Question

1. Explain the classes of substances associated with substance-related disorders.

2. Explain the central nervous system stimulants (amphetamines and cocaine). Include the general effects, diagnostic criteria, treatment, and epidemiology.

3. Explain opioid related, hallucinogen-related, and cannabis-related disorders. Include the general effects and treatment.

Answer 1

Substance related disorders can develop whether or not a drug is legal, is socially acceptable, or has an accepted medical use .

Classes of substances associated with substance related disorders are :-

* Alcohol

* Caffeine

* Cannabis

* Hallucinogens

* Inhalants

* Opioids

* Sedatives, hypnotics and anxiolytics

* Stimulants

* Tobacco

1. Alcohol - CNS depressant

* Intoxication

- Blood alcohol level 0.08 g/dl

* Alcohol withdrawal

- Early :- anxiety, irritability, tremor, insomnia, nausea, tachycardia, hyperactive reflexes

- Seizures :- generally seen 24-48 hours,. Most often grand mal

- Withdrawal delirium :- between 48-72 hours, altered mental status, hallucinations, marked autonomic instability.

2. Benzodiazepine / Barbiturates

Similar to alcohol but less cognitive or motor impairment

* Withdrawal :- similar to alcohol with anxiety, irritability, insomnia, fatigue, tremor, sweating, poor concentration. Time frame depends on half life.

3. Opioids

Bind to the my receptors in the CNS to modulate pain

* Intoxication :- pinpoint pupils, sedation, constipation, bradycardia, hypotension and decreased respiratory rate

* Withdrawal :- not life-threatening unless severe medical illness but extremely uncomfortable. Dilated pupils , lacrimation, goosebumps, diarrhea, myalgia, arthralgia or agitation.

4. Stimulants

* Intoxication :- euphoria, enhanced vigor, grigariousness, restlessness, hyperactivity, tachycardia, papillary dilation, Hypertension, diaphoresis, chills, weight loss, confusion, seizure, coma

* Withdrawal :- not severe, but have exhaustion with sleep .

5. Cocaine

- can get rhabdomyolysis with compartment syndrome from hyermetabolic state

- Can see psychosis associated with intoxication that resolves.

6. Amphotericin

- Similar to intoxication syndrome to cocaine but usually longer

- Chronic use results in neurotoxicity

- Can see permanent amphotericin psychosis with continued use.

7. Tobacco

* Withdrawal :- dysphoria, irritability, anxiety, decreased concentration, insomnia, Increased appetite.

8. Hallucinogens

Intoxication :- illusion, hyperacusis , sensitivity of touch, taste / smell altered

Tolerance :- develop quickly and unpleasant side-effects with continued use.

Withdrawal :- unclear syndrome ( may be similar to mild stimulants - sleepiness and depression )

9. Cannabis

Withdrawal :- insomnia, irritability, anxiety,poor appetite, depression, physical discomfort

10. Phenacyclidine - Angel dust

Dissociative anesthetic

Intoxication :- severe dissociative reactions - paranoid delusion, hallucinations, can become very agitated or violent with decreased awareness of pain.

Thankyou ?