other substance use disorders

1. OTHER SUBSTANCE USE
DISORDERS
-SUHANYA RAJ V

2. Opioid use disorders
SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT 2

3. INTRODUCTION
In the last few decades ,the use of opioid s has
increased markedly world over. The most
important dependence producing derivatives are
morphine ,heroin. The overuse of opioids leads
to distress and impairment .Opioids abuse and
addiction is a serious public issue.
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4. DEFINITION
Opioid use disorder is a problematic pattern of
opioid use that causes significant impairment.
Opioid's including substance such as heroin ,
morphine, codeine.
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5. ACUTE INTOXICATION
Intoxication is characterized by
• Apathy
• Bradycardia
• Hypo tension
• Respiratory depression
• Sub normal body temperature
• Pin-point pupils
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6. WITHDRAWAL SYNDROME
The onset of withdrawal symptoms occurs
typically within 12-24 hours ,peaks within 24-72
hours and symptoms usually subside within 7-10
days of the last dose of opioids.
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7. CHARACTERISTICS SYMPTOMS
● Rhinorrhoea
● Pupillary dilation
● Sweating
● Diarrhea
● Tachycardia
● Mild hypertension
● Raised body temperature
● Muscle cramps
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8. COMPLICATION
Complication due to :
1. Illicit drug
2. Intravenous drug use
Drug peddling and involvement in criminal
activities.
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9. TREATMENT
Before treatment :
1. Naloxone challenge test
2. Urinary opioids test.
Treatment can be divided into three main types.
1. Treatment of overdose .
2. Detoxification
3 . Maintenance therapy
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10. DETOXIFICATION
1. Use of substitution drugs .
2. Clonidine
3 . Naltrexone with clonidine
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11. MAINTENANCE THERAPY
1. Methadone maintenance ( Agonist substitution
therapy )
2. Opioid antagoinst
3. Psychosocial rehabilitation
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12. MANAGEMENT
• Opioid use disorder typically require long term treatment
• Goal
● Reduce the drug use
● Reducing the criminal behaviour
● Reducing the risk for individual
● Improving the long term physical and psychological condition
of the person.
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13. CANNABIS USE DISORDER
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14. INTRODUCTION
•Cannabis is derived from hemp plant,Cannabis Sativa.
•The dried leaves and flowering tops are often referred to as
ganja or marijuana.
•The resin of the plant is referred to as hashish.
•Bhang is a drink made from cannabis.
•It is either smoked or taken in liquid form.
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15. ACUTE INTOXICATION
•Mild intoxication
•Severe intoxication
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16. MILD INTOXICATION
• Mild impairment of
consciousness and orientation
• Tachycardia
• Euphoria
• Dream-like states
• “Flashback” phenomenon
• A sense of floating in the air
• Alteration in psychomotor
activity
• Tremors
• Photophobia
• Lacrimation
• Dry mouth
• Increased appetite
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17. SEVERE INTOXICATION
Perceptual disturbances like:
•Depersonalization
•Derealization
•Synesthesias
•Hallucinations
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18. WITHDRAWAL SYNDROME
• Increased salivation
• Hyperthermia
• Insomnia
• Decreased appetite
• Loss of weight
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19. COMPLICATIONS
• Acute anxiety
• Paranoid psychosis
• Hysterical fugue-like states
• Hypomania
• Schizophrenia-like state
• Amotivational syndrome
• Memory impairement
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20. TREATMENT
•Supportive and symptomatic treatment
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21. COCAINE ANDAMPHETAMINE DISORDER

22. INTRODUCTION
•Central nervous system stimulant
•Extracted from coca leaves
•Amphetamines are subclass of phenylethylamines
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23. THE LEAVES OF COCA PLANT
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24. ETIOLOGY
•Genetic factors
•Socio cultural factors
•Learning and conditioning
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25. NEUROPHARMACOLOGY
oCocaine is a competitive blockade of dopamine
reuptake by the dopamine transporter.
oThis blockade increases the concentration of
dopamine the synaptic cleft and result in increased
activation of both dopamine receptors.
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26. ACUTE INTOXICATION
•Pupillary dilation
•Tachycardia
•Hypertension
•sweating
•Increased psychomotor activity
•Grandiosity
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27. Pupillary dilatation
Sweating
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28. Nausea and vomiting Hypertension
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29. WITHDRAWAL SYNDROME
HYPOMANIC PICTURE
• Depression
• Fatigue
• Sleepiness
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30. HYPERMANIC PICTURE
•Agitation
•Exhaustion
•Hypersomnia
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31. COMPLICATIONS
• Anxiety reaction
• Uncontrolled compulsive behaviour
• Psychotic episodes like delusions and hallucinations
• Delirium
• Cardiac arrythmias
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32. ADVERSE EFFECTS
•Nasal congestion
•Ulceration of nasal mucosa
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33. •Bleeding
•Inflammation
•Swelling
•Cardiac effects
•Death
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34. TREATMENT
•Oxygenation
•Muscle relaxants
•IV thiopentone
•Bromocriptine
•amantadine
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35. PSYCHOSOCIAL THERAPIES
• FAMILY THERAPY
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36. AMPHETAMINE USE DISORDERS
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37. INTRODUCTION
•Its is a phenyl-iso-propylamine
•It is a powerful cns stimulant with sympathomimetic
effects
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38. MECHANISM OF ACTION
•Act by the inhibition of the reuptake of monoamine
oxidase which significantly increase the monoamine
concentration
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39. INTOXICATION
ACUTE INTOXICATION:
• HYPERTENSION
 HAEMORRHAGE
 CARDIAC FAILURE
• TREMORS
CHRONIC INTOXICATION
• CRAVING
• HALLUCINATION
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40. WITHDRAWAL SYNDROME
• DEPRESSION
• SUICIDAL IDEATION
• ASTHENIA
• APATHY
• FATIGUE
• AGITATION
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41. TREATMENT
•SYMPTOMATIC MEASURES
•Eg. hyperpyrexia[ cold sponging ,parenteral antipyretics ]
•Seizures [parentral diazepam]
•Acidification of urine facilitates the elimination of
amphetaminesa
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42. LSD USE DISORDER
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43. INTRODUCTION
• LSD is a powerful hallucinogen, which presumably produces its
effects by acting on 5-HT levels in brain.
• A common pattern of LSD use is ‘trip’(occasional use followed
by a long period of abstinence)
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44. INTOXICATION
• Perceptual changes occurring in clear consciousness
• Autonomic hyperactivity
• Marked anxiety
• Paranoid ideation
• Impairment of judgement
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45. WITHDRAWAL SYNDROME
• Flashbacks
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46. COMPLICATIONS
• Anxiety
• Depression
• Psychosis or visual hallucinosis
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47. TREATMENT
• Symptomatic treatment with antianxiety, antidepressant or
antipsychotic medications.
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48. BARBITURATE USE DISORDER
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49. INTRODUCTION
• Commonly used barbiturates are secobarbital, pentobarbital
and amobarbital
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50. INTOXICATION
• Irritability
• Lability of mood
• Disinhibited behavior
• Slurring of speech
• Incoordination
• Attention and memory impairment
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51. WITHDRAWAL SYNDROME
• Marked restlessness
• Tremors
• Seizures in severe cases
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52. COMPLICATIONS
IV use can leads to:
• Skin abscesses
• Cellulitis
• Infections
• Embolism
• Hypersensitivity reactions
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53. TREATMENT
• Symptomatic.
If patient is conscious;
• Induction of vomiting and use of activated charcoal can reduce
the absorption.
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54. INHALANTS OR VOLATILE SOLVENT USE DISORDER
SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT 54

55. INTRODUCTION
• The commonly used volatile solvents include - petrol, aerosols,
thinners, varnish remover and industrial solvents.
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56. INTOXICATION
• Euphoria
• Excitement
• Belligerence
• Slurring of speech
• Apathy
• Impaired judgement
• Neurological signs
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57. WITHDRAWAL SYNDROME
• Anxiety
• Depression
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58. COMPLICATIONS
• Irreversible damage to the liver and kidneys
• Peripheral neuropathy
• Perceptual disturbances
• Brain damage
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59. TREATMENT
• Reassurance and diazepam for intoxication
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60. BIBLIOGRAPHY
• Kaplan and Sadocks, Synopsis of Psychiatry Behavioural Sciences / Clinical
Psychiatry 11 edition, Page no-672, 674
• Mary C Townsend, Psychiatric Mental Health Nursing, 8th edition, Jaypee
Publications
• Niraj Ahuja, A Short Textbook of Psychiatry, Jaypee Publications
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61. THANK YOU