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Disorders Due to PsychoactiveSubstances
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Disorders Due to Psychoactive
Substances
Mental disorders due to substance
abuse Intoxication
Abuse
Addiction Withdrawal syndrom
Psychotic disorders due to addiction
Physical complications of substance
abuse
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Abused Psychoactive Substances Alcohol (F10) Opioids (F11)
Cannabinoids (F12) Sedatives/hypnotics and benzodiazepins
(F13) Cocaine (F14)
Other stimulants (F15) Hallucinogens(F16) Tobacco (F17) Inhalants (F18)
Other substances or combinations (F19)
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Mental Disorders due to
Substance (ab)useF 1x.0 Intoxication
F 1x.1 Substance abuse
F 1x.2 Addiction (syndrome ofdependence)
F 1x.3 Withdrawal syndrome
F 1x.4 DeliriumF 1x.5 Psychosis
F 1x.6 Amnestic disorder
F 1x.7 Residual psychotic disorder
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Psychoactive Substance AbuseContinuing to use substance even though
the person knows there are reoccurring
physical or psychological problemsbeing caused by using the substance
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Psychoactive Substance Dependence Craving (strong desire or sense of compulsion
to take a drug) Change of tolerance (needing increased
amounts to achieve the same effect) Difficulties in controlling drug-taking behavior
(onset, termination, levels of use) Progressive neglect of alternative pleasures
or interests because of drug use (increasingtime for drug)
Withdrawal symptoms Persisting with drug use despite clear
evidence of harmful consequences
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Alcohol IntoxicationAlteration in behavior depending on the
amount of used alcohol and individual
variation and tolerance(impaired judgment, mood lability, disinhibition of aggressive
impulses, social dysfunction)
0,3g/l euphoric effect
0,5g/l cognitive deficits, motor coordination problem2,5g/l significant confusion, decreased state ofconsciousness
4g/l coma, death
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Alcohol Withdrawal Syndrome
Uncomplicated Tremor, hyperreflexia
Anxiety
Increased heart rate and blood presure
Sweating
Nausea, vomiting insomnia
Alcohol withdrawal seizure
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Alcohol Withdrawal Delirium Disorientation
Fluctuating consciousness
Vivid hallucinationsAgitation
Mild hyperpyrexia
Onset 48-72hours after the last drink(up to 7 days)
Mortality: 10-15% (untreated)
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Alcohol Psychotic Disorders Alcoholic paranoid psychosis
Heresy jealous, persecute
Alcoholic hallucinosis Auditory hallucinations without clouding of
sensorium
Alcohol amnestic disorder (Korsakoffspsychosis) Memory defect, confabulations, intellectual
function is preserved
Alcoholic dementia
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Physical Complications of Alcohol
Abuse/dependence Alcoholic peripheral neuropathy
Alcoholic encephalopathy
Alcoholic liver disease (steatosis, hepatitis,cirrhosis)
Cardiovascular disorders (dilatedcardiomyopathy, hypertension, hemorrhagic
stroke, holiday heart syndrome) Hematological disorders (anemia,
macrocytosis, leukopenia, thrombocytopenia,abnormalities of homeostasis)
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Physical Complications of Alcohol
Abuse/dependence GIT complications (gastritis, peptic ulcer,
esophagitis, esophageal varices, diarrhea,malabsorption, acute or chronic pancreatitis)
Malnutrition (thinning of the hair, ecchymosis,glossitis, peripheral oedema, abdominaldistension, neuropathy, tetany)
Endocrinological Disease (amenorrhoea,hypogonadism, virilisation/feminization)
Acute or chronic alcoholic myopathy Osteoporosis
FAS
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Orofacial Consequencies of
Alcohol Addiction Parotid gland enlargement
Neglected teeth, early loss of teeth
Gingivitis, parodontitis
Stomatitis, glossitis, cheilitis
Cancer of the mouth Carcinoma of the pharynx
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Sedatives/hypnotics/benzodiazepins
Addiction Most often: Alprazolam, bromazepam,
clonazepam, diazepam, zolpidem
High doses (multiple LD) Signs of intoxication and withdrawal as
alcohol addiction, withdrawal oftencomplicated by seizure or delirium
Consequences: seizures, memory impairment,dementia, accidents!
Combinations with alcohol or replacement ofalcohol
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Opioids Illegal drugs (heroin=diacetylmorphine,
brown=codeine)
Subutex (buprenorphine), methadone Opioid analgetics (morphine, dihydrocodeine,
hydromorphone, oxycodone)
Opioid-like analgetics (pethidine, tramadol,
fentanyl) Medicaments with contents of codeine
Alnagon, Korylan, Spasmoveralgin, Spasmopan
Pleumolysin, Talvosilen
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Opioid Intoxication
Euphoria immediately after use, thenapathy and psychomotor retardation
Miosis
Slow regular respiration
Slurred speech
Impairment of judgment, attention,concentration, memory
analgesia
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Opioid Withdrawal
Craving
Lacrimation, rhinorrhea, yawning, sweating
Mydriasis, piloerection Anorexia, tremor, irritability, insomnia
Weakness
Nausea, vomiting, diarrhoea Muscle spasms, restless lower extremities
Abdominal pain
Flushing, fever
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Medical Complications of OpioidAbuse/addiction
Mental: depression, dementia, personality dis.Physical:
illness of dirty needles: abscesses,lymphadenopathy, osteomyelitis, endocarditis,glomerulonephritis, septicemia, memingitis, septicemboli
Infective diseases: hepatitis (C,B,A), AIDS, tbc,syphilis
Pneumonia, pulmonary hypertension Consequences of overdoses (paralysis, dementia,
blindness, acute transverse myelitis) Consequences of analgesia (peritonitis,
osteomyelitis etc)
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Stimulants
Cocaine, pervitin, phentermine, ephedrine
Intoxication Anxiety, irritability, agitation, paranoia, confusion,
hallucinations, sympathomimetic effects(dizziness, tremor, mydriasis, tachycardia,hypertension, hyperpyrexia)
Withdrawal Dysphoria, insomnia/hypersomnia, hyperphagia
Risks Convulsions, heart attack, psychosis, accidents
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Marihuana
Intoxication: Tachycardia, conjunctival injection, dry mouth,
increased appetite, Impaired short-term memory, labile affect, altered
time perception, enhanced sociability
Withdrawal: Craving, insomnia, dysphoria, irritability
Medical and psychological consequences: Bronchitis, impaired sexual function, chromosomal
damage Panic attacks, amotivational syndrome, cannabis
psychosis, dementia
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Inhalants
Abused inhalants: alkyl-nitrites, toluene andtoluene mixtures glues, paints, thinners,gasoline, ketones nail polish remover,printing ink, halogenated hydrocarbonshalothane, trichloroethylene, ethylene glycol
Clinic similar to alcohol, high toxicity!!, highrisk of overdoses!!
Consequences: hepatopathia, neuropathia,nefropathia, cardiopathia, pneumonia,organic mental syndrome, pulmonary andbrain oedema
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Addicts at the Doctors
Abstining addicts
Good collaboration
Valid anamnesis including informationabout addiction in an.
Carefully asking for used medication
CAVE: no psychoactive substancesexcluding vital indication (benzodiazepines,tramadol etc.)
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Addicts at the Doctors
Active addicts Poor collaboration, not valid anamnesis Come in intoxication or withdrawal syndrome Often come even with inflammatory complications Irritability, manipulative Asking for psychoactive substances
CAVE: alcohol: vomiting reflex, seizure IUD: infection!!, analgesia or hypersensitivity Cave combination therapy with abused substances Cave high tolerance to psychoactive substances