4. Mental health is a level of psychological well being, or an
absence of a mental disorder; it is the "psychological state of
someone who is functioning at a satisfactory level of
emotional and behavioral adjustment".
According to World Health Organization (WHO) mental
health includes "subjective well-being, perceived self-efficacy,
autonomy, competence, intergenerational dependence, and
self-actualization of one’s intellectual and emotional potential,
among others.”
WHO further states that the well-being of an individual is
encompassed in the realization of their abilities, coping with
normal stresses of life, productive work and contribution to
their community
6. INDIA
POINT PREVALENCE OF 18 – 207 PERONS / 1000 POPPULATION
AROUND 13 CRORE PEOPLE(Ganguly and Murali).
PSYCHOTIC SUBSTANCE USERS
SCHIZOPHRENIA
MOOD DISORDERS
NEUROTIC STRESS RELATED
BEHAVIOURAL SYNDROMES
DISORDERS OF ADULT PERSONALITY
MENTAL RETARDATION
CHILDHOOD
PSYCHOLOGICAL
ORGANIC
UNSPECIFIED
FREQUENCY OF CASES IN SPECIALISED HOSPITALS IN 2004.
8. The DALY loss due to psychiatric disorders including
substance use is 11.5% and expected to constitute 15% of the
disease burden by 2020 according to world health report 1999.
The most common disorders were depression at 10%.
generalised anxiety disorder at 8%. alcohol at 3%.
Incidence is 0 - 59 years in Men.
women 15 - 44 years.
CAUSE YLD IN MALES
(IN MILLION)%
YLD IN FEMALES
(IN MILLION)%
UNIPOLAR
DISORDERS
24.3 41.0
ALCOHOL USE
DISORDERS
19.9 0
SCHIZOPHRENIA 8.3 8
BIPOLAR DISORDER 7.3 7.1
9. The DALY in Mental illnesses is greater than that in diarrhea,
Malaria, HIV and Tuberculosis.
1.2 lakh people commit suicide every year in India due to
psychiatric illnesses.
60% of these deaths can be prevented with proper counseling.
A morbidity of 40% was detected in one of the studies of
primary care evaluation of mental disorders.
India has the least number of psychiatric clinics in
comparison to developed and developing countries.
Mortality caused due to neuropsychiatric disorders is 2.2 in
females and 2.1 in males.
10. Not at war with self, free from internal conflicts
Well-adjusted, accepts criticism & not easily
upset.
Searches for identity
Has a strong sense of self-esteem
Knows oneself, ones needs, problems & goals
(self- actualization)
Has good self control, balances rationality &
emotionality
Tries to cope up with stress & anxiety
12. Stating a threat to oneself.
Speaking about death, murder etc.
Excessive amount of violent games and internet games.
Writes about violence on facebook, twitter etc..
Running away or making trouble at home.
Reading negative books.
Suspended or expelled from school.
Avoiding social activities.
13.
14.
15. Mental illness is defined as a condition that causes serious
disorder in a persons behaviour and thinking.
A Mental disorder, also called a mental illness,
psychological disorder or psychiatric disorder, is mental or
behavioral pattern that causes either suffering or a poor
ability to function in ordinary life. Many disorders are
described. Conditions that are excluded include social
norms. Signs and symptoms depend on the specific
disorder.
In addition, this syndrome or pattern should not merely
be an acceptable or a culturally appropriate response to
a particular event.
It must currently be considered a manifestation of a
behavioral, psychological or biological dysfunction of
the individual.
16. MENTAL
ILLNESS
ICD 10
DSM IV
TR
There are two widely accepted classifications of mental
disorders.
1) ICD-10( International classification of diseases ).
2) DSM IV(Diagnostic and statistical manual of mental
disorders).
17. ICD 10 MENTAL DISORDER PREVALENCE RATE/1000 POPULATION.
ORGANIC DISRDERS.
F00-F04
F05
DEMENTIA
DELIRIUM
0.4
3-3.5
-
PSYCHOACTIVE SUBSTANCE USE.
F10
F11
F11.1
ALCOHOL USE
DRUG USE
TOBACCO USE
6.9
59-365
2-37
50-500
MOOD, STRESS RELATED AND ANXIETY
DISORDERS
F32
F40
F41.0
F41.2
F43
F44
F45
F48
DEPRESSION
PHOBIAS
PANIC
ANXIETY
ADJUSTMENT
DISSOCIATIVE
SOMATIC
NEURASTHENIA
12.3-20.7
8-10
2
1
5
-
-
-
-
PHYSIOLOGICAL
F50
F51
F52
EATING
SLEEP
SEXUAL
PERSONALITY DISORDERS
F60
2-10.
DEVELOPMENT DISORDERS
F70 MENTAL RETARDATION
4.2
1
DISORDERS OF CHILDHOOD
F90
F91
F98.0
HYPERCONDUCT
CONDUCT
ENEURESIS
16.5
-
4.5
1.6
COMMON MENTAL DISORDERS GENERAL PUBLIC
PHC / HOSPITAL SETTING
20
130-500
18. The DSM-IV TR, Organized each psychiatric diagnosis into
five dimensions (axes) relating to different aspects of disorder
or disability:
Axis I: All psychological diagnostic categories except mental
retardation and personality disorder
Axis II: Personality disorders and mental retardation
Axis III: General medical condition; acute medical conditions
and physical disorders
Axis IV: Psychosocial and environmental factors contributing
to the disorder
Axis V: Global Assessment of Functioning or Children's
Global Assessment Scale for children and teens under the age
of 18
20. CONDITIONS DIRECT HEALTH
CAUSES
INDIRECT HEALTH
CAUSES
SCHIZOPHRENIA -IMMUNOLOGICAL
-GENETIC
-ALCOHOL AND
DRUG ABUSE
-OUTCOME OF
CONDITIONS
-PERSONALITY /
NATURE OF THE
INDIVIDUAL
-VIOLENCE
-VIRAL INFECTIONS
-POVERTY
-STIGMA
-MARITAL STATUS
-DRUGS
-LACK OF FAMILY
SUPPORT
-LIVING ALONE
-SOCIAL ADVERSITIES
-GENDER AND AGE
ALCOHOL AND DRUG -PREDISPOSITION OF
THE INDIVIDUAL
-PERSONALITY
PROFILE
-FAMILY HISTORY OF
USAGE
-EASY AVAILABILITY
-EXTENSIVE
PROMTION
-LIBERALIZED
VALUES
-LACK OF STRICT
POLICIES.CONT….
21. CONDITIONS DIRECT
HEALTHCAUSES
INDIRECT HEALTH
CAUSES
MENTAL
RETARDATION
-OBSTETRIC
-NEONATAL SEPSIS
-INFECTIONS OF THE
NERVOUS SYSTEM
-INBORN ERROR OF
METABOLISM
-ABSENCE OF
PREMARITAL AND
GENETIC
COUNSELLING
-PREVIOUS MEDICAL
CONDITIONS.
-LACK OF
INVESTGATIVE
FACILITIES.
-POOR LIFE SKILLS
-SOCAIL FACTORS
-LACK OF
REHABILTATION
SKILLS
-LAD RESOURCES
-ABSENCE OF
POLICIES ON
REHABILITATION
-LACK OF IODINE IN
NUTRITION
22. CONDITIONS DIRECT HEALTH
CAUSES
INDIRECT HEALTH
CAUSES
DEMENTIA HISTORY OF MENTAL
DISORDERS
-EMERGING SOCIAL
ISSUES SUCH AS
ISOLATION
-DEPRIVATION OF
BASIC CARE
-ABSENCE OF
SUPPORTIVE CARE.
Can also be classified under:
A) Organic: arteriosclerosis, neurological diseases,
metabolic disorders, leprosy, epilepsy etc
B) Heredity.
C) Social pathological causes: Poverty, isolation,
stress, family issues, worries, marriage, insecurity
23. In adults:
Confused thinking
Prolonged depression, sadness or irritability (2 weeks or more)
Feelings of extreme highs and lows
Excessive fears, worries and anxieties
Social withdrawal
Disinterest in activities that were previously sources of enjoyment
Inappropriate reactions to stimulus (i.e. laughing at a funeral, indifference to
crucial situations)
Sudden shifts in personality
Dramatic changes in eating or sleeping habits (too much or too little)
Strong feelings of anger
Delusions or hallucinations
Growing inability to cope with daily problems and activities
Suicidal thoughts
Denial of obvious problems
Numerous unexplained physical ailments
Deterioration or abandonment of normal hygiene
Substance use or abuse outside the individual’s normal patterns
24. In older children and pre-adolescents:
Substance abuse
Inability to cope with problems and daily activities
Changes in sleeping and/or eating habits
Excessive complaints of physical ailments
Defiance of authority, truancy, theft, and/or vandalism
Intense fear of weight gain
Decline in academic or athletic performance
Disinterest or refusal to participate in activities they
previously enjoyed
Inability to cry or excessive crying
Prolonged negative mood, often accompanied by poor
appetite or thoughts of death
Frequent outbursts of anger
25. In younger children:
Changes in school performance
Poor grades despite strong efforts
Excessive worry or anxiety (i.e. refusing to go to
bed or school)
Hyperactivity
Inability to cry or excessive crying
Persistent nightmares
Persistent disobedience or aggression
Frequent temper tantrums
26.
27. Three levels of
preventions have been
described:
Primary: It operates
on a community basis.
Consists of improving
the social environment
and promotion of the
social, emotional and
physical well being of
the people.
Secondary: Consists
of early diagnosis of
mental illness and of
social and emotional
disturbances through
screening programs in
school, universities
and other community
setups.
Tertiary: It seeks to
reduce the duration of
mental illness.
28. Use of modern
psychoactive drugs and
good after care services.
Early diagnosis and
treatment.
Rehabilitation.
Group and individual
psychotherapy.
Mental health education.
30. Early childhood interventions
Support for children
Socio economic empowerment of women
Social support for elderly population
Program targeted at vulnerable groups
Mental health promotional activities in school
Mental health intervention at work
Housing policies
Violence prevention
Community development program
31. The government has launched national mental
health program in 1982 keeping in mind the heavy
burden of mental illness in the community.
AIMS:
Prevention and treatment of neurological and mental
disorders and their associate disabilities.
Use of mental health technologies to improve
general health services.
Application of mental health principles in total
national development to improve quality of life.
32. OBJECTIVES:
To ensure availability and accessibility of minimum
mental health care for all in the foreseeable future,
particularly to the most vulnerable and underprivileged
sections of the society.
To encourage application of mental health knowledge in
general health care and in social development.
To promote community participation in the mental
health services development and to stimulate efforts
towards self help in the community.
STRATEGIES:
Integrating mental health with primary health care
through the NMPH.
Provision of tertiary care institutions for treatment of
mental disorders.
Eradicating stigmatization of mentally ill patients and
preventing their rights.
33. MENTAL HEALTH CARE SYSTEM:
The mental morbidity requires priority in health care
delivery and treatment.
PRIMARY HEALTH CARE AT VILLAGE AND SUB
CENTER LEVELS.
Multi purpose worker(MPW) and health supervisor will be
trained
AT PRIMARY HEALTH CENTER LEVEL.
Medical officers will be trained.
AT THE DISTRICT HOSPITAL LEVEL.
There is an urgent need for psychiatric specialty
MENTAL HOSPITAL AND TEACHING PSYCHIATRIC
UNIT.
These higher centers will actively and directly function
with links to the peripheries.
34. The district of Bellary, Karnataka was the first
district where district mental health care program
for the population of district was pilot tested by
NIMHANS between 1986-1995.
This model of DMPH was implemented in 27
districts of the country in 1996.
35. OBJECTIVES:
To provide sustainable mental health services to
the community.
Early detection and treatment of patients.
To see that patients do not have to travel long
distance
To take the pressure off mental health
To reduce the stigma attached
To treat and rehabilitate patients
To detect, manage and suitably refer cases.
36. COMPONENTS OF DMHP:
Expansion of the program all over the country to 500 districts with
some modifications
Improvement of health man power development under scheme A for
nursing and work force and scheme B for physicians and appointment
of program officer in every district
Availability of outsourced vehicle
Availability of all the essential drugs
District hospital to have all the higher drugs
Health promotion using life skills
Training program for medical officers
Monitoring, support and supervision
School mental health program to be implemented by imparting life
skills education
NGOs to have an important role to play
College and workplace counselling services
37. Ministry of
health and
family
welfare
State monitor
agency
Central
monitoring
agency
District program
officers
The
administrative
unit
The functional unit
District Level
MONITORING OF THE DMHP
38. CURRENT STATUS OF DMHP
At present the program in place only at 123 districts
The central grant released will be 2.5 crores for 20 lakh population
Most of the centers have trained staff
PHCs are providing services and referral to patients
The state of Karnataka also has a deputy director mental health
responsible for monitoring the progress of DMHP
BARRIERS IN IMPLEMENTATION OF DMHP
Administrative barriers
Lack of man power resources
Motivational barriers
General issues like doctors spending more time in curative than
preventive medicine
39. The national mental health program in its 11th 5th
year plan envisages health promotion using life
skills approach for adolescents by
institutionalizing life skills education in the
schools. In 2010 this program has been
implemented in all the DMHP centers.
40. The life skills that need to be taught
are:
Critical and creative thinking
Decision making and problem
solving
Communication skills and inter
personal relations
Coping with emotions and stress
Self awareness and empathy
Health promotion through
Life skills education in
adolescent school going
children.
41. Information, education and communication
Support for health promotion using life skills
education
Support for follow up
Organization of health camps
Networking with PHCs and ASHA(Rural health
mission)workers
Facilitation of disability welfare benefits
Home care for severely disabled persons
Disseminating information
42. MENTAL HEALTH ACT, 1987
Objectives and Aims:
1. To regulate admission to psychiatric hospitals or psychiatric nursing homes of
mentally ill-persons who do not have sufficient understanding to seek treatment on a
voluntary basis, and to protect the rights of such persons while being detained
2. To protect society from the presence of mentally ill persons who have become or
might become a danger or nuisance to others
3. To protect citizens from being detained in psychiatric hospitals or psychiatric
nursing homes without sufficient cause
4. To regulate responsibility for maintenance charges of mentally ill persons who
are admitted to psychiatric hospitals or psychiatric nursing homes
5. To provide facilities for establishing guardianship or custody of mentally ill
persons who are incapable of managing their own affairs
6. To provide for the establishment of Central Authority and State Authorities for
Mental Health Services
7. To regulate the powers of the Government for establishing, licensing and
controlling psychiatric hospitals and psychiatric nursing homes for mentally ill persons
8. To provide for legal aid to mentally ill persons at State expense in certain cases.
43. MENTAL HEALTH CARE BILL,2013.
The new bill seeks to decriminalize suicide, while at the same time,
making affordable mental health care a right for everyone.
FEATURES:
All those who attempt suicide will be considered as mentally ill
until and unless proven otherwise.
The bill seeks to offer proper mental care for people with mental
illness.
The bill also prohibits inhuman practices such as electro
convulsive therapy without anesthesia, chaining and tonsuring of
heads as well as sterilization as a treatment for illness.
The bill also provides for registration of the Mental Board to be
set up by the government at both central and state levels.
The bill provides for Central Mental Health Authority and State
Mental Health Authority together with the Mental Health Review
Commission for regulating the sector and registering the
institutions.
44. Mental health action plan 2013 - 2020
Four major objectives are set forth:
More effective leadership and governance for
mental health.
The provision of comprehensive, integrated
mental health and social care services in
community-based settings.
Implementation of strategies for promotion
and prevention.
Strengthened information systems, evidence
and research.
45. WHO Mental Health Gap Action Programme
(mhGAP)
The WHO Mental Health Gap Action Programme
(mhGAP) aims at scaling up services for mental,
neurological and substance use disorders for
countries especially with low- and middle-
income. The programme asserts that with proper
care, psychosocial assistance and medication, tens
of millions could be treated for depression,
schizophrenia, and epilepsy, prevented from
suicide and begin to lead normal lives– even
where resources are scarce.
46.
47.
48. Drug is defined by WHO as any substance which
when taken into the living organism, may modify
one or more of its functions.
Drug abuse is defined as self administration of a
drug in excess for a reason that is non medical, in
qualities and quantities that may impair the
individual's ability to function effectively and
which may result in social, physical or emotional
harm.
49. Drug dependence is defined as a state, sometimes
psychic and sometimes also physical, resulting
from interaction between the drug and the living
organism, characterized by behavioral and other
responses that always include the compulsion to
take the drug on a continuous and periodic basis
in order to experience its psychic effects, and
sometimes to avoid the discomfort that its absence
brings about.
Alcoholism, also known as alcohol use disorder
and alcohol dependence syndrome, is a broad
term for any drinking of alcohol that results in
problems.
50. An estimated 12-20 million people consume
marijuana in the US.
30-50% of high school students have made it a
part of their life in the US.
There are believed to be 62.5 million people in
India who at least occasionally drink alcohol.
A dramatic rise was seen between 1970 and 1995
of 106.7% in Alcohol consumption.
India has also become one of the largest producers
of alcohol – it produces 65% of alcoholic beverages
in South-East Asia.
51. Some evidence suggests that there is an increasing use of illicit drugs and
reported numbers point to over 3 million drug addicts in India.
Cannabis, heroin, opium and hashish are the most commonly used drugs in
India.
HIV is a significant issue for drug addicts in India with over 2.4 million
people infected.
There are 2 billion alcohol consumers in the world with 2.3 million cases of
alcoholism and 1.8 million cases every year with a prevalence of 5-20%
The world average is 2058 male and 276 female per 1000 population.
There are approximately 2 lakh new cases of alcohol abuse every year in
India.
Over 65% of the alcohol produced in south east Asia if from India and India
is the 7th largest supplier of alcohol in the region.
54. ALCOHOL OPIOIDS CANNABINOIDS SEDATIVES AND
HYPNOTICS
COCAINE OTHERSTIMULANTS
INCLUDING
CAFFEINE
HALLUCINOGEN
S
TOBACCO
VOLATILE
SOLVENTS
OTHER PSYCHOACTIVE
SUBSTANCES AND DRUGS
FROM DIFFERENT CLASSES
USED IN COMBINATION
55. Ethanol is thought to cause harm partly as a result of
direct damage to DNA caused by its metabolites.
Alcohol abuse is a pattern of drinking that results in
harm to one’s health, interpersonal relationships, or
ability to work.
The older adult population (over 65 years) is
frequently overlooked when discussing alcohol abuse.
A smaller volume of consumed alcohol has a greater
impact on the older adult than it does on a younger
individual.
Binge drinking is defined as consuming more than
five units in men and four units in women.
56. ALCOHOL ABUSE
SHORT TERM
BINGE DRINKING - It increases chances for vandalism,
fights, violent behaviors, injuries, drunk driving, trouble
with police, negative health, social, economic, or legal
consequences to occur. Binge drinking is also associated
with neuro cognitive deficits of frontal lobe processing
and impaired working memory as well as delayed
auditory and verbal memory deficits.
violence, injuries, unprotected sexual activities and,
additionally, social and financial problems.
Binge drinking is also associated with neuro cognitive deficits
of frontal lobe processing and impaired working memory as
well as delayed auditory and verbal memory deficits.
LONG TERM
damage to the central nervous system and peripheral nervous
system can occur from chronic alcohol abuse. The long-term
use of alcohol is capable of damaging nearly every organ and
system in the body.
higher rates of cardiovascular disease.
Alcoholism, malnutrition, chronic pancreatitis, alcoholic
liver disease and cancer.
the developing fetal brain is also vulnerable, and fetal
alcohol spectrum disorders(FASDs) may result if pregnant
mothers consume alcohol.
EFFECTS OF ALCOHOL.
57. Difficulty with interpersonal relationships, problems at work or school, legal problems,
irritability and insomnia. Alcohol abuse is also an important cause of chronic fatigue.
Inebriation and poor judgment, chronic anxiety, irritability, insomnia, elevated liver
function tests, cirrhosis and liver failure.
The skin of a patient with alcoholic cirrhosis can feature cherry angiomas, palmar
erythema and in acute liver failure : Jaundice and ascites.
The derangements of the endocrine system lead to the enlargement of the male breasts.
The inability to process toxins leads to liver disease, such as hepatic encephalopathy.
Alcohol abuse can result in brain damage which causes impairments in executive
functioning such as impairments to working memory, visuo spatial skills, and can cause
an abnormal personality as well as affective disorders to develop.
Binge drinking is associated with individuals reporting fair to poor health compared to
non-binge drinking individuals and which may progressively worsen over time.
Alcohol also causes impairment in a person's critical thinking. The social skills that are impaired
by alcohol abuse include impairments in perceiving facial emotions, difficulty with perceiving
vocal emotions and theory of mind deficits, the ability to understand humor is also impaired in
alcohol abusers.
58. DIAGNOSIS:
The CAGE questionnaire may be used to screen for alcohol misuse.
EPIDEMOLOGY:
Risk taking, expectancies, sensitivity and tolerance, personality and
psychiatric co morbidity, hereditary factors, and environmental
aspects. Studies show that child maltreatment such as neglect, physical,
and/or sexual abuse, as well as having parents with alcohol abuse
problems, increases the likelihood of that child developing alcohol use
disorders later in life.
Genetic and environmental factors. The influence of genetic risk factors
in developing alcohol use disorders increase with age ranging from 28%
in adolescence and 58% in adults
59. TREATMENT.
Youth treatment and intervention should focus on eliminating or
reducing the effects of adverse childhood experiences, like childhood
maltreatment.
Approaches like contingency management and motivational
interviewing have shown to be effective means of treating substance
abuse.
Educating youth about what is considered heavy drinking along with
helping them focus on their own drinking behaviors.
“Drinking in moderation.“
Mindfulness-based intervention programs.
Initiation of self help groups.
Treatment basically consists of two parts: Detoxification and
60. Post establishing diagnosis, the idea should be to initiate
a behaviour change by providing motivation and sound
advice. Once behavior change is established, a regular
monitoring system is required for maintenance of their
remission.
The FRAMES acronym summarizes a counseling
strategy used in brief interventions:
Feedback
Review problems faced due to drinking
Responsibility: Changing alcohol use is the patients
responsibility
Advice: Advice to cut down or abstain
Menu: Provide options for changing behaviour
Empathy: Use an empathic approach
Self efficacy: Encourage optimism about changing
behavior
61. TERM CRITERION
MODERATE DRINKING
MEN: LESS THAN 2 DINRKS/DAY.
WOMEN: LESS THAN 1 DRINK/DAY.
OVER 65 YEARS: LESS THAN ONE DRINK/DAY.
AT RISK DRINKING MEN: MORE THAN 14 DRINKS A DAY
WOMEN: MORE THAN 7 DINKS A DAY
ALCOHOL ABUSE
MANIFESTED BY THREE OR MORE OFTHE FOLLOWING OVER A
PERIOD OF A 12 MONTH PERIOD:
FAILURE TO EXECUTE DUTIES
RECURRENT USE
LEGAL PROBLEMS
CONTINUED USE DESPITE SOCIAL AND INTERPESONAL
PROBLEMS
ALCOHOL DEPENDENCE
MANIFESTED BY THREE OR MORE OFTHE FOLLOWING OVER A
PERIOD OF A 12 MONTH PERIOD:
TOLERANCE
WITHDRAWAL SYMPTOMS
USE OF LARGER QUANTITIES
PERSISTENT DESIRE
GRET DEAL OF TIME SPENT
GIVING UP SOCIAL AND RECREATIONAL ACTIVITIES
HAZARDOUS DRINKING PERSON AT RISK OF ADVERSE CONSEQUENCES
HARMFUL USE PHYSICAL OR PHYSIOLOGICAL HARM
TERMS AND CRITERION FOR PATTERNS OF USE OF ALCOHOL(DSM IV).
62. Preventing or reducing the harm has been called
for via increased taxation of alcohol, stricter
regulation of alcohol advertising and the
provision of brief Interventions.
Information and education on social norms and
the harms associated.
Education to be set in place to reduce the
likelihood of reoccurrence
63. Alcohol policy is under the legislative powers of the
states. Haryana and Andhra had introduced
abstinent in the mid 1990s, but then withdrawn.
An important aspect of policy is to delay initiation
by delaying the legal age to drink.
The cable television act regulation act,2000 prohibits
the advertisement of alcohol and cigarette.
The ministry of social justice and empowerment has
been active in this field.
Community initiative.
Health and social interventions such as greater
knowledge and motivation amongst medical
practitioners.
64. Tobacco is legal to use anywhere in the world. Yet it
causes more deaths than any other psychoactive
substance there is.
About 3 million premature deaths a year are
attributed to tobacco use. It is responsible for 30% of
all cancer deaths in developed countries.
Women who smoke run even more risk than men.
India has the dubious distinction of harboring the
world’s largest number of oral cancer patients with an
annual age standardized incidence of 12.5 per 100,000,
and oral cancer amounts to 9.4 percent of all cancers in
India.
65. Just 10 seconds after a cigarette smoker inhales,
nicotine is absorbed through the skin and the mucosal
linings in the nose, mouth and lungs, and travels
through the bloodstream to the brain. It
stimulates adrenal glands to produce epinephrine, a
hormone and neurotransmitter you also know as
adrenaline.
It also stimulates the production of dopamine, a
neurotransmitter that controls the brain's pleasure
center.
Smoking harms non smokers too. Passive smoking
can also give rise to potential life threatening diseases
such as heart diseases, cancer and stroke.
At present, about 1070 million men and 230 million
women consume tobacco in the world. In India the
prevalence rate of tobacco use is 40% in men and 20%
in women.
66.
67. Cannot stop smoking or
chewing, despite attempts
to quit
Has withdrawal
symptoms when he or
she tries to quit ( shaky
hands, sweating,
irritability, or rapid
heart rate
Must smoke or chew
after every meal or
after long periods of
time without using,
like after a movie or
work meeting
Needs tobacco products
to feel “normal” or turns
to them during times of
stress
Gives up activities or
won’t attend events
where smoking or
tobacco use is not
allowed
Continues to smoke
despite health
problems
68. BODY SYSTEM OR ORGAN EFFECT
Lungs Cancer
Asthma
COPD
Infections
Heart coronary heart disease
angina pectoris
heart attack
arrythmia
aneurysm
Cardiomyopathy
Blood vessels vascular disease
TAO
Skin wrinkling
finger nail discoloration
psoriasis
Brain TIA
MS
69. BODY SYSTEM OR ORGAN EFFECT
Cancer lung
esophageal
laryngeal
oral
bladder
kidney
cervical
pancreatic
valvular
stomach
Colorectal
Bones degeneration
osteoporosis
osteoarthritis
delayed fracture healing
Reproductive infertility
impotence
miscarriage
early menopause
70. BODY SYSTEM OR ORGAN EFFECT
Unborn child prematurity
still birth
birth defects
growth retardation
intellectual impairment
Others Cataract
Snoring
Macular degeneration
Stomach and duodenal ulcers
Crohn’s disease
Impaired immunity
71. The Patch Nicotine Gum
Spray or
Inhaler
Medications
Psychological
and Behavioral
Treatments
72. Smoke Free Places: Smoking is completely banned in many public
places and workplaces such as healthcare, educational, and government
facilities and on public transport.
Tobacco Advertising, Promotion and Sponsorship: Advertising through
many forms of mass media is prohibited, but tobacco companies still
may advertise at the point of sale, subject to some restrictions.
Tobacco Packaging and Labeling: Health warning labels are pictorial
and text; cover 40 percent of the front panel of the package.
The Cigarettes and Other Tobacco Products (Prohibition of
Advertisement and Regulation of Trade and Commerce, Production,
Supply and Distribution) Act, 2003 (COTPA)
Educational and community approach.
73. Opioids are substances that act on the nervous
system in a similar way to opiates such
as morphine and codeine.
Examples:
oxycodone, hydrocodone and hydromorphone. O
pioids are primarily used in medicine for the
treatment of pain.
The side effects of opioids
include sedation, respiratory
depression, constipation, and a strong sense
of euphoria.
Dependence on opioids is a multi factorial
condition involving genetic and psychosocial
factors.
74. There are three stages to treating opioid
dependence.
Stabilization is usually by opioids substitution
treatments, and aims to ensure that the drug use
becomes independent of mental state (such as
craving and mood) and independent of
circumstances (such as finance and physical
location).
The next stage is to withdraw (detox) from opioids.
The final stage is relapse prevention.
Methadone and buprenorphine are seen to be most
effective.
75. Cannabis is one of the most widely used drugs in the
world.
Symptoms include dysphoria (anxiety, irritability,
depression, restlessness), disturbed sleep,
gastrointestinal symptoms, and decreased appetite.
Prolonged marijuana use produces
both pharmacokinetic changes (how the drug is
absorbed, distributed, metabolized, and excreted)
and pharmaco dynamic changes (how the drug
interacts with target cells) to the body.
The most commonly accessed forms of treatment are
12-step programmes, physicians, rehabilitation
programmes, and detox services, with inpatient and
outpatient services equally accessed.
76. A sedative or tranquilizer (or tranquillizer, see American and British
English spelling differences) is a substance that induces sedation by
reducing irritability or excitement.
At higher doses it may result in slurred speech, staggering gait, poor
judgment, and slow, uncertain reflexes. Doses of sedatives such
as benzodiazepines, when used as a hypnotic to induce sleep, tend to be
higher than amounts used to relieve anxiety, whereas only low doses are
needed to provide a peaceful effect.
Sedatives can be misused to produce an overly-calming effect
examples: Barbiturates, benzodiazepines, non benzodiazepines, anti
histamines etc.
Different sedatives have different antidotes and different modes of
77. Cocaine, also known
as benzoylmethylecgonine or coke, is a
strong stimulant mostly used as a recreational
drug. It is commonly snorted, inhaled, or injected
into the veins.
Mental effects may include loss of contact with
reality, an intense feeling of happiness,
or agitation. Physical symptoms may include
a fast heart rate, sweating, and large pupils. High
doses can result in very high blood
pressure or body temperature.
Cocaine is addictive due to its effect on the reward
pathway in the brain. After a short period of use,
there is a high risk that dependence will occur.
78. Physical side effects from chronic smoking of
cocaine include coughing up
blood, bronchospasm, itching, fever, diffuse
alveolar infiltrates without effusions, pulmonary
and systemic eosinophilia, chest pain, lung
trauma, sore throat, asthma, hoarse
voice, dyspnea (shortness of breath), and an
aching, flu like syndrome. Cocaine constricts
blood vessels, dilates pupils, and increases body
temperature, heart rate, and blood pressure.
79. There are many different types of cocaine addiction
treatment. The most common methods of treatment
include:
Cognitive Behavioral Therapy
Behavioral Therapy
Motivational Therapy
Rewards Therapy
Support Groups
Individual Counseling
Family Counseling
Group Counseling
80. Hallucinogens, or psychedelics, are drugs that affect a
person's perceptions, sensations, thinking, self-awareness,
and emotions by disrupting normal functioning of the
serotonin system.
Heavy users sometimes develop signs of organic brain
damage, such as impaired memory and attention span,
mental confusion, and difficulty with abstract thinking. It
is not known whether such mental changes are
permanent. Large doses may cause drowsiness,
convulsions, and coma. Taking large amounts of PCP can
also cause death from repeated convulsions, heart and lung
failure, or ruptured blood vessels in the brain.
While there is no specific protocol for hallucinogens, there
are medications that can calm the body and mind during
withdrawal and then, if necessary, handle any
psychological shifts caused by the absence of the drug.
81. Caffeine is a central nervous system stimulant. It works by
stimulating the brain. Caffeine is used to restore mental
alertness or wakefulness during fatigue or drowsiness.
In the event that any of these side effects do occur, they may
require medical attention.
More common: Feeding intolerance
Less common: Agitation, black, tarry stools, coma, confusion,
coughing or vomiting blood, dizziness, fast heartbeat,
indigestion, irritability, lightheadedness, muscle twitching,
rapid weight gain, rash, seizures, severe stomach pain etc.
There is no such treatment for caffeine addiction. The only
way is to reduce and monitor the dosage.
82. Many volatile substances, if inhaled in sufficient
quantity, produce effects similar to those of
central nervous system depressants such as
ethanol and barbiturates.
Common household products which often contain
organic solvents include cleaning and polishing
fluids, contact adhesives, and paint and nail-
polish removers.
In the short term, inhalers may experience slurred
speech, headaches, vomiting, wheezing, loss of
motor co-ordination and hallucinations. Dangers
always present with solvent abuse include
aspiration of vomit and hypoxia which is where
the body is deprived of sufficient oxygen
83. Loss of interest in daily routine.
Loss of body weight.
Unsteady gait, clumsy movement and tremors.
Redness and puffiness of eyes and haziness.
Slurring of speech
Fresh numerous injection marks on the body and blood stains on clothes.
Nausea, vomiting and body pain.
Drowsiness or sleeplessness.
Lethargy and passivity.
Anxiety, depression and profuse sweating.
Changing mood and temper.
De personalization and emotional detachment.
Impaired memory and concentration
Presence of needles and strange packets at home.
84. Unemployment
Living away from home.
Migration
relaxed parental control
Alienation from family
Early exposure to drugs
Giving up school early
Broken homes and one parental families
Large urban environments
Areas where drugs are traded, sold or produced.
Certain occupations(tourism)
Areas with high rate of crimes
Areas where delinquency is common
88. Article 47 of the constitution of India directs the
state to regard the raising of the level of nutrition
and the standard of living of its people and the
improvement of public health amongst its
primary duties.
Section71 of the narcotic drugs and psychotropic
substances act, 1985 provides as follows: POWER
OF GOVERNMENT TO ESTABLISH CENTRES
FOR IDENTIFICATION, TREATMENT ETC OF
ADDICTS AND FOR THE SUPPLY OF
NARCOTIC DRUGS AND PSYCHOTRPOIC
SUBSTANCES.
89. A two pronged strategy with the aim to reduce
supply and demand. The supply is under the
purview of the enforcement agencies with the
department of revenue as the nodal agency, the
demand reduction strategy is under the domain of
social sector and the ministry of social justice and
empowerment in government of India is
responsible for the implementation of demand
reduction strategy in the country.
90. Government of India
has the following
strategy for demand
reduction:
1) Building awareness and
educating the people about
ill effects of drug abuse.
2) Dealing with addicts
through programs of
motivational counseling,
treatment, follow up and
social re integration of
recovered addicts.
3) To impart drug abuse
prevention and
rehabilitation training to
volunteers with a view to
build up an educated cadre
of service providers.
91. De addiction cum
rehabilitation
centers will
provide the
following services
to the community:
1) Preventive
education
2) Identification
of addicts
3) Motivational
counseling
4)
Detoxification/De
addiction
5) Vocational
rehabilitation
6) After care and
reintegration in to
the society
mainstream.
92. Training and Man power development.
The government has established a national center for drug abuse
prevention(NC DAP) under the aegis of the national Institute of social
defense, New Delhi, to serve as the apex body in the country in the field
of training, research and documentation.
Inter sectoral collaboration.
The government has been taking an integrated approach in the matter.
The cooperation of the media, youth organizations and sectors such as
industry, tourism and health sector.
International cooperation.
The ministry of social justice and empowerment, in collaboration with
the ILO and the UNODC(United nations office on drugs and crimes)
has implemented a program on "Developing community drug
rehabilitation and workplace prevention programs".
93. •1) Information linkage
•2) Better and
personalized data
management.
•3) Research on usage
of indigenous methods
•4) Accelerated
awareness programme
Possibilities
of a future
linkage are
with:
94. The ministry of social justice and empowerment,
under its demand reduction strategy, provides
preventive awareness, motivational counseling,
curative treatment and post treatment
rehabilitation to victims of drug and alcohol
addiction through voluntary organizations and
government bodies.
There are 401 treatment cum rehabilitation centers
and 24 de addiction centers have been sanctioned
to increase the coverage of the scheme.
Overall supervision is being carried out by the
National institute of social defense, New Delhi.
