APAKAH PUNCA YANG MENYEBABKAN PENAGIH DADAH SANGGUP MEMBUNUH? Pelakunya sering dikaitkan dengan masalah utama berikut: Menagih dadah dan drug dependency Mengalami hallucination dan delusion Mempunyai mental disturbance (gangguan mental) Berada di tahap luar sedar (unconsciousness) Bertindak agresif dan di luar kawalan

1. DR NOOR HASSLINE MOHAMED
TOPIK 5
PENILAIAN DAN DIAGNOSIS
PENYALAHGUNAAN BAHAN

2. At the end of the topic, students should be
able to:
• Identify the factors that influence drug
addicts to kill people
• Describe the diagnosis of substance
use and induced disorders according
to DSM-5
• Explain how drugs do affect the brain
physiologically
• Discuss the drugs screening and
assessment practices
2
LEARNING OUTCOMES

3. ❑ 18 Mei 2018
❑ Suspek tetak mati tiga beradik disahkan positif dadah di Teluk
Intan
❑ 17 Jun 2019
❑ Penagih dadah bunuh ibu kandung
❑ 10 Jan 2020
❑ Suspek kelar dan bunuh dua beradik di Yan Kedah positif ganja
❑ 27 Jan 2020
❑ Suspek tikam dan bunuh anak saudara di Felda Cherul 2,
Kemaman, Terengganu positif dadah
❑ Ibu berhabis lebih RM1 juta tanggung 3 anak penagih dadah
3
KESAN AKIBAT DADAH

4. 4
APAKAH PUNCA
YANG MENYEBABKAN
PENAGIH DADAH
SANGGUP
MEMBUNUH?

5. ❑ Pelakunya sering dikaitkan dengan masalah utama berikut:
1. Menagih dadah dan drug dependency
2. Mengalami hallucination dan delusion
3. Mempunyai mental disturbance (gangguan mental)
4. Berada di tahap luar sedar (unconsciousness)
5. Bertindak agresif dan di luar kawalan
5
KESAN AKIBAT DADAH

6. ❑ Deria yang normal memerlukan stimulus (ransangan) yang boleh dikesan oleh 5
organ deria dan diinterpretasi oleh otak.
❑ Halusinasi berlaku apabila organ deria tidak dapat mengesan ransangan tetapi otak
boleh menginterpretasi sehinggakan ransangan dirasa seperti wujud oleh penagih.
1. Halusinasi pendengaran (auditory hallucination)
❑ Penagih mendengar suara/bunyi sedangkan ianya tidak wujud dan tidak dapat
didengari oleh orang lain
❑ Contohya, penagih mendengar suara berbisik mengarahkannya untuk
memukul adiknya sendiri
2. Halusinasi penglihatan ( visual hallucination )
❑ Penagih dapat melihat sesuatu dengan jelas sedangkan orang lain tidak dapat
melihatnya.
❑ Contohnya, penagih melihat bidadari datang menghampirinya
3. Hallucination somatic and odor 6
HALLUCINATION

7. 1. Second person auditory hallucination
❑ Penagih mendengar suara ghaib bercakap dengannya dan menyuruh dia
melakukan sesuatu.
❑ Contohnya:
❑ Penagih mendengar suara ghaib memberi arahan kepadanya“ awak bunuh
sahaja budak itu kerana dia dajal’,
2. Third person auditory hallucination
❑ Penagih mendengar banyak suara yang bersembang di kalangan mereka
mengenai diri penagih.
❑ Contohnya:
❑ Penagih mendengar suara A bercakap dengan suara B; ”dia itu (penagih)
memang tidak berguna langsung”.
7
AUDITORY HALLUCINATION

8. 3. Running commentary
❑ Penagih mendengar suara yang terus mengkritik setiap perbuatanya.
Contohnya:
❑ ”dia (penagih) sedang makan nasi mentah,” ”
❑ ”dia sakit perut dan terus lari masuk tandas,”
4. Thought echo
❑ Berlaku apabila penagih mendengar otaknya sendiri bercakap dengan kuat
apabila dia berfikir.
❑ Contoh:
❑ ”aku orang waras,”
❑ ”aku orang baik,”
❑ ”betul ke aku waras?”
8
HALLUCINATION

9. 1. Visual Hallucination
❑ Berlaku apabila penagih dapat melihat sesuatu dengan jelas tanpa dapat dilihat
oleh orang lain.
❑ Contohnya
❑ Penagih melihat adiknya sedang dipukul orang sedangkan adiknya sedang
tidur di bilik.
2. Halusinasi somatik/taktil
❑ Penagih merasa seperti terdapat sesuatu bergerak dalam badannya atau merasa
kesakitan pada badannya
3. Halusinasi bau
❑ Penagih dapat menghidu sesuatu tanpa orang lain dapat menghidunya
9
VISUAL AND OTHER TYPES OF HALLUCINATION

10. ❑ Delusi adalah kepercayaan karut yang sangat dipercayai oleh penagih
walaupun di pertikaikan atau diragui oleh orang lain.
❑ Kepercayaan karut ini tidak sejajar dengan budaya, agama, masyarakat ,
keadaan sosial sekeliling dan ilmu pengetahuan yang ada pada penagih.
❑ Delusi iaitu kepercayaan yang ada pada penagih itu hanyalah kepercayaan
karut yang tidak sebenarnya berlaku tetapi kepercayaan ini sangat kukuh
dipercayai oleh penagih.
Jenis-Jenis Delusi:
1. Delusi paranoid (paranoid or persecutory delusion)
❑ Mempercayai bahawa terdapat orang lain cuba untuk menganiaya ,
mencederakan, mendatangkan kemudaratan atau membunuhnya.
❑ Contohnya:
❑ Percaya bahawa ibunya telah memasukkan racun ke dalam makanan 10
DELUSION

11. 4. Delusi grandiose (grandiose delusion)
❑ Mempercayai bahawa dirinya mempunyai kelebihan tersendiri yang
melampaui orang lain di dunia ini.
❑ Contohnya:
❑ Percaya bahawa dirinya adalah nabi yang turun untuk menyelamatkan dunia
ini
❑ Percaya bahawa dirinya boleh berkomunikasi dengan tuhan
❑ Percaya bahawa dirinya boleh mencipta kenderaan untuk sampai ke bulan
dengan sekelip mata
❑ Percaya bahawa dirinya raja memerintah dan banyak lagi
11
TYPES OF DELUSION

12. 5. Delusi nihilistik (nihilistic delusion)
❑ Mempercayai bahawa diri sendiri atau sebahagian daripada tubuh badan
sudah tidak wujud lagi atau mempercayai bahawa dunia sudah tidak wujud
lagi.
❑ Contohnya
❑ Percaya bahawa darah tidak mengalir lagi dalam tubuhnya atau sebelah
tangannya hilang.
6. Delusi merujuk (delusion of reference)
Mempercayai bahawa orang lain di sekeliling bercakap mengenai dirinya.
Contonya
Percaya bahawa jiran bersembang mengenai dirinya, percaya bahawa televisyen
menyiarkan cerita mengenainya.
12
TYPES OF DELUSION

13. 2. Delusi kawalan ( delusion of control)
❑ Mempercayai bahawa perbuatan, kemahuan dan perasaan menjadi pasif dan
hanya dikawal oleh kuasa dari luar tanpa kehendak diri sendiri.
❑ Contohnya:
❑ Tangan penagih menumbuk seseorang kerana di paksa oleh kuasa lain tanpa
kawalan dan kehendak dirinya sendiri, merasai makhluk telah masuk ke dalam
badan dan memaksa membunuh seseorang.
3. Delusi pelik (bizarre delusion)
❑ Mempercayai dengan kukuh sesuatu yang pelik.
❑ Contohnya:
❑ Percaya bahawa malaikat telah datang menyerang bumi dan syaitan akan
datang menyerang pula bumi setelah kematian malaikat. 13
TYPES OF DELUSION

14. ❑ Individu mula mengambil methamphetamine atau syabu dengan dos kecil
❑ Merasa teruja dan keseronokan luar biasa
❑ Meningkatkan dos pengambilan untuk merasa keseronokan yang lebih
❑ Mengalami halusinasi atau delusi yang menyeronokkan
❑ Mengalami ketagihan
❑ Jika tidak mendapat dadah, individu akan mula gelisah dan menjadi agresif
❑ Dia akan mengalami halusinasi atau delusi yang memberi tekanan/depressi
❑ Dia tidak berupaya mengawal emosinya yang keterlaluan
❑ Dia akan berkelakuan ganas dan bertindak di luar kawalan
❑ Sehingga ke peringkat memukul, mencederakan atau membunuh
❑ Ini kerana, dia tidak lagi sedar akan apa yang dilakukannya
14
BAGAIMANA PENAGIH BOLEH BERTINDAK MEMBUNUH?

15. ❑ Individu mula mengambil methamphetamine atau syabu dengan dos kecil
❑ Merasa teruja dan keseronokan luar biasa
❑ Meningkatkan dos pengambilan untuk merasa keseronokan yang lebih
❑ Mengalami halusinasi atau delusi yang menyeronokkan
❑ Mengalami ketagihan
❑ Jika tidak mendapat dadah, individu akan mula gelisah dan menjadi agresif
❑ Dia akan mengalami halusinasi atau delusi yang memberi tekanan/depressi
❑ Dia tidak berupaya mengawal emosinya yang keterlaluan
❑ Dia akan berkelakuan ganas dan bertindak di luar kawalan
❑ Sehingga ke peringkat memukul, mencederakan atau membunuh
❑ Ini kerana, dia tidak lagi sedar akan apa yang dilakukannya
15
BAGAIMANA PENAGIH BOLEH BERTINDAK MEMBUNUH?

16. 16
“
“
Salah guna dadah
mengundang
penyakit mental
Sakit mental akibat
dadah meningkat di
Malaysia
Dadah menyebabkan
psikosis kerana
dadah yang diambil
telah merosakkan
otak
DIFFERENCE

17. ● Bilangan pesakit yang
dimasukkan ke Hospital
Bahagia Ulu Kinta berpunca
daripada dadah meningkat
dalam tempoh tiga tahun
(2014, 2015 dan 2016).
● Peningkatan pesakit mental
akibat dadah ini berpunca
daripada penggunaan dadah
sintetik yang boleh
mengakibatkan penagihnya
mengalami psikosis (gejala
seperti halusinasi).
2014
357
Hospital Bahagia
Ulu Kinta
17
Sakit mental akibat dadah meningkat di Malaysia
2015
395
2016
411

18. ● Pengambil dadah tidak mengetahui bahawa pengambilan dadah boleh
menyebabkan anda PSIKOSIS (GILA).
● Dadah boleh menyebabkan semua jenis penyakit mental ;daripada anxiety
kepada psikosis.
● Tanda -tanda psikosis yang dialami sama seperti penyakit skizofrenia.
● Psikosis berlaku kerana dadah yang diambil telah merosakkan otak .
● Kerosakan otak bermanifestasi dengan psikosis.
18
Dadah menyebabkan psikosis kerana ia merosakkan otak

19. ● Dadah sintetik yang diklasifikasikan sebagai 'New
Psychoactive Drug' (NPS) sebenarnya mempunyai kesan
ketagihan yang jauh lebih kuat serta meninggalkan
kerosakan otak kekal dan teruk ke atas penagih.
● Pengambilan dadah sintetik seperti methamphetamine
atau meth mengundang kesan amat buruk.
● Meth merosakkan otak.
● Kajian neurosains, contohnya, mendapati kesan
pengambilannya selama tiga bulan lebih teruk daripada
dadah kokain.
19
Dadah sintetik tinggalkan kerosakan otak kekal

20. ● Angela Fatino started using meth at the age of 12.
● She was a very young girl when she started to fight
against methamphetamine addiction for 2 1/2 years.
● The first picture is her school picture on top. The second
was taken just one year later at a Polk County juvenile
detention center.
● She finally committed suicide and it was confirmed that
there was meth in her system when she killed herself.
She died on October 8, 1997. She was 15.
● http://recovery-corner.blogspot.com/2012/10/my-
name-is-meth.html 20
Angela Fatino

21. 21

22. 22

23. ● Drugs interfere with the way neurons send, receive, and process signals via
neurotransmitters.
● E.g. marijuana and heroin, can activate neurons, but they don't activate neurons in
the same way as a natural neurotransmitter, this lead to abnormal messages being
sent through the network.
● E.g. amphetamine or cocaine are disrupt the normal communication between
neurons.
23
How do drugs work in the brain?

24. ● Drugs can alter important brain areas that are necessary for life-sustaining
functions and can drive the compulsive drug use that marks addiction.
● Brain areas affected by drug use include:
The basal ganglia
❑ Play an important role in positive forms of motivation, including the pleasurable
effects of healthy activities like eating, socialising, etc.
❑ Drugs over-activate this circuit,
■ producing the euphoria of the drug high
■ but with repeated exposure
■ the circuit adapts to the presence of the drug
■ diminishing its sensitivity
■ making it hard to feel pleasure from anything
besides the drug
24
What parts of the brain are affected by drug use?

25. The extended amygdala
❑ Plays a role in stressful feelings like anxiety, irritability, and unease,
❑ Which characterise withdrawal after the drug high fades
❑ Thus motivates the person to seek the drug again
❑ Over time, a person with substance use disorder uses drugs to get temporary relief from
this discomfort rather than to get high
The prefrontal cortex
❑ Powers the ability to think, plan, solve problems, make decisions, and exert self-control
over impulses
❑ This is also the last part of the brain to mature, making teens most vulnerable
❑ A person with a substance use disorder seek the drug compulsively with reduced impulse
control
Brain stem
❑ It controls basic functions critical to life, such as heart rate, breathing, and sleeping
❑ Drugs overdoses can cause depressed breathing and death. 25
What parts of the brain are affected by drug use?

26. 2
6

27. The extended amygdala
❑ Plays a role in stressful feelings like anxiety, irritability, and unease,
❑ Which characterise withdrawal after the drug high fades
❑ Thus motivates the person to seek the drug again
❑ Over time, a person with substance use disorder uses drugs to get temporary relief from
this discomfort rather than to get high
The prefrontal cortex
❑ Powers the ability to think, plan, solve problems, make decisions, and exert self-control
over impulses
❑ This is also the last part of the brain to mature, making teens most vulnerable
❑ A person with a substance use disorder seek the drug compulsively with reduced impulse
control
Brain stem
❑ It controls basic functions critical to life, such as heart rate, breathing, and sleeping
❑ Drugs overdoses can cause depressed breathing and death. 27
How do drugs produce pleasure?

28. ❑ Pleasure or euphoria—the high from drugs
❑ When some drugs are taken, surges of the neurotransmitter dopamine
produced by drugs directly caused the euphoria
❑ But dopamine has more to do with getting individuals to repeat
pleasurable activities (reinforcement) than with producing pleasure
directly
28
How do drugs produce pleasure?

29. ❑ Pengambilan dadah meningkatkan bahan kimia bernama Dopamin di dalam otak.
❑ Apabila Dopamin tinggi, kita akan seronok.
❑ Dopamin tinggi beri keseronokan luar biasa.
❑ Dadah diambil sebab mahu tingkatkan dopamin dengan cara tidak betul.
❑ Semakin kerap diambil, semakin kurang sensitiviti, jadi perlu diambil dengan
kuantiti tinggi untuk dapat nikmat yang dikehendaki.
❑ Dadah sintetik beri kesan kepada sistem memori manusia.
❑ Penagih tidak ingat apa yang berlaku.
❑ Kemampuan berfikir secara logik juga terjejas teruk.
❑ Mereka tidak mampu beri tumpuan dan fokus serta tidak dapat membendung
desakan dan keinginan bertindak ganas.
29
How does dopamine reinforce drug use?

30. ❑ The brain of someone who misuses drugs adjusts by producing fewer
neurotransmitters in the reward circuit, or by reducing the number of receptors
that can receive signals.
❑ As a result, the person's ability to experience pleasure from naturally rewarding (i.e.,
reinforcing) activities is also reduced.
❑ This is why a person who misuses drugs eventually feels flat, without motivation,
lifeless, and/or depressed, and is unable to enjoy things that were previously
pleasurable.
❑ Now, the person needs to keep taking drugs to experience even a normal level of
reward—which only makes the problem worse, like a vicious cycle.
❑ Also, the person will often need to take larger amounts of the drug to produce the
familiar high—an effect known as tolerance.
30
Why are drugs more addictive than natural rewards?

31. 31

32. 32
EVIDENCE BASED
SCREENING AND
ASSESSMENT TOOLS
https://www.drugabuse.gov/nidamed-medical-health-
professionals/screening-tools-resources/chart-
screening-tools

33. 33

34. 34
Interrelationships between stages of screening, assessment,
and treatment

35. 35
DIAGNOSIS is the process which involved:-
❑ Identification of the nature of an illness or
other problem by examination of the
symptom
❑ Determining which illness or condition
explains a person's symptoms and signs
❑ 2 types of diagnoses: medical and psychiatric

36. 3
6
PSYCHOLOGICAL ASSESSMENT:
❑ Mental health practitioners used
psychological assessment to help them arrive
at a diagnosis and a treatment plan.

37. 37
Screening Vs Diagnosis
Screening
To detect early illness or
risk factors for the illness
Example:
• Addiction screening
• Relapse screening
• Hearing/visual
impairment screening
Diagnosis
To determine which illness
affect the individuals
Example:
• Medical diagnosis
• Psychiatric diagnosis

38. 3
8
Psychological Assessment VS Testing
Psychological Testing
• Involves the administration
of psychological tests, such
as questionnaires or
checklists.
• For example,
• Drug Screening test
• Personality test
• Mental health test
• Occurs as part of the
process of psychological
assessment.
Psychological Assessment
• Involves numerous
techniques and tools used
to understand the patients:
• Clinical Interview
• Demographic information
• Medical information
• Personal history
• Psychological tests
• Observational data

39. Venus has a beautiful
name and is the second
planet from the Sun. It’s
hotter than Mercury and
its atmosphere is
poisonous
VENUS
MERCURY
Mercury is the closest
planet to the Sun and
the smallest one in the
Solar System—it’s only
a bit larger than our
Moon
39
SCREENING
TOOLS
https://d14rmgtrwzf5a.cloud
front.net/sites/default/files/
opioidrisktool.pdf

40. 4
0

41. 41

42. MSE
PSYCHOLOGICAL TESTING
DSM-5
Diagnostic and Statistical
Manual of Mental Disorder
4
2
Mental State Examination (MSE) – a
comprehensive observational data
Tools used in conducting
psychological assessment

43. ❑ They come in computerized versions, picture formats, verbal interviews, and in
observing someone in a natural environment.
❑ There are four primary types of tests that cover main components of a person’s psyche:
1. Clinical interview
❑ The clinical interview can also be known as an admission, diagnostic, or intake test.
❑ Generally, they are administered at the onset of treatment plans or therapies in order for
the psychologist to gain a better understanding of the individual’s situation.
❑ They don’t take long, maybe a couple hours at the most, and are used to glean
information about family and personal background.
4
3
Kinds of Psychological Testing

44. 2. Assessment of intellectual functioning (IQ)
❑ These types of evaluations don’t necessarily measure one’s actual intelligence, but they
do indicate general intelligence.
❑ PsychCentral notes two kinds of these tests:
1. Neuropsychological
2. Intelligence
❑ Neuropsychological assessments are typically administered to measure cognitive
abilities after a person has suffered brain damage or abnormalities.
❑ Intelligence tests are the most common and help to determine cognitive strengths and
weaknesses.
4
4
Kinds of Psychological Testing

45. 3. Personality assessments
❑ Evaluations like these can help psychologists better diagnose and comprehend mental
illness.
❑ Personality assessments can be objective or projective.
❑ Objective tests like
❑ Minnesota Multiphasic Personality Inventory (MMPI-2)
❑ Millon Clinical Multiaxial Inventory – III (MCMI-III)
❑ Are the most commonly used and help to identify a dysfunction within a person’s
personality.
❑ Projective tests, on the other hand, are very beneficial in helping psychologists to diagnose a
person with a mental illness.
❑ Rorschach Inkblot test evaluates personality characteristics in children and adults.
Finding images out of inkblots may seem silly, but it does serve a purpose.
❑ By describing what you see and how you feel about the images, psychologists can
determine thought disturbances and get a more detailed view of your personality.
45
Kinds of Psychological Testing

46. 4. Behavioural assessments
❑ This often involves observing a person in a natural or comfortable setting and then
examining those behaviours.
❑ Behavioural assessments are great in helping to understand addictions and how certain
triggers incite a particular response.
❑ Self-monitoring methods like journaling can be useful in understanding a person’s
behaviours as well.
❑ Psychological tests are invaluable to addiction and mental health treatment.
❑ By administering assessments like those mentioned above, clinicians and psychologists can
learn more about the individual.
❑ Especially if the individuals enrolled in or are considering treatment for a mental illness or
substance abuse problem, these tests can only be advantageous to their recovery.
46
Kinds of Psychological Testing

47. 47

49. Rorschach Inkblot Test (Printed Card)

50. Rorschach Inkblot Test Popular Responses

51. 51

52. 52
DSM-5
SUBSTANCE-RELATED
AND ADDICTIVE
DISORDERS

53. SUBSTANCE INDUCED
DISORDER
• Mental impairment
that are caused by
substance use
• Mental disorder that
develop in people who
did not have mental
health problems before
using substances
• The substance used
must be known to be
capable of causing the
disorder
SUBSTANCE USE DISORDER
• Known as drug
addiction
• Disease that affects a
person's brain and
behaviour
• Leads to an inability
to control the use of a
legal or illegal drug
• Patterns of symptoms
resulting from the use
of a substance that
individual continue to
take
53
SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

54. 5
4
SUBSTANCE USE
DISORDER:
Drug Addiction

55. ❑ The DSM 5 criteria for
substance use disorders
are based on decades of
research and clinical
knowledge.
❑ This edition was
published in May 2013,
nearly 20 years after the
original publication of
the previous edition, the
DSM-IV, in 1994.
55
SUBSTANCE USE DISORDER

56. 1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance
use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance
use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem
that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the
substance.
5
6
SUBSTANCE USE DISORDER COVERS 11 CRITERIA

57. 1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance
use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance
use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem
that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the
substance. 57
SUBSTANCE USE DISORDER COVERS 11 CRITERIA

58. The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate
classes of drugs:
1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other
hallucinogens, such as LSD);
5. Inhalants
6. Opioids
7. Sedatives, hypnotics, or anxiolytics
8. Stimulants (including amphetamine-type substances, cocaine, and other
stimulants)
9. Tobacco
10. Other or unknown substances 5
8
SUBSTANCE USE DISORDER-10 DRUG CLASSES

59. 59
❑ Withdrawal Syndrome
❑ Sindrom putus dadah merupakan kesan-kesan fizikal dan
mental yang terhasil apabila seseorang berhenti mengambil
sesuatu bahan terutamanya dadah yang sudah menjadi
kebiasaan bagi penagih.
❑ Kesan-kesan tersebut adalah seperti
❑ tubuh menjadi lemah
❑ badan berpeluh, ketar dan loya
❑ menghadapi tekanan melampau bergantung kepada
jenis dadah yang diambil dan tempoh penagihan yang
dialami
❑ Untuk mengatasi masalah withdrawal symptom ini, penagih
akan mengambil dadah semula sehingga berulang kali untuk
menenangkan mereka.
❑ Tingkah laku ketagihan dadah atau penagihan berulang
(relapse) merupakan perkara yang biasa berlaku selepas
seseorang pulih dari ketagihan dadah.
Kriteria Diagnostik Untuk Sindrom Putus Dadah (Withdrawal)

60. 6
0
MILD
2/3 symptoms
indicate a mild
substance use
disorder
MODERATE
4/5 symptoms
indicate a moderate
substance use
disorder
SEVERE
6/ more symptoms
indicate a severe
substance use
disorder
CRITERIA FOR DIAGNOSING SUBSTANCE ABUSE
DISORDER (DSM-5)
The DSM 5 allows clinicians to specify how severe or how much of a problem the
substance use disorder is, depending on how many symptoms are identified.

61. 61
SUBSTANCE-INDUCED
DISORDER:
When Substances Cause
Mental Illness

62. 1. Intoxication:
❑ Psychological changes due to substance use
❑ E.g. slurred speech, lowered inhibitions, euphoria, impaired balance, impaired thinking
2. Withdrawal:
❑ Physical and/or psychological symptoms resulting from the cessation of substance use
❑ E.g. depressed mood, nausea/vomiting, muscle aches, diarrhoea, fever, insomnia
3. Substance-induced psychosis
❑ Hallucinations and/or delusions as a result of substance use
❑ Not typically present when substances are not being used
4. Substance-induced bi-polar disorder
❑ Alternating manic, or “high,” and depressed mood swings
❑ Induced by substance use
❑ Not typically present when substances are not being used
62
SUBSTANCE INDUCED DISORDER COVERS 11 CATEGORIES

63. 5. Substance-induced depressive disorder
❑ Symptoms of depression–sadness, hopelessness, suicidal thoughts, low energy, difficulty
concentrating, social withdrawal that are induced by substance use
❑ Not typically present when substances are not being used
6. Substance-induced anxiety disorder:
❑ Generalised anxiousness, panic, irritability that are induced by substance use
❑ Not typically present when substances are not being used
7. Substance-induced obsessive-compulsive disorder:
❑ Feelings of being “compelled” to carry out certain behaviours or actions
❑ E.g. re-checking locked doors, repeatedly washing hands, etc., usually carried out in an
attempt to reduce stress, that are induced by substance use
❑ Not typically present when substances are not being used 6
3
SUBSTANCE INDUCED DISORDER COVERS 11 CATEGORIES

64. 8. Substance-induced sleep disorder:
❑ E.g. insomnia, or the inability to get to sleep or stay asleep; hypersomnia, or excessive
sleepiness; or parasomnia that are induced by substance use
❑ Not typically present when substances are not being used
9. Substance-induced sexual dysfunction:
❑ Problems with sexual desire, arousal, orgasm, or pain beyond that which is associated
with intoxication that are induced by substance use
❑ Not typically present when substances are not being used
10. Substance-induced delirium:
❑ Mental confusion, disorientation and blurred awareness that is induced by substance
use
❑ Not typically present when substances are not being used 64
SUBSTANCE INDUCED DISORDER COVERS 11 CATEGORIES

65. 11. Substance-induced neuro-cognitive disorders:
❑ Disturbance of cognitive function
❑ E.g. memory impairment
❑ Aphasia or the loss of ability to understand speech
❑ Apraxia the inability to perform purposeful actions
❑ Induced by substance use
❑ Not typically present when substances are not being used
6
5
SUBSTANCE INDUCED DISORDER COVERS 11 CATEGORIES

66. 66
The symptoms
must have
developed within
one month
The symptoms
must have
developed following
the abuse of the
substance
The symptoms
interfere person’s
normal
activities/behaviour
/thought
CRITERIA FOR DIAGNOSING SUBSTANCE INDUCED
DISORDER (DSM-5)
To be diagnosed as a substance-induced disorder, the symptoms must be clinically
significant, meaning that they cause significant distress and/or interfere with the person’s
ability to take part in normal, daily activities.

67. Cocaine – associated with substance-
induced anxiety and panic
Caffeine – associated with
substance-induced anxiety
Hallucinogens (Marijuana, LSD) – associated
with substance-induced depression, anxiety,
delusions and hallucinations
Methamphetamines – associated with
substance-induced depression, anxiety, and
hallucinations
67
Substances Can Cause Substance-Induced Mental Illness

68. Nicotine – associated with substance-
induced anxiety, irritability and nausea
Alcohol – associated with substance-induced
mood disorders (depression, anxiety, bi-polar),
substance-induced sleep disorders and
substance-induced psychotic disorders
Sedatives/Benzodiazepines (Xanax, Valium, Ativan,
Klonopin) – associated with substance-induced
anxiety, substance-induced mania, substance-
induced sleep disorders and substance-induced
sexual disorders
Opioids – associated with substance-
induced anxiety/irritability and depression
68
Substances Can Cause Substance-Induced Mental Illness

69. TREATMENT PLAN
01
• DIAGNOSIS
• The process of identifying and determining the nature of a disease or disorder
by its signs and symptoms, through the use of assessment techniques (e.g., tests
and observation).
• Psychological diagnoses have been codified for professional use, notably in the
DSM–5.
02 TREATMENT PLAN
• A detailed plan tailored to the individual
patient and is a powerful tool for engaging the
patient in their treatment, which include:
• Patient’s personal information
• Diagnosis of the disorder
• Outline of the treatment prescribed
(psychotherapies)
• A space to measure outcomes as the client
progresses through treatment

70. Then detoxification must be initiated to
rid the person’s system of the drug
Non-medical treatment
• Psychotherapy/Counselling
• Family/Peer support groups
• The aim is to help the person remain abstinent
from substance use, develop positive coping skills
and to create a healthier, more meaningful lifestyle.
The intake of the substance must be
ceased
Medical treatment
• SI depression, antidepressants (Paxil, Prozac, Cymbalta,
Effexor or Elavil used to elevate mood.
• SI psychosis, antipsychotic medication, (Risperdal or
Seroquel).
• In severe cases, hospitalisation may be required.
7
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Treatment of Substance-Induced Disorders

71. 71
THANKS
hassline@ums.edu.my
IG: dr.lynnee
FB: Noor Lynn