Disorders Due to Psychoactive Substance Use Department of

Disorders Due to Psychoactive Substance Use Department of Psychiatry 1st Faculty of Medicine Charles University, Prague Head: Prof. MUDr. Jiří Raboch, DrSc.

Psychoactive Substance Psychoactive (psychotropic) substance is any substance which after absorption has influence on mental processes both cognitive and affective. 1. 2. 3. stimulative suppressive hallucinogenic

Mental and Behavioural Disorders Due to Psychoactive Substance Use Disorders due to use of: F10.x alcohol F11.x opioids F12.x cannabinoids F13.x sedatives or hypnotics F14.x cocaine F15.x other stimulants (caffeine) F16.x hallucinogens F17.x tobacco F18.x volatile solvents F19.x multiple drugs and other psychoactive drugs

Mental and Behavioural Disorders Due to Psychoactive Substance Use Specific Clinical Conditions: F1x.0 Acute intoxications F1x.1 Harmful use F1x.2 Dependence syndrome F1x.3 Withdrawal state F1x.4 Withdrawal state with delirium F1x.5 Psychotic disorder F1x.6 Amnesic syndrome F1x.7 Residual state, late-onset psychotic disorder F1x.8 Other mental and behavioural disorders F1x.9 Unspecified mental and behavioural disorder

F1x.0 Acute Intoxication Df.: A transient condition following the administration of psychoactive substance resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses Closely related to dose levels Uncomplicated With trauma or other medical complications With delirium With coma With convulsions Pathological intoxication (applies only to alcohol)

F1x.1 Harmful Use The damage may be physical and/or mental. Socially negative consequences are not evidence (neither acute intoxication or hangover).

F1x.2 Dependence Syndrome (Addiction) a) b) c) d) e) f) A strong desire or sense of compulsion to take the substance („craving“) Difficulties in controlling substance-taking Withdrawal sy characteristic for the substance Evidence of tolerance Progressive neglect of pleasures and interests Persisting with substance use despite clear evidence of overtly harmful consequences Physical dependence Psychic (psychological) dependence

F1x.2 The Course of Dependence Syndrome F1x.20 currently abstinent (remission) F1x.21 currently abstinent in a protected environment F1x.22 currently abstinent on a maintenance regime F1x.23 currently abstinent - receiving treatment with aversive or blocking drugs (naltrexone, disulfiram) F1x.24 currently active dependence F1x.25 continuous (chronic) use F1x.26 episodic use (dipsomania)

F1x.3 Withdrawal State Symptoms occurring on absolute or relative withdrawal of a substance after repeated and prolonged use of the substance Uncomplicated With convulsions

F1x.4 Withdrawal State with Delirium Delirium tremens - in severely dependent users with a long history of use of alcohol Prodromal symptoms: insomnia, tremor, fears followed by illusions, hallucinations, clouding of consciousness and marked tremor

F1x.5 Psychotic Disorder Psychotic phenomena occurring during or immediately after psychoactive substance use Schizophrenia-like Predominantly delusional, hallucinatory, depressive, manic (alcoholic hallucinosis, jealousy) Persistence for more than 48 hours

F1x.6 Amnesic Syndrome Impairment of recent memory (learning of new material) Absence of defect in immediate recall, of impairment of consciousness, and of generalized cognitive impairment History of chronic use of psychoactive substance (Korsakov’s psychosis or syndrome)

F1x.7 Residual and late-onset psychotic disorder Onset related to the use of psychoactive substance, the disorder should persist beyond any period of time during which direct effects of the psychoactive substance might be assumed Flashbacks - duration in seconds or minutes, duplication of previous drug-related experiences Personality disorder Dementia

F10.x Mental Disorders Due to Use of Alcohol Acute intoxication: euphoria, flushed face, ataxia, slowed reaction time, impaired motor performance, slurred speech, poor concentration; in higher doses behavioural changes – disinhibition of sexual and aggressive impulses, increased suicidal and homicidal behaviour Pathological intoxication: sudden change of consciousness with aggressive behaviour and amnesia Harmful use: physical complications – hypertension, arteriosclerosis, heart infarction, cardiomyopathy, brain stroke, liver cirrhosis, fatty liver, gastritis, etc. psychic complications - depression

F10.x Mental Disorders Due to Use of Alcohol Dependence syndrome: increased tolerance to alcohol, morning drinking, alcohol bouts, blackouts, deterioration in occupational and marital life, behavioural changes, withdrawal symptoms Withdrawal state: tremor, anxiety, easy getting startled, agitation, insomnia, nausea, sweating, epileptic seizures and delirium tremens Delirium tremens: usually starts in evening hours – growing tremulousness, severe agitation, anxiety and perceptual distortion a state seriously endangering patient's life recovery after several days, retrograde amnesia

F10.x Mental Disorders Due to Use of Alcohol Other psychotic disorders: alcoholic hallucinosis pathological jealousy Korsakov's psychosis Wernicke encephalopathy alcoholic dementia Treatment of alcoholism Withdrawal from alcohol, benzodiazepines, clomethiazol Aversion therapy Alcohol-Antabuse (disulfiram) Reaction (AAR) Psychotherapy

F11.x Mental Disorders Due to Use of Opioids Morphine, heroin (diacetylmorphine), codeine, pethidine, methadone Heroin: dependence develops within two weeks of daily use overdose may lead to death withdrawal symptoms are extremely unpleasant needle-sharing represents a serious risk of transmission of HIV and hepatitis B C viruses treatment of the withdrawal state – buprenorphine, benzodiazepines, spasmolytics; in serious cases of dependence heroin is replaced by methadone

F12.x Mental Disorders Due to Use of Cannabinoids Marijuana (marihuana) is a colloquial term for dried leaves and flowers of cannabis plant (Cannabis sativa L.) Δ9-tetrahydrocannabinol (Δ9-THC) is responsible for the psychoactive properties of the cannabis plant Complex physiological functions of the cannabinoid system: motor coordination, memory procession, control of appetite, pain modulation and neuroprotection Summary of adverse effects: acute: anxiety, panic, impaired attention, memory, reaction time and psychomotor performance and coordination, increased risk of road accident, and increased risk of psychotic symptoms among vulnerable persons chronic: chronic bronchitidis, a cannabis dependence syndrome, subtle impairments of attention, short-term memory and ability to organize and integrate complex information

F12.x Mental Disorders Due to Use of Cannabinoids Effect of cannabinoids on central nervous system: Euphoria, enhancement of sensory perception, tachycardia, antinociception, difficulties in concentration, impairment of memory Cannabis use may exacerbate symptoms of schizophrenia and may precipitate disorders in persons who are vulnerable to developing psychosis; heavy cannabis use may increase depressive symptoms among some users Tolerance develops; the relatively long half-life and complex metabolism of cannabis may result in a low intense withdrawal syndrome Marijuana use tends to impair executive function in the brain, e.g. higher risk for all types of injuries is associated with cannabis use Cannabis abuse and dependence were highly associated with increasing risks of other substance dependence

F13.x Mental Disorders Due to Use of Sedatives and Hypnotics benzodiazepines – potentiate the action of GABA risk of dependence short-acting benzodiazepines: alprazolam, flunitrazepam, oxazepam, lorazepam, temazepam long-lasting benzodiazepines: diazepam, clorazepate, chlordiazepoxide, etc. withdrawal state can be accomplished with epileptic seizures interaction with alcohol may induce qualitative changes of consciousness

F14.x,15.x Mental Disorders Due to Use of Stimulants Cocaine, amphetamine, metamphetamine (pervitine), phenmetrazine, methyphenidate, MDMA (ecstasy, methylenedioxymetamphetamine) Positive mood, activity, planning, diminished need of sleep Tachycardia, arrhythmia, hypertension, hyperthermia, intracerebral haemorrhage Withdrawal symptoms: severe craving, depression, decreased energy, fatigue, sleep disturbance Prolonged use can trigger paranoid psychoses, impulsivity, aggressivity, irritability, suspiciousness and anxiety states

F16.x Mental Disorders Due to Use of Hallucinogens Lysergid acid diethylamide (LSD), psilocybin, mescaline, phencyclidine Acute intoxication: distorted perception (optic hallucinations and illusions); unpredictable and dangerous behaviour Withdrawal syndrome has not been described

F18.x Mental Disorders Due to Use of Volatile Solvents Toluene, acetone, adhesives, petrol, cleaning fluids, etc. Acute intoxication: euphoria, disorientation, incoordination, slurred speech; optic hallucinations The way of use is very dangerous

Drug Addiction Treatment HEALTH SERVICE: acute states (detox program, tox. psychosis) weaning treatment after-treatment care substitution (maintainance) treatment OUT OF HEALTH SERVICE: contact centers daily static centers therapeutic communities after-treatment centers protected workshops and habitations mutual help groups – Alcoholics Anonymous, Narcotics Anonymous

Links Czech National Focal Point for Drugs and Drug Addiction: www.drogy-info.cz European Monitoring Centre for Drugs and Drug Addiction: http://www.emcdda.eu.int/