substance to achieve the desired effect
or diminished effect if using the same
amount of the substance
9. EPIDEMIOLOGY
• Lifetime prevalence of substance abuse or
dependence in the United States:
Approximately 17%
• More common in men than women
• Caffeine, alcohol, and nicotine are the most
commonly used substances.
• Depressive symptoms are common among
persons with substance abuse or
dependence.
10. Categories of drugs
of abuse
• Stimulants e.g. amphetamine, cocaine .
• Depressants e.g. benzodiazepines ,
barbiturates, alcohol, GHB.
• Opiates e.g. heroin, methadone, codeine,
buprenorphine , pethidine.
• Hallucinogens e.g. LSD, PCP, mushrooms,
ketamine.
• Others e.g. cannabis, volatile substances,
nicotin.
11. Stimulants
• These drugs potentiate neuro-transmission and
increase cortical excitability producing effects of
increased alertness and endurance, diminished
need for sleep, and a subjective sense of wellbeing.
• Include cocaine (and crack cocaine),
amphetamines, MDMA or (ecstasy), and
caffeine.
12. COCAINE
Cocaine blocks dopamine reuptake from the
synaptic cleft, causing a stimulant effect.
Dopamine plays a role in behavioral
reinforcement (“reward” system of the
brain).
13. Cocaine Intoxication
CLINICAL PRESENTATION
Cocaine intoxication often produces
euphoria, increased or decreased blood
pressure, tachycardia or bradycardia,
nausea, dilated pupils, weight loss,
psychomotor agitation or depression,
chills, and sweating.
It may also cause respiratory depression,
seizures, arrhythmias, and hallucinations
(especially tactile).
14. Cont …
Since cocaine is an indirect sympathomimetic,
intoxication mimics the fight-or-flight response.
• Cocaine’s vasoconstrictive effect may result in
myocardial infarction (MI) or cerebrovascular
accident (CVA).
• Chronic harmful effects include necrosis of nasal
septum, foetal damage, panic and anxiety disorders,
persecutory delusions, and psychosis.
• No tolerance.
• No physical dependence.
15. Cont …
DIFFERENTIAL DIAGNOSIS
Amphetamine or phencyclidine (PCP)
intoxication, sedative withdrawal
DIAGNOSTIC EVALUATION
Urine drug screen (positive for 3 days,
longer in heavy users)
16. TREATMENT
Intoxication
1. For mild-to-moderate agitation: Benzodiazepines
2. For severe agitation or psychosis: Haloperidol
3. Symptomatic support (i.e., control hypertension,
arrhythmias)
Dependence
1. Psychotherapy, group therapy
2. Tricyclic antidepressants (TCAs)
3. Dopamine agonists (amantadine, bromocriptine)
17. Cocaine Withdrawal
Abrupt abstinence is not life threatening but
produces a dysphoric “crash”: malaise, fatigue,
depression, hunger, constricted pupils, vivid
dreams, psychomotor agitation or retardation .
TREATMENT
Usually supportive—let patient sleep off crash.
18. AMPHETAMINES
Classic amphetamines: Dextroamphetamine (Dexedrine),
methylphenidate (Ritalin), methamphetamine (Desoxyn, ice,
speed, “crystal meth,”“crack”)
Substituted (“designer”) amphetamines: MDMA (ecstasy),
MDEA (eve)
Classic amphetamines release dopamine from nerve endings,
causing a stimulant effect. They are used medically in the
treatment of narcolepsy, attention deficit hyperactivity
disorder (ADHD), and depressive disorders.
Designer amphetamines release dopamine and serotonin
from nerve endings and have both stimulant and
hallucinogenic properties.
19. Amphetamine Intoxication
CLINICAL PRESENTATION
Amphetamine intoxication causes symptoms
similar to those of cocaine.
DIFFERENTIAL DIAGNOSIS
Cocaine or PCP intoxication. Chronic use in
high doses may cause a psychotic state
that is similar to schizophrenia.
20. Cont …
DIAGNOSTIC EVALUATION
Urine drug screen (positive for 1 to 2 days). A negative
routine drug screen does not rule out amphetamine use,
since most assays are not of adequate sensitivity.A
negative drug screen can never completely rule out
substance abuse or dependence.
TREATMENT
Similar to cocaine
Amphetamine Withdrawal
Similar to cocaine withdrawal
21. SEDATIVES-HYPNOTICS
• Drugs of this group produce their effects by
generalised or specific cortical depression.
• They include the benzodiazepines, alcohol, and
the barbiturates.
• They are taken for their anxiolytic and relaxant
properties alone, or as a way of counteracting
unpleasant side-effects of other drugs of abuse.
• These drugs are highly abused in the United
States since they are more readily available than
other drugs such as cocaine or opioids.
22. SEDATIVES-HYPNOTICS
Benzodiazepines (BDZs) are commonly used in the
treatment of anxiety disorders and are therefore
obtained easily via prescription. They potentiate the
effects of GABA by increasing the frequency of
chloride channel opening.
Barbiturates are used in the treatment of epilepsy
and as anesthetics, and they potentiate the effects
of GABA by increasing the duration of chloride
channel opening. At high doses they act as direct
GABA agonists and have a lower margin of safety
relative to BDZs.
23. Cont …
In combination BDZs and barbiturates are
synergistic due to their complementary
effect on GABA channel opening.
Respiratory depression can occur as a
complication.
24. Cont ..
Sedative-Hypnotic Intoxication
• Intoxication with sedatives produces drowsiness,
slurred speech, incoordination, ataxia, mood lability,
impaired judgment, nystagmus, respiratory
depression, and coma or death in overdose
(especially barbiturates). Symptoms are augmented
when combined with EtOH.
•
Long-term sedative use causes dependence.
• Tolerance develops rapidly (with cross tolerance to all
drugs in the benzodiazepine group & with
barbiturates), so requiring increasing doses to achieve
similar effects.
25. Cont …
DIFFERENTIAL DIAGNOSIS
Alcohol intoxication, generalized cerebral
dysfunction (i.e., delirium)
DIAGNOSTIC EVALUATION
Urine or serum drug screen (positive for 1
week), electrolytes, electrocardiogram
26. Cont …
TREATMENT
•
•
Maintain airway, breathing, and circulation.
Activated charcoal to prevent further gastrointestinal
absorption
• For barbiturates only: Alkalinize urine with sodium
bicarbonate to promote renal excretion.
• For benzodiazepines only: Flumazenil in overdose
• Supportive care—improve respiratory status, control
hypotension
27. Cont …
Sedative-Hypnotic Withdrawal
Abrupt abstinence after chronic use can be life threatening.
While physiological dependence is more likely with shortacting agents, longer-acting agents can also cause withdrawal
symptoms.
CLINICAL PRESENTATION
Symptoms of autonomic hyperactivity (tachycardia, sweating,
etc.), insomnia, anxiety, tremor, nausea/vomiting, delirium,
and hallucinations. Seizures may occur and can be life
threatening.
TREATMENT
Administration of a long-acting benzodiazepine such as
chlorodiazepoxide or diazepam, with tapering of the dose
Tegretol or valproic acid may be used for seizure control.
28. OPIATES
Examples: Heroin, codeine, dextromethorphan,
morphine, methadone, meperidine (Demerol).
These compounds stimulate opiate receptors
(mu , kappa, and delta), which are normally
stimulated by endogenous opiates and are
involved in analgesia, sedation, and
dependence. Opiates also have effects on the
dopaminergic system, which mediates their
addictive and rewarding properties. Endorphins
and enkephalins are endogenous opiates.
29. Cont …
Opiate Intoxication
Opiate intoxication causes drowsiness, nausea/vomiting, constipation,
slurred speech, constricted pupils, seizures, and respiratory
depression, which may progress to coma or death in overdose.
Meperidine and monoamine oxidase inhibitors taken in combination
may cause the serotonin syndrome: Hyperthermia, confusion,
hyper- or hypotension, and muscular rigidity.
DIFFERENTIAL DIAGNOSIS
Sedative-hypnotic intoxication, severe EtOH intoxication
DIAGNOSTIC EVALUATION
Rapid recovery of consciousness following the administration of
intravenous (IV) naloxone (opiate antagonist) is consistent with
opiate overdose. Urine and blood tests remain positive for 12 to 36
hours.
30. TREATMENT
Intoxication
Ensure adequate airway, breathing, and circulation.
Overdose
Administration of naloxone or naltrexone (opiate antagonists) will
improve respiratory depression but may cause severe
withdrawal in an opiate-dependent patient. Ventilatory support
may be required.
Dependence
Oral methadone once daily, tapered over months to years
Psychotherapy, support groups (Narcotics Anonymous, etc.)
31. Opiate Withdrawal
CLINICAL PRESENTATION
While not life threatening, abstinence in the opiatedependent individual leads to an unpleasant withdrawal
syndrome characterized by dysphoria, insomnia,
lacrimation, rhinorrhea, yawning, weakness, sweating,
piloerection, nausea/vomiting, fever, dilated pupils, and
muscle ache.
TREATMENT
Moderate symptoms: Clonidine and/or buprenorphine
Severe symptoms: Detox with methadone tapered over 7
days.
32. HALLUCINOGENS
• Hallucinogens (or psychedelics) are a
heterogeneous group of natural and synthetic
substances which produce altered sensory and
perceptual experiences.
• They include: lysergic acid diethylamide (LSD),
phenylcyclidine (PCP), ketamine, mescaline and
dimethyltriptamine (DMT).
33. HALLUCINOGENS
Pharmacological effects vary, but LSD is
known to act on the serotonergic system.
Tolerance to hallucinogens develops
quickly but reverses rapidly after
cessation. Hallucinogens do not cause
physical dependence or withdrawal.
34. Cont …
Hallucinogen Intoxication
Hallucinogens cause perceptual changes,
papillary dilation, tachycardia, tremors,
incoordination, sweating, and palpitations.
TREATMENT
Guidance and reassurance (“talking down”
the patient) are usually enough. In severe
cases, antipsychotics or benzodiazepines
may be used.
35. Cont …
Hallucinogen Withdrawal
No withdrawal syndrome is produced, but
patients may experience “flashbacks” later
in life (recurrence of symptoms due to
reabsorption from lipid stores).
36. PHENCYCLIDINE (PCP)
PCP, or “angel dust,” is a hallucinogen that
antagonizes N-methyl-D-aspartate
(NMDA) glutamate receptors and activates
dopaminergic neurons.
Ketamine is similar to PCP. Both were
developed as anesthetic agents.
37. Cont …
PCP Intoxication
Intoxication with PCP causes recklessness,
impulsiveness, impaired judgment, assaultiveness,
rotatory nystagmus, ataxia, hypertension,
tachycardia, muscle rigidity, and high tolerance to
pain. Overdose can cause seizures or coma.
38. Cont …
TREATMENT
• Monitor blood pressure, temperature, and
electrolytes.
• Acidify urine with ammonium chloride and ascorbic
acid.
• Benzodiazepines or dopamine antagonists to
control agitation and anxiety
• Diazepam for muscle spasms and seizures
• Haloperidol to control severe agitation or psychotic
symptoms
39. Cont …
DIFFERENTIAL DIAGNOSIS
Acute psychotic states, schizophrenia
DIAGNOSTIC EVALUATION
Urine drug screen (positive for > 1 week). Creatine
phosphokinase (CPK) and aspartate
aminotransferase (AST) are often elevated.
PCP Withdrawal
No withdrawal syndrome, but “flashbacks” may
occur
40. MARIJUANA
The main active component in marijuana, or
cannabis, is THC (tetrahydrocannabinol).
Cannabinoid receptors in the brain inhibit
adenylate cyclase. Effects are increased
when used with EtOH.
Marijuana has been shown to successfully treat
nausea in cancer patients and to increase
appetite in AIDS patients
No dependence or withdrawal syndrome has
been shown.
41. Marijuana Intoxication
Marijuana causes euphoria, impaired coordination, mild
tachycardia, conjunctival injection, dry mouth, and
increased appetite.
Marijuana can be smoked or eaten.
TREATMENT
Supportive and symptomatic
DIAGNOSTIC EVALUATION
Urine drug screen is positive for up to 4 weeks in heavy
users (released from adipose stores).
42. Marijuana Withdrawal
CLINICAL PRESENTATION
No withdrawal syndrome, but mild irritability,
insomnia, nausea, and decreased appetite
may occur in heavy users.
TREATMENT
Supportive and symptomatic
43. INHALANTS
Examples: Solvents, glue, paint thinners, fuels, isobutyl
nitrates (“rush,” “locker room,” “bolt”). Inhalants generally
act as CNS depressants. User is typically an adolescent
male.
Inhalant Intoxication
Inhalants may cause impaired judgment, belligerence,
impulsivity, perceptual disturbances, lethargy, dizziness,
nystagmus, tremor, muscle weakness, hyporeflexia, ataxia,
slurred speech, euphoria, stupor, or coma. Overdose may
be fatal secondary to respiratory depression or
arrhythmias. Long-term use may cause permanent
damage to CNS, peripheral nervous system (PNS), liver,
kidney,and muscle.
44. TREATMENT
• Monitor airway, breathing, and circulation.
• Symptomatic treatment as needed
• Psychotherapy and counseling for dependent patients
DIAGNOSTIC EVALUATION
Serum drug screen (positive for 4 to 10 hours)
Inhalant Withdrawal
A withdrawal syndrome does not usually occur, but
symptoms may include irritability, nausea, vomiting,
tachycardia, and occasionally hallucinations.
45. CAFFEINE
Caffeine is the most commonly used
psychoactive substance in the United
States, usually in the form of coffee or tea.
Caffeine acts as an adenosine antagonist,
causing increased cyclic adenosine
monophosphate (cAMP) and a stimulant
effect via the dopaminergic system.
46. Caffeine Intoxication
CLINICAL PRESENTATION
Intoxication may occur with consumption of over 250
mg of caffeine. Signs and symptoms include
anxiety, insomnia, twitching, rambling speech,
flushed face, diuresis, gastrointestinal disturbance,
and restlessness. Consumption of more than 1
gram of caffeine may cause tinnitus, severe
agitation, and cardiac arrhythmias. In excess of 10
g, death may occur secondary to seizures and
respiratory failure.
TREATMENT
Supportive and symptomatic
47. Cont …
Caffeine Withdrawal
Withdrawal symptoms resolve within 1 week and
include headache, nausea/vomiting, drowsiness,
anxiety, or depression.
TREATMENT
Taper consumption of caffeine-containing
products. Use analgesics to treat headaches.
Rarely, a short course of benzodiazepines may
be indicated to control anxiety.
48. NICOTINE
Nicotine is derived from the tobacco plant and
stimulates nicotinic receptors in autonomic
ganglia of the sympathetic and parasympathetic
nervous systems.
Cigarette smoking poses many health risks, and
nicotine is rapidly addictive through its effects on
the dopaminergic system.
49. Cont …
Nicotine Intoxication
Nicotine acts as a CNS stimulant and may cause
restlessness, insomnia, anxiety, and increased
gastrointestinal motility. Tobacco users report
improved attention, improved mood, and
decreased tension.
TREATMENT
Cessation
50. Cont …
Nicotine Withdrawal
Withdrawal causes intense craving, dysphoria,
anxiety, increased appetite, irritability, and
insomnia.
TREATMENT
Smoking cessation with the aid of:
1. Behavioral counseling
2. Nicotine replacement therapy (gum, transdermal
patch)
3. Zyban—antidepressant that helps reduce
cravings
4. Clonidine
Relapse after abstinence is common.
51. Thank you
References:
1- Jaffe JH, Anthony JC. Substance-related disorders: introduction and
overview. In: Sadock BJ, Sadock VA, eds. Kaplan & Sadock's
Comprehensive Textbook of Psychiatry. 8th ed. Vol. 1. Baltimore: Lippincott
Williams & Wilkins; 2005:1137.
2- Anthony JC. Epidemiology of drug dependence. In: Galanter M, Kleber
HD, eds. Textbook of Substance Abuse Treatment. 3rd ed. Washington,
DC: The American Psychiatric Press, Inc.; 2003.
Editor's Notes
Substance abuse/drug abuse is not limited to mood-altering or psycho-active drugs. If an activity is performed using the objects against the rules and policies of the matter (as in steroids for performance enhancement in sports), it is also called substance abuse. Therefore, mood-altering and psychoactive substances are not the only types of drugs abused
Tolerance: is the need to increase a dose to achieve the desired effect.
cross tolerance: i.e. development of tolerance to a drug to which the person has never been exposed, because it contains characteristics similar to those of a drug for which tolerance has developed.
Crack cocaine is the freebase form of cocaine that can be smoked
MDMA (3,4-methylenedioxy-N-methylamphetamine
The main route of intake is by inhalation as it undergoes rapid first pass liver metabolism.
Acute harmful effects include arrhythmias, intense anxiety, hypertension and CVA and impaired judgement.
Psychic dependence is produced.
No tolerance.
No physical dependence.
Cocaine overdose can cause death secondary to cardiac arrhythmia , seizure or respiratory depression .
-methylenedioxy-N-ethylamphetamine
There is chemical similarity to noradrenaline and dopamine, producing similar pharmacological effects to cocaine, but its slower metabolism gives a longer duration of action.
Intravenous administration , pill, smoked
Acute harmful effects include tachycardia, arrhythmias, hyperpyrexia. Irritability, post-use depression, and quasi-psychotic state with visual, auditory, and tactile hallucinations.
Anxiety and depressive symptoms are frequently seen in users w/ psychological dependence.
They have therapeutic uses as anxiolytics, hypnotics, anti-convulsants, and muscle relaxants.
All have similar effects and are distinguished by their length of action: short-acting (e.g. temazepam, oxazepam), medium-acting (e.g. lorazepam, alprazolam), long-acting (e.g. diazepam, nitrazepam, chlordiazepoxide).
They enhance GABA transmission and produce marked anxiolytic and euphoriant effects.
The opiates are a group of chemicals derived from the opium poppy ; synthetic compounds with similar properties are called opioids.
Have potent analgesic , euphoriant and anxiolytic properties.
Heroin is the most frequently abused opiate.
These include also dihydrocodeine, morphine, methadone, pethidine, buprenorphine, and codeine.
Classic triad of opioid
overdose:
Respiratory depression
Altered mental status
Miosis
“Rebels Admire Morphine
α2 adrenergic agonist.
a semi-synthetic opioid
The forcing of a fluid into the conjuctiva, the mucous membrane that lines the eyelids.