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Phy 123
Phy 123
Psychotic Disorders
Substance Induced Disorder
Occurrence of adverse social, behavioral,
psychological, & physiological effects caused by 1 or
more of the following abused substances:
1) Alcohol 7) Cannabis
2) Inhalants 8) Cocaine
3) Amphetamines 9) Sedatives, Hypnotics, or Anxiolytics
4) Nicotine 10) Hallucinogens
5) Caffeine
6) Opioids
TERMINOLOGIES
• Substance
• Substance dependence
• Substance abuse
• Withdrawal
• Tolerance
• Substance intoxication
Substance
A chemical that alters a person’s mood or behavior when it is
smoked, injected, junked, inhaled, or swallowed in pill form.
Substance Dependence
Maladaptive pattern of use manifested by cognitive, behavioral,
and physiological symptoms during a 12 month period and caused by
continued use of substance.
Substance Abuse
Tolerance:
Extent to which the individual requires larger and larger
amounts of a substance in order to achieve its desired effects, or the
extent to which the individual feels less of its effects after using the
same amount of the substance.
Substance Intoxication:
The temporary maladaptive experience of behavioral or
psychological changes that are due to the accumulation of a
substance in the body.
SUBSTANCE ABUSE
• 8.9 percent of the population are current users of illicit drugs.
• Marijuana is the most commonly used illicit drug
• Most drugs of abuse directly or indirectly target the reward center of the
brain by flooding its circuits with dopamine.
DSM-IV-TR DIAGNOSTIC CRITERIA:
EFFECTS OF DRUGS OF ABUSE ON
DOPAMINE PATHWAYS
ALCOHOL EFFECTS
• Alcohol is a depressant
• A psychoactive substance that causes the depression of central nervous system activity.
• Immediate effects
• Sedating
• Central nervous system depressant
• Potentially fatal in excess
• Long-term effects
• Permanent brain damage
• Dementia
• Wernicke’s disease
• Korsakoff’s syndrome
Korsakoff’s syndrome
Permanent form of dementia associated with long term alcohol
use in which the individual develops retrograde and anterograde
amnesia, leading to an inability to remember recent event or learn new
information.
THEORIES AND TREATMENT OF ALCOHOL
DEPENDENCE
• Biological
• Genetic factors
Genetics of alcohol-related disorders comes from studies examining associations with
genes involved in alcohol metabolism and neural transmission.
• Medications
• Naltrexone
• Disulfiram
• Acamprosate
Naltrexone
Blocks the effects of the body’s production of alcohol induced opioids
through involving dopamine.
Disulfiram
Used in the treatment of alcoholism that inhibits aldehyde
dehydrogenase (ALDH) and causes severe physical reactions when combined
with alcohol.
Acamprosate
Reduces the risk of relapse by reducing the individual’s urge to drink
and thereby reducing the drive to use alcohol as a way of reducing anxiety and
other negative psychological state.
THEORIES AND TREATMENT OF ALCOHOL
DEPENDENCE
• Psychological
• Dual-process theory
Proposes there are automatic processes that generate an impulse to drink
alcohol and controlled, effortful processing that regulates these automatic
impulses.
• Sociocultural
• Family, community, & cultural stressors
• Children of alcoholics at greater risk
SUBSTANCES OTHER THAN ALCOHOL
STIMULANTS
• This category of drugs includes substances that have an activating effect
on the nervous system.
• Amphetamine
Affects the central nervous and the autonomic nervous system.
• Methamphetamine
Related to amphetamine but provokes more intense central nervous system effects.
• Cocaine
Highly addictive central nervous system stimulants that an individual
snorts, injects, or smokes.
LONG-TERM EFFECTS OF METHAMPHETAMINE
ON THE BRAIN
COCAINE IN THE BRAIN
AMPHETAMINE OR COCAINE
INTOXICATION
Behavioral & Psychological Changes:
• Euphoria or affective blunting
• Changes in sociability
• Hypervigilance
• Interpersonal sensitivity
• Anxiety, tension, or anger
• Stereotyped motor behaviors
• Impaired judgment
• Impaired social/occupational functioning
AMPHETAMINE OR COCAINE
INTOXICATION
Clinical Signs & Symptoms:
• Tachycardia or bradycardia
• Pupil dilation
• Elevated or lowered blood pressure
• Perspiration or chills
• Nausea or vomiting
• Weight loss
• Psychomotor agitation or retardation
• Muscular weakness, respiratory depression, chest pain, cardiac arrhythmias
• Confusion, seizures, dyskinesias, dystonias, or coma
AMPHETAMINE OR COCAINE
WITHDRAWAL
• Dysphoric mood
• Fatigue
• Vivid, unpleasant dreams
• Insomnia or hypersomnia
• Increased appetite
• Psychomotor retardation or agitation
CANNABIS
• Marijuana
Psychoactive substance derived from the hemp plant whose primary active
ingredient is delta-9-tertrahydrocannabinol (THC).
• Hashish
Containing a more potent form of THC, comes
from the resins of the plants flowers.
CANNABIS INTOXICATION
Behavioral & Psychological Changes:
• Impaired motor coordination
• Euphoria
• Anxiety
• Sensation of slowed time
• Impaired judgment
• Social withdrawal
Clinical Signs & Symptoms:
• Conjunctival injection
• Increased appetite
• Tachycardia
• Dry mouth
SUMMARY OF EFFECTS OF CANNABIS
ON EXECUTIVE FUNCTIONS
HALLUCINOGENS
• Hallucinogens are drugs that cause people to experience profound distortions in their
perception of reality.
• LSD – Lysergic Acid Diethylamide
Users ingest in tablets, capsules, and liquid form. Produces tolerance.
• Peyote
Primary ingredient is mescaline
• Psilocybin
Found in certain mushroom.
• PCP – Phencyclidine AKA Angel dust
Originally develops as an intravenous anesthetic. Symptoms that mimic schizophrenia,
disturbance, memory loss, difficulties with speech and thinking, weight loss and depression.
• MDMA - methylenedioxymethamphetamine
Known on the street as ecstasy, is a synthetic substance chemically similar to methamphetamine
and mescaline. Users experience feelings of increased energy, euphoria, emotional warmth,
distorted perceptions and sense of time, and unusual tactile experiences.
• Included in hallucinogen-related disorders are use and intoxication, but not withdrawal.
HALLUCINOGENS
Methylenedioxymethamphetamine PCP
• Hydrocodone
clinicians prescribed hydrocodone products for a variety of painful conditions including
dental and injury related pain.
• Oxycodone
• Morphine
Physicians use morphine before and after surgical procedures to alleviate severe pain
• Codeine
Clinicians prescribe codeine for mild pain
• Heroin
Synthesized from morphines
OPIOID INTOXICATION
Behavioral & Psychological Changes:
• Initial euphoria followed by apathy
• Dysphoria
• Psychomotor agitation or retardation
• Impaired judgment
• Impaired social/occupational functioning
Clinical Signs & Symptoms:
• Pupillary constriction
• Drowsiness or coma
• Slurred speech
• Impaired attention or memory
OPIOID WITHDRAWAL
• Dysphoric mood
• Nausea or vomiting
• Muscle aches
• Lacrimation or rhinorrhea
• Pupillary dilation, piloerection, or sweating
• Diarrhea
• Yawning
• Fever
• Insomnia
SEDATIVES, HYPNOTICS, &
ANXIOLYTICS
• Sedatives have calming effects on the central nervous
system
• Increases:
• An individual’s perceived level of energy alertness
• Blood pressure and may lead to increases in the body’s production of
cortisol
CAFFEINE INTOXICATION
Clinical Signs & Symptoms:
• Restlessness
• Nervousness
• Excitement
• Insomnia
• Flushed face
• Diuresis
• Gastrointestinal disturbance
• Muscle twitching
• Rambling flow of thought and speech
• Tachycardia or cardiac arrhythmia
• Periods or inexhaustibility
• Psychomotor agitation
TOBACCO
• Volatile solvents
• Aerosols
• Gases
• Nitrites
INHALANT INTOXICATION
Clinical Signs & Symptoms:
Dizziness Blurred vision or diplopia
Nystagmus Stupor or coma
Incoordination Euphoria
Slurred speech Tremor
Unsteady gait Lethargy
Depressed reflexes Generalized muscle weakness
Psychomotor retardation
Reductions in the amount or frequency of substance use, substitution of a less risky substance, and
reduction of high-risk behaviors associated with substance use may be achievable goals when
abstinence is initially unobtainable. Engaging an individual to participate and remain in treatment that
may eventually lead to further reductions in substance use and its associated morbidity is a critical
early goal of treatment planning and is often enhanced by motivational interviewing techniques.
MOTIVATIONAL INTERVIEWING
Reduction in the frequency and severity of substance use episodes is a primary goal of long term
treatment. The individual is educated about common types of substance use triggers, such as
environmental cues, stress, and exposure to a priming substance. The individual is then helped to develop
skills to prevent substance use; these skills include identifying and avoiding high-risk situations as well as
developing alternative responses to situations in which substance use may occur. Individuals are at a
greater risk of using substances when any of the following are present:
1) craving or urges to use a substance due to acute or protracted withdrawal states and/or classically
conditioned responses to cues associated with substance use
2) easy access to substances
3) social facilitation of substance use (e.g., holiday parties, association with other substance users)
4) negative affective states
5) negative life events, or any significant, even positively viewed, life event if the event carries with it a
significant increase in responsibility (e.g., marriage, the birth of a child, beginning school or a new job,
work promotion)
6) physical discomfort
7) unstructured time or boredom; or nonadherence to prescribed treatment.
Many clinicians do not recognize that individuals with substance use
disorders have a chronic condition and may have future episodes of substance use.
Therefore, the clinician may become discouraged when an individual doing well in
treatment over an extended period of time resumes substance use. A useful clinical
strategy is to explicitly anticipate the reality of future substance use and plan a
strategy for recovery in the event of substance use relapse; such a strategy helps
both the patient and the clinician optimally manage and contain the negative
consequences resulting from a return to substance use.
MEDICATION
DRUGS USED FOR
SUBSTANCE ABUSE TREATMENT
Drug Use Dosage Nursing Considerations
Lorazepam Alcohol withdrawal 2-4 mg every 2—4 hour Monitor vital signs and global
(Ativan) may cause dizziness or
drowsiness
Chlordiazepoxide Alcohol withdrawal 50—100 mg, repeat in Monitor vital signs and global
(Librium) 2-4 hours if necessary; assessments for effectiveness;
not to exceed 300 mg/day may cause dizziness or
drowsiness
Disulfiram (Antabuse) Maintains abstinence from 500 mg/day for 1—2 Teach client to read labels to
alcohol weeks then 250 mg/day avoid products with alcohol
Methadone (Dolophine) Maintains abstinence Up to 120 mg/day for May cause nausea and
from heroin maintenance vomiting
Levomethadyl (Orlaarn) Maintains abstinence 60—90 mg three times Do not take drug on consecutive
from opiates for maintenance days; take-home doses
are not permitted
Drug Use Dosage Nursing Considerations
Naltrexone Blocks the effects of 350 mg/week„ divided into Client may not respond to
(ReVia, Trexan) opiates; reduces three doses for opiate - narcotics used to treat
alcohol cravings blocking effect; 50 mg/day for cough, diarrhea, or pain;
up to 12 weeks alcohol cravings take with food or milk; may
cause headache restlessness,
or irritability
Clonidine (Catapres) Suppresses opiate 0.1 mg every 6 hours PRN Take blood pressure before
withdrawal symptoms each dose; withhold if client
is hypotensive
Acamprosate (Campral) Suppresses alcohol 666 mg three times day Monitor for diarrhea,
cravings vomiting, flatulence, and
pruritis
Drug Use Dosage Nursing Considerations
Thiamine(vitamin B)) Prevents or treats 100 mg/day Teach client about proper
Wernicke-Korsakoff nutrition
syndrome in alcoholism
Folic acid (folate) Treats nutritional 1—2 mg/day Teach client about proper
deficiencies nutrition; urine may be dark
yellow
Powerlessness
May be related to
Substance addiction with/without periods of abstinence
Episodic compulsive indulgence; attempts at recovery
Lifestyle of helplessness
Anxiety/Fear
May be related to
Cessation of alcohol intake/physiological withdrawal
Situational crisis (hospitalization)
Threat to self-concept, perceived threat of death
Sensory-Perceptual Alterations
May be related to
Chemical alteration:
Exogenous (e.g., alcohol consumption/sudden cessation)
Endogenous (e.g., electrolyte imbalance, elevated ammonia and BUN)
Sleep deprivation
Psychological stress (anxiety/fear)
Source: http://www.manilatimes.net/baron-geisler-
jailed-unjust-vexation/357129/
Mark Anthony Fernandez
Source: http://www.manilatimes.net/acto
r-faces-life-in-prison-for-marijuana-
possession/289569/
http://www.mhhe.com/whitbourne7eupdate
http://www.manilatimes.net/ph-actors-actresses-arrested-drug-alcohol-abuse/359016/
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