Disorders Due to Psychoactive

Substance Use
Department of Psychiatry
1st Faculty of Medicine
Charles University, Prague
Head: Prof. MUDr. Ji 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 (Korsakovs 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.)
9-tetrahydrocannabinol (9-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/