LAST LECTURE OF YEAR 1 Flashcards by Trevor Losego

intoxication

The DSM-5 term referring to the diagnosis of a reversible substance-specific syndrome due to recent ingestion of a drug and its effects on the CNS

Syndrome consists of significant maladaptive behavioral, psychological, physical changes

can be determined by blood, urine, or tissue drug levels

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withdrawal

The DSM-5 term referring to the diagnosis of a
substance-specific syndrome that develops following
cessation of a substance after heavy/prolonged use

Syndrome consists of significant maladaptive
behavioral, psychological, physical changes

symptoms are usually the opposite of intoxication
symptoms appear 72 hours after cession and may last for weeks

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substance use disorder (SUD)

A maladaptive pattern of substance use as manifested by >2 of 11 symptoms in a 12-month period

impaired control (cravings and time consuming)

social impairment (failure to meet role duties)

risk use (using despite consequences)

pharm criteria (tolerance and withdraw symptoms)
if only symptoms NOT SUD

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Dependence

A term referring to compulsive drug use despite
negative consequences (SUD)

with withdraw and dependence = physical depend

no withdraw and dependence = psychological depend

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screening tools used for alcohol and drug use

CAGE = determine if it is clinically significant (2 or more yes)

AUDIT (alcohol related issues)

NIDA -modified ASSIST (drug/alcohol use in the last 3-12 months)

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drug rehabilitation

in-patient setting
usually 90 days or more
recovery is lifetime

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acute phase of drug rehab

detox

treat med and psych issues

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recovery phase of drug rehab

preventing relapse

can use therapy (CBT, family therapy, med assist therapy, self-help groups)

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schedule I drug

Drugs with a high harm risk and NO safe, accepted medical use

Ex: LSD, heroin

cannot prescribe

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Schedule II drug

Drugs with a high harm risk but with safe and accepted medical use. These drugs are highly addictive

Ex: opioids, stimulant’s, barbiturate’s

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Schedule III, IV, V drug

Drugs with a harm risk less than Schedule II drugs with safe and accepted medical uses

III: anabolic steroid, codeine, dronabinol

IV: benzos

V: liquid codeine (cough medicine)

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initial cause of addition: psychosocial and biological reasons

psychosocial: 
age of first use 
method of administering 
other mental illnesses 
coping strategies

genetic:
account for 40-60% vulnerability
unknown reason

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continued and compulsive use of drugs…why?

the effects of the drug on brain functioning

stimulation of the reward pathway
overrides the punishing effects
greater release of Dopamine in the NA, thus positive effects of the drug
dysfunction of the prefrontal cortex
alter in self-control- due to reward pathway stimulation
acute withdraw symptoms
discomfort may lead to relapse
Protracted Abstinence Syndrome
less dopamine is available due to the drug
relapse may be triggered by anhedonia
classical conditioning effects
drug is paired with environmental cues

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common features of sedative drug intoxication

sedation, sleepy, less anxiety, impaired judgement, slurred speech, incoordination

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sedatives examples

alcohol
barbiturates
inhalants
benzos

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withdraw symptoms from sedatives

agitation 
insomnia 
anxiety 
tachycardia or hypertension 
nausea
vomiting 
hand tremors  
hallucinations

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treatment for acute alcohol withdraw?

benzos (diazepam) for acute

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Naltrexone

Opioid receptor antagonist that reduces the pleasurable effects of alcohol

reduce the amount of drinking

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Acamprosate

Decreases the anhedonia of protracted abstinence → makes the person feel euthymic → decreases the cravings & helps to maintain abstinence

mechanism is not completely known (NMDA antagonist maybe)

reduce alcohol intake

Disulfiram

Inhibits aldehyde dehydrogenase → acetaldehyde accumulates and causes a toxic reaction (e.g. nausea) for 30-60 min.

alcohol aversion agent

used short term due to compliance

treatment for benzodiazepine overdose/toxicity

Flumazenil

competitive antagonist
high affinity for the benzo GABAa receptor

inhalants

substances with psychoactive vapors
(paint, glue)

signs: rash, red and runny nose, chemical smell, face discoloration
intoxication is similar to sedative

intoxication features of simulants

psych:
paranoia / hallucinations
psychomotor acceleration
euphoria

physical: 
loss of appetite
chest chain 
seizure 
dilated pupils 
tachy / hypertension

drug screen is needed to differentiate from schizo and bipolar I

common features of simulant withdraw

dysphoric mood 
fatigue 
slowing of psychomotor 
increased appetite
hypersomnia

sounds like MDD, but its not

Methamphetamine vs Cocaine

both are addictive direct action on the reward pathway produce a rush due to euphoria effects of cocaine are shorter meth: meth mouth ( dry mouth and dental carries) meth face = repetitive motor movements

Ecstasy (simulant)

``` empathy inducing perceptual changes (things are more interesting, time and sensory distortion) ``` increased thirst increased temp neurotoxic

caffeine

DSM-5 does not recognize caffeine use disorder effects on sleep, anxiety, mood,

caffeine intoxication

more than 250mg ``` increased energy insomnia nervous rambling thoughts tachy GI disturbance ```

caffeine withdraw

headache dysphoria fatigue less concentration

nicotine

DSM 5 does not recognize nicotine intoxication stimulant

nicotine withdraw

``` dysphoric mood restless, anxious irritable less concentration less HR ```

treatment for nicotine abstinence

nicotine replacement therapy | medications

hallucinogens

sympathomimetic drugs visual distortions auditory distortions distorted thinking, trouble concentrating, working memory impairment

classic hallucinogens

LSD, mescaline, psilocybin (mushroom) high potency effects last 8-12 hours no withdraw symptoms low addiction rates intoxication: increased HR, increased BP, sweating, pupil dilation, dehydration, euphoria, hallucination

side affects of classic hallucinogens

``` irrational fears anxiety panic paranoia rapid mood swings hopelessness intrusive thoughts of harming others or self ```

psychoactive affects of cannabis

relaxation and slight euphoria introspection and metacognition increased appetite and HR

cannabis intoxication

dry mouth, increased appetite, poor muscle coordination, delayed reaction time, can have bad trips similar to LSD

cannabis withdraw

irritability and nervous dysphoric mood sleep disturbance decreased appetite headache, shakiness

Dissociative Anesthetics intoxication

PCP and ketamine ``` depersonalization agitation and confusion impulsivity ataxia decreased pain response ``` rapid eye movements increased HR, BP, and RR no withdraw syndrome

treatment for PCP intoxication

benzo/ antipsychotic

opioids

analgesics to reduce pain ``` side effects / intoxication: euphoria decreased RR Low BP constipation drowsiness miosis impaired cognition ```

opioid withdraw

``` dysphoria nausea, vomiting, diarrhea muscle aches pupil dilation sweating / fever ```

Naloxone

used for acute overdose not used at treatment reverses CNS depression

treatment for opioid addiction

1. abstinence based therapy Naltrexone (blocks affects of opioid) 2. replacement therapy methadone (opioid agonist) addictive buprenorphine (partial opioid agonist) less addictive

gambling disorder

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting 4+ symptoms over 1 year ``` preoccupation with gambling unable to control, stop, or cut back lying used as an escape losing relationships or reliant on others to pay debt ```

treatment for gambling disorder

SSRI CBT support group family therapy