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					Mental disorders due to
alcohol and drug abuse
Intoxication – the
 psychological and physical
 effects of a substance which
 disappear when the
 substance is eliminated.
Withdrawal state – symptoms
 and signs occurring when the
 level оf substance is reduced
 or its action stops.
Tolerance – the state in which
 repeated administration of
 the substance leads to
 decreasing effect.
Dependence syndrome
 includes withdrawal states,
 tolerance and other features
 (persistent use despite
 harmful effects).
• Excessive consumption – is
  consumption above the limit at
  which alcohol is thought to be
• Alcohol-related disability –refers
  to any mental, physical or social
  harm resulting from excessive
  alcohol consumption.
   Risk factors of excessive
• Consumption in the community
• Age and gender
• Occupation – barmen, brewery
  workers, executives, sailors,
  journalists, actors, doctors
• Genetic factors
• Personality factors
  Medical effects of excessive
    consumption of alcohol
• Alimentary
- Gastritis and peptic ulcer
- Oesophageal varices
- Acute and chronic pancreatitis
- Hepatitis and cirrhosis
 Medical effects of excessive
   consumption of alcohol
• Nervous system
- Peripheral neuropathy
- Dementia
- Cerebellar degeneration
- Epilepsy
 Medical effects of excessive
   consumption of alcohol
• Other
Episodic hypoglycemia
   Neuropsychiatric effects of
    excessive use of alcohol
• Abnormal forms of intoxication
- Memory blackouts – losses of memory of
  events during the period of intoxication
- Idiosyncratic intoxication (pathological
  drunkenness) – marked change of
  behaviour that occurs within minutes of
  taking alcohol in amounts that would not
  induce drunkenness in most people.
Alcohol dependence syndrome
1. Feeling of being compelled to drink.
2. Primacy of drinking over other
3. Altered tolerance of alcohol.
4. Repeated withdrawal symptoms.
5. Relief drinking.
6. Stereotypical pattern of drinking.
7. Reinstatement after abstinence.
         Stages of alcoholism
1. Psychological dependence – more often intake
    of alcohol, increasing of tolerance, memory
    blackouts, post-intoxication symptoms
2. Physical dependence – compulsive desire to
    consume alcohol, withdrawal syndrome,
    secondary drive to alcohol, greatly increased
    tolerance, loss of vomiting reflex, loss of
    amount control
•    Encephalopathic stage – decreasing of
    tolerance, constant consuming of alcohol,
    degrading of personality
•   Alcohol withdrawal
-   Tremor
-   Agitation
-   Nausea
-   Sweating
-   Disturbances of perception
Delirium tremens – confused state of
  consciousness, disorientation in time
  and place, impairment of recent
  memory, illusions, hallucinations
  (visual, auditory, tactile), fear,
- Gross tremor, autonomic NS
  disturbances (sweating, tachycardia,
  raised blood pressure, dilation of
  pupils), insomnia, fever.
- Dehydration and electrolyte
  disturbance, leucocytosis, increased
  erythrocyte sedimentation rate,
  impaired liver function
- Lasts 3-7 days, worsens at night,
  ends with deep and prolonged
• Toxic and nutritional states
- Korsakov’s syndrome
- Wernicke’s encephalopathy (acute
  mental confusion, ataxia, and
  ophthalmoplegia. Korsakov
  syndrome is a late neuropsychiatric
  manifestation of Wernicke
- Alcohol dementia
•  Associated states
1. Depressive disorder
2. Anxiety
3. Suicide and deliberate self-harm 6-
4. Personality changes – egocentricity,
   lack of concern of others, decline of
   behavioural standards (honesty,
5. Pathological jealousy – non-
   delusional suspiciousness
6. Sexual dysfunction – effects of
   alcohol and impaired relationship
   with the sexual partner
7. Transient hallucinations – vision or
   hearing, during withdrawal
8. Alcohol hallucinosis – distressing
   auditory hallucinations
   (threatening, giving instructions),
   may lead to delusions
- Review with the patient extent of
  drinking, evidence for dependence,
  alcohol related problems
- Arrange alcohol withdrawal
- Treat urgent medical or psychiatric
Psychotherapy (conditional reflex, self-
  help groups)
   Classification of Addictive Drugs

Narcotic Analgesics
Volatile Solvents
Other drugs of abuse
Pain killing or pain relieving drugs with
 opium-like effects
Natural sources – Opium – Morphine,
Semi synthetic : Heroin (brown sugar)
Synthetic : Buprenorphine (tidigesic),
 Methadone, Pentazocine
           Mode of intake

• Opium – oral, inhalation
•ƒMorphine – injection
•ƒCodeine – oral (tablets and cough
•ƒHeroin – injection, inhalation
•ƒBuprenorphine – oral, injection
         Short – term effects

•ƒThought process impairment,
 drowsiness, apathy
•ƒFeelings of hunger and pain are not
•ƒOverdose of heroin can cause
 convulsions, coma and death
        Long – term effects

•ƒMood instability
•ƒReduced libido
•ƒRespiratory impairments
•ƒPhysical deterioration
• Infections like serum hepatitis and
  HIV can occur among IV users due to
  use of unsterile needles.
• In female abusers, menstrual
  irregularity and fetal addiction /
  abnormality can occur
         Withdrawal symptoms
•ƒFeeling of unpleasantness
•ƒAches and pains all over the body
•ƒDilation of pupils
• Drugs which excite or speed up
 the central nervous system
       Type and mode of intake

• ƒ Amphetamines – can be smoked,
  injected, inhaled or taken by mouth
• ƒ Cocaine – is inhaled or "snorted." It
  may also be dissolved in water and
  injected. Crack is a smokable form of
  cocaine that produces an immediate
  and more intense high.
       Short – term effects

• ƒ heightened feeling of well-
  being, euphoria
• ƒ sense of super-abundant energy
•ƒ Increased motor and speech
•ƒ Suppression of appetite
•ƒ Increased wakefulness
        Long-term effects

•ƒChronic sleep problem
•ƒPoor appetite
•ƒRapid and irregular heart beat
•ƒMood swings
•ƒ`Amphetamine psychosis’ may
      Withdrawal symptoms
•ƒExtreme fatigue
•ƒDisturbed sleep
•ƒVoracious appetite
•ƒModerate to severe depression

• Drugs which depress or slow
 down the functions of the central
 nervous system

Sedative-hypnotics – Barbiturates,
 Benzodiazepines (oral tablets)
         Short – term effects

•ƒRelief from anxiety and tension
•ƒLowering of inhibitions
•ƒPoor motor coordination
•ƒImpaired concentration and
•ƒSlurred speech and blurred vision
•ƒSedation, sleep with larger doses
      Long – term effects

•ƒChronic fatigue
•ƒRespiratory impairments
•ƒImpaired sexual function
•ƒDecreased attention span
•ƒPoor memory and judgement
•ƒChronic sleep problems
     Tolerance and dependence

•ƒTolerance does not develop
•ƒCross tolerance can develop
•ƒPhysical and psychological
 dependence develop
       Withdrawal symptoms
•ƒIrritability and restlessness
•ƒDelirium tremens

• Hallucinogens are drugs which affect
  perception, emotions and mental
    Type and mode of intake

• LSD -Lysergic acid diethylamide
  (oral tablets)
• PCP –Phencyclidine (inhaled /
• Mescaline (oral tablets)
• Psilocybin (smoked)
        Short – term effects
•ƒAlterations of mood
•ƒDistortion of the sense of
 direction, distance and time
•ƒ‘Pseudo’ hallucinations
•ƒSynesthesia – melding of two
 sensory modalities
•ƒFeelings of depersonalization
         Long-term effects

  Flash back or spontaneous
• ƒ
 recurrence of on LSD experience
 can occur
•ƒAmotivational syndrome
•ƒLSD precipitated psychosis
    Tolerance and dependence
• Tolerance develops rapidly
• Withdrawal symptoms are not
• Drugs from cannabis plant come
  under this category

•ƒGanja / Marijuana
•ƒHashish / Charas
•ƒHashish oil
Mode of intake : Smoking

Short – term effects
• ƒMild euphoria
• ƒLowering of inhibitions
• ƒReddening of eyes
• ƒSense of smell, touch and taste are often
• ƒAltered sense of time perception
• ƒImpaired short-term memory
• ƒImpairment of ability to perform complex
  motor tasks
             Long-term effects
•ƒ Decreased cognitive ability
•ƒ Amotivational syndrome
•ƒ Psychosis
•ƒ Respiratory problems
•ƒ Sterility / impotence
• ƒ women abusers, fetal damage
  can occur
Tolerance and psychological
 dependence develop

Withdrawal symptoms
•ƒSleep disturbances
•ƒLoss of appetite, irritability
•ƒDepression or psychotic symptoms
 may become prominent
• Drugs under this category are
 volatile hydrocarbons, Petroleum

Type and mode of intake
• Glue and solvents (eraser fluids)
  and petrol through sniffing.
         Short – term effects
•ƒClouded thinking
•ƒSlurred speech
•ƒStaggering gait
•ƒSudden death
        Long – term effects
•ƒPermanent brain damage
•ƒLiver, kidney and heart damage

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Tags: Psychiatry
Description: Psychiatry lecture course