Addiction: psychological and physical dependence.
Dependence : Craving, tolerance, withdrawal and compulsive use.
Examples of substances– Alcohol
– Genetics and family influence: modeling effect. Identification. In case of alcoholism, 50% risk in first generative relatives.
– Peer pressure
– Psychosocial stress
– Chronic disease
– Personality disorder
-recent ingestion of alcohol
-significant mal adaptive behavior or psychological changes like inappropriate sexual or aggression ,lability of affect, or impaired judgment developed during or shortly after alcohol use.
-one or more of the following signs developed during or shortly after alcohol intake:
slurred speech-incoordination-unsteady gait-nystagmus-impairment of attention or memory-stupor or coma.
-symptoms not resulted from other medical condition or another mental disorder .
-cessation and reduction of alcohol that have been heavy and prolonged
-two or more of the following have been resulted from several hours to few days : autonomic hyperactivity-increased tremors-insomnia-nausea and vomiting –transient hallucinations usually visual-psychomotor agitation-severe anxiety-grand mal seizures.
-criteria in B causes marked significant distress or impairment.
-not resulted from general medical condition or another mental disorder
investigations : MCV,AST,GT,BIOCHESTRY PROFILE, PLASMA URIC AID CNCENTRATION.
seizures: diazepam 10mg iv state
DT: increase BP ,sweating, fever anxiety , insomnia , and hallucinations ,(+-)psychomotor activity
The condition treated by Librium 25-50mg every 2-4 hours.
Alcoholic encephalopathy and dementia:
Wernicke encephalopathy: ataxia , confusion and nystagmus. treated by thiamine iv 100mg-300mg
Korsakoff syndrome :Recent memory impairment, antrograde amnesia, confabulation .my need administration of antipsychotics
*Seizure measures should be taken
* DT measures should be put in your agenda
*Monitoring( vital signs every 2-4 hours(pulse-temp-BP) -Respiratory rate. Pupillary signs.
*In case you give iv line don’t give glucose before giving parental vitamin B Complex and thiamine
Otherwise the patient might go to wernick,s encephalopathy.
*Assess need for seclusion and restrain , take care that BZ to sedate them, it might be followed by respiratory depression or failure and death.
*Physical related disabilities:
– GIT PROBEMS includes gastritis and gastric ulcer ,mal nutrition and hepatic damage, Pancreatitis.
– Iron deficiency anemia, arrhythmia, macrocytosis ,cardiomyopathy,
– Polyneurropathy, myopathy, encephalopathy, dementia.
– Accidents and traumas.
*psychiatric complications includes
depression, suicide, personality changes, alcohol hallucinosis, delusional disorder, gambling, and sexual disorders, blackouts an amnestic syndrome,
THESE GROUP INCLUDES SUBTANCES WHICH ARE DEPRESSANTS TO THE CENTRAL NERVOUS SYSTEM AND HAVING CROSS TOLERANCE WITH ALCOHOL
DIAGNOSTIC CRITERIA FOR SEDATIVES HYPNOTICS AND ANXIOLYTICS intoxication
*recent use . *significant maladaptive behavior or psychological changes(mood liability, impaired judgment, aggression, impaired functioning.)*one or more of these signs during or shortly after use(slurred speech, incoordination, unsteady gait, nystagmus, impairmement of attention or memory, stupor or coma.
*symptoms not due to medical condition or psychological problem.
*Cessation or reduction after prolonged use . *two or more of the following develops within several hours to days (*hypervigilance, insomnia, nausea and vomiting, hallucinations, agitation, anxiety, fits, ). *symptoms causing significant distress or impairment. *not due to medical or psychological problem.
In acute intoxication flumazenil(anexate) is life saving.
– amphetamine is used in narcolepsy,ADHD,depression.
– Amphetamine like substances N,methyle D,asppertate (NMDA)
*mal adaptive behavior resulted during or shortly after intake.
*clinically significant maladaptive behavior or psychological changes including euphoria ,irritability, hpervigilance, anger , impaired judgment.
*two or more of the following (tachycardia or bradicardia. pupillary dilatation. elevated or lowered BP.CHILLS. nausea or vomiting. weight loss. agitation or retardation. muscular weakness.
Confusion, seizures, dystonia, and coma.
*symptoms are not due too general medical condition or other psychiatric disorders .
on cessation or decrease after prolonged use .
*dysphoria mood with two or more of the following (fatigue. vivid unpleasant dreams. Insomnia or hypersomnia. increased appetite. Agitation or retardation.)
*symptoms above cause significant distress or impairment.
*symptoms are not due to other medical or psychiatric problems.
– EG heroin and morphine
*Morphine is analgesic and sedative it works on opioid receptors on brain
*our own endogenous opioids are present in the form of endorphin , and ankaphaline
* they work as pain suppressors.
*they cross blood brain barriers BBB .has rapid onset of action . with low tolerance and high dependence.
*Recent use of opioid .* mal adaptive behavior or psychological changes that developed during or shortly after opioid use (euphoria followed by dysphoria agitation or retardation. impaired judgment and functions)
*pupillary constriction with one or more of the following drowsiness or coma –slurred speech-impairment of attention or memory. *not due to general medical or psychological problems.*with or without perceptual disturbances.
*cessation or reduction of opioids after prolonged use or administration of opioid antagonist
*one or more of these symptoms develop few minutes up to few days(dysphoria nausea and vomiting muscle aches lacrimation and rhinorrhea ,pupillary dilatation ,sweating ,diarrhea, yawning, fever, insomnia.
*Symptoms above clinically causing distress or impairment.*symptoms not due to other medical or psychological problems.
As in alcohol psychotherapy is very important illustration of how to over come withdrawal manifestations and craving . overdose .and how to avoid complications.
Tetrahydrocanabinol is the active ingredient it is mainly cns depressant but might do the reverse
(sense of happiness and euphoria-overeating that might lead to death from vagal over stimulation
distortion of perception (size height distance shape ) also might go to hallucinatory experiences.
The nurse should put in mind patient safety from violence and over eating) keep patient calm .
They are CNS depressants –during intake patient experiences flashes of light coming. With or without hallucinatory experiences ,Sedation even drowsiness .
Long term use might lead to dementia. or severe psychotic changes