SlideShare ist ein Scribd-Unternehmen logo
1 von 29
Downloaden Sie, um offline zu lesen
Prof. Fareed A.Minhas
Head,
Institute of Psychiatry
Rawalpindi Medical College
Rawalpindi
Substance use disorder (DSM IV)
Disorders due to psychoactive drug use
(ICD 10)
Conditions arising from the abuse of
alcohol, psychoactive drugs and other
chemicals such as volatile solvents
DSM IV

ICD 10

Intoxication

Intoxication

Abuse

Harmful use

Dependence

Dependence syndrome

Withdrawal

Withdrawal state

Withdrawal delirium

Withdrawal with delirium

Psychotic disorders

Psychotic disorder

Dementia
Amnestic Disorder

Amnestic syndrome

Mood disorders

Residual and late-

Anxiety disorders

-onset psychotic disorder

Sexual dysfunctions

Other mental and
INTOXICATION – transient syndrome due to recent
substance ingestion that produces clinically significant
psychological and physical impairment
ABUSE – maladaptive patterns of substance use that
impair health
DEPENDENCE – certain physiological and
psychological phenomena induced by repeated taking of
a substance (strong desire, neglect to other sources of
satisfaction, development of tolerance and a physical
withdrawal state)
TOLERANCE – state in which, after repeated
administration, a drug produces a decreased effect
or increasing doses are required to produce the same
effect

WITHDRAWAL – state is a group of symptoms and
signs occurring when a drug is reduced in amount or
withdrawn, lasting for a limited time
ESCALATION – refers to a phenomenon when a
person taking so called softer drugs moves on to
harder drugs
DSM IV

ICD 10

Alcohol

Alcohol

Amphetamines
Caffeine

Other stimulants such
as caffeine

Cannabis

Cannabinoids

Cocaine

Cocaine

Hallucinogens

Hallucinogens

Inhalents

Volatile solvents

Nicotine

Tobacco

Opioids

Opioids

Phencyclidine
Sedatives/Hypnotics

Sedatives/Hypnotics
Multiple drug use
Availability of
drugs

A vulnerable
personality

Adverse
Social
circumstances
EXTENT OF THE PROBLEM –
- Atleast 300,000 ppl in UK have this problem
- Ppl with drinking problems have a 2 to 3
percent greater chance of dying
- 1 in 5 admissions in acute medical wards in
UK is directly or indirectly related to
alcohol
- Admissions to psychiatric hospitals for this
purpose have increased 25 fold
TERMINOLOGY OF DRINKING HEAVY
BINGE
DRINKERS

PROBLEM

DRINKERS

DRINKERS
DETECTION –

History
Absenteeism from work
Unexplained dyspepsia or GI bleeds
Admissions for accidents
Fits, turns or falls

Signs
Plethoric face with/without telangiectases
Blood shot conjuctivae
Smell of stale alcohol
Facial resemblance to Cushing’s Syndrome
Marked tremors and other signs of disease
‘At risk’ factors
Marital discord
Days off work
An affected relative having similar problems
High-risk occupations eg. Salesmen
Associated physical/mental conditions

Markers
Gamma-glutamyl transpeptidase
Mean corpuscular volume (MCV)
Carbohydrate-deficient transferrin
HDL Cholesterol
Blood/Urinary Alcohol
Rapid reinstatement
Of syndrome on drinking
After a period of
abstinence
Relief from withdrawal
By further drinking
Withdrawal symptoms

The subjective
Awareness of a
Compulsion to drink

ALCOHOL
DEPENDENCE
SYNDROME

Increased tolerance
To alcohol. Need for
More to achieve
Same results

A narrowing of the
Drinking repertoire

Primacy of drinking
Over other activities
SYMPTOMS OF ALCOHOL DEPENDENCE –
Unable to keep a drink limit/Difficulty avoiding getting drunk
Spending considerable time drinking
Missing meals/Memory lapses, blackouts
Restless without drink/Trembling after drinking
Organizing day around drink
Morning retching and vomiting
Sweating at night/Withdrawal fits
Morning drinking/Increased tolerance
Hallucinations/ frank delirium tremens

DIAGNOSTIC CRITERIA OF ALCOHOL WITHDRAWAL
Any THREE of the following :
Tremor of outstretched hands, tongue or eyelids
Sweating
Nausea / retching/ vomiting
Tachycardia or hypertension
Anxiety
Psychomotor agitation
Headache
Insomnia
Malaise or weakness
Transient visual, auditory or tactile hallucinations/illusions
Grandmal convulsions
TREATMENT –
Raise awareness of the problem
Increase motivation to change
Withdraw alcohol (controlled drinking)
Support and advice
CBT (Social skills, relapse prevention)
Marital therapy
Medication (Diazepam/chlormethiazole/Disulfiram
or Acamprosate)
 Psychological dependence
 Glue-sniffing – adolescents. Tolerance develops in
weeks or months
 Intoxication characterized by euphoria,
excitement, floating sensation, dizziness, slurred
speech and ataxia
 Acute intoxication – amnesia + visual hallucinations
 There is risk of tissue damage including that to
bone marrow, brain, liver and kidneys which can prove
fatal
 Derived directly from opium poppy: Morphine/Codeine
 Semi-synthetic  Heroine / Diacetylmorphine
Synthetic  Methadone/Meperidine/Dihydrocodeine
 Uses  Pain relief; suppression of cough; treatment of
acute myocardial infarction and also diarrhea
 Effects  Pleasant mood and a euphoric detachment
 Causes of death in narcotics addicts 
Heart disease (including infective endocarditis)
Tuberculosis
Glomerulonephritis
Tetanus/Malaria/Hepatitis B
 NARCOTIC ABSTINENCE SYNDROME –
Yawning/Rhinorrhea/Lacrimation
Pupillary dilatation
Sweating/Piloerection/Restlessness

12 – 16
HRS AFTER
DOSE

Muscle twitches/Aches and pains
Abdominal cramps/Vomiting/Diarrhea
Hypertension
Insomnia/Anorexia/Agitation
Profuse sweating/Weight loss

24 – 72 HRS
AFTER
LAST OPIATE
DOSE
Abrupt withdrawal is highly dangerous. May
result in a mental disorder, similar to alcohol
withdrawal, may lead to seizure & sometimes to
death.
 
Withdrawal symptoms may not appear for
several days. Anxiety, restlessness, and
disturbed sleep anorexia, nausea.
 
May progress to vomiting, hypotension, pyrexia,
tremulousness, major Seizures, disorientation &
hallucinations.
 Elevate mood, increase wakefulness, give an
enhanced sense of mental and physical energy
 Pleasurable stimulation & excitement potential
of misuse
 Cocaine, amphetamines, Synthetic
(Phenmetrazine diethylpropon), Khat, Caffeine 

 
 Effects similar to these Amphetamines
 Strong Psychological dependence
 Excitation,dilated pupils, tremulousness
 Dizziness and sometimes convulsions
 Confusion, depression, paranoid psychosis and
formication
 Chlordiazepoxide (Librium), Diazepam (Valium),
Lorazepam (Ativan) and Nitrazepam (Mogadon)
 Cause:
Sedation, anxiety relief and Muscle relaxation
Withdrawal Symptoms:
Anxiety, restlessness, tachycardia and sensory
disturbances
Produce strange, intense, & transcendental
effects,which gives them ‘recreational’ popularity
Peyote, mescaline, ‘Magic mushroom’
LSD:lysergic acid diethyl-amide
Do not give rise to dependence in true sense,
nonetheless use is intensely hazardous
Effects vary with dose, persons expectation ,
mood, & social setting
Exaggerates pre-existing mood: exhilaration,
depression or anxiety
Increased enjoyment of aesthetic experience &
distortion of time & space
Reddening of the eyes, dry mouth, irritation of
respiratory treat & coughing
 No definite withdrawal Syndrome
 No evidence of Tolerance. No serious side
effects amongst intermittent users

 No evidence of teratogenecity. Not safe in
first trimester

 Psychosis:

disagreement
PRE-COMTEMPLATION:
Misuser doesn’t see the problem; others recognize it

CONTEMPLATION:
Individual weighs pros/cons. Considers change is needed
DECISION POINT:
Where the decision is made to act on this issue

ACTION USER:
Choose necessary strategy for change
MAINTENANCE GAINS:
Are maintained and consolidated

RELAPSE:
Return to previous pattern of behavior
1.DETOXIFICATION
2.INSISTENCE ON ABSTINENCE
3.INVOLVEMENT OF FAMILY
4.TOXICOLOGY SCREENS (periodic urine
screens are often essential in identifying relapse
and noncompliance)
5.SELF-HELP GROUPS
6. SANCTIONED TREATMENT
(patient forced to remain in therapy by a legal
sanction e.g. drivers/professional license)
7. CONTINGENCY CONTRACTING
(This approach provides a powerful negative
contingency for leaving treatment or relapsing
or a positive contingency for remaining drug
free)
Substance abuse prof. fareed minhas

Weitere ähnliche Inhalte

Was ist angesagt?

Substance related disorder
Substance related disorderSubstance related disorder
Substance related disorderEmirul Roslan
 
Drug addiction, tolerance and depandance
Drug addiction, tolerance and depandanceDrug addiction, tolerance and depandance
Drug addiction, tolerance and depandanceAMANKUMAR1483
 
Psychoactive Substance Use Disorders: Scope for Social Work - Tasmin Kurien
Psychoactive Substance Use Disorders: Scope for Social Work - Tasmin KurienPsychoactive Substance Use Disorders: Scope for Social Work - Tasmin Kurien
Psychoactive Substance Use Disorders: Scope for Social Work - Tasmin KurienTasminKurien
 
Drug Abuse PPT by nirav
Drug Abuse PPT by niravDrug Abuse PPT by nirav
Drug Abuse PPT by niravniravkd
 
Opioids dependence and management
Opioids dependence and managementOpioids dependence and management
Opioids dependence and managementBSMMU
 
Drugs of abuse - Pharmacology
Drugs of abuse - PharmacologyDrugs of abuse - Pharmacology
Drugs of abuse - PharmacologyAreej Abu Hanieh
 
Addiction Psychiatry
Addiction PsychiatryAddiction Psychiatry
Addiction PsychiatryJacob Kagan
 
Addiction
AddictionAddiction
Addictionjben501
 
Antabuse therapy
Antabuse therapyAntabuse therapy
Antabuse therapyNithiy Uday
 
Drug dependance maha
Drug dependance  mahaDrug dependance  maha
Drug dependance mahasurya720
 
Substance abuse by jaber
Substance abuse by jaberSubstance abuse by jaber
Substance abuse by jaberJaber Manasia
 
Drug identification and behavioral ill effects
Drug identification and behavioral ill effectsDrug identification and behavioral ill effects
Drug identification and behavioral ill effectsJoeben Bade
 

Was ist angesagt? (20)

Substance related disorder
Substance related disorderSubstance related disorder
Substance related disorder
 
Drug addiction, tolerance and depandance
Drug addiction, tolerance and depandanceDrug addiction, tolerance and depandance
Drug addiction, tolerance and depandance
 
Psychoactive Substance Use Disorders: Scope for Social Work - Tasmin Kurien
Psychoactive Substance Use Disorders: Scope for Social Work - Tasmin KurienPsychoactive Substance Use Disorders: Scope for Social Work - Tasmin Kurien
Psychoactive Substance Use Disorders: Scope for Social Work - Tasmin Kurien
 
Drug Abuse PPT by nirav
Drug Abuse PPT by niravDrug Abuse PPT by nirav
Drug Abuse PPT by nirav
 
Drug addiction
Drug addictionDrug addiction
Drug addiction
 
Drugs Of Abuse
Drugs Of AbuseDrugs Of Abuse
Drugs Of Abuse
 
Opioids dependence and management
Opioids dependence and managementOpioids dependence and management
Opioids dependence and management
 
Substance related
Substance relatedSubstance related
Substance related
 
Drugs of abuse - Pharmacology
Drugs of abuse - PharmacologyDrugs of abuse - Pharmacology
Drugs of abuse - Pharmacology
 
Addiction Psychiatry
Addiction PsychiatryAddiction Psychiatry
Addiction Psychiatry
 
Addiction
AddictionAddiction
Addiction
 
Addiction
AddictionAddiction
Addiction
 
Antabuse therapy
Antabuse therapyAntabuse therapy
Antabuse therapy
 
Substance abuse
Substance abuseSubstance abuse
Substance abuse
 
Drug dependance maha
Drug dependance  mahaDrug dependance  maha
Drug dependance maha
 
Substance abuse by jaber
Substance abuse by jaberSubstance abuse by jaber
Substance abuse by jaber
 
Inhalant abuse
Inhalant abuseInhalant abuse
Inhalant abuse
 
Substance abuse
Substance abuseSubstance abuse
Substance abuse
 
Abuse Of Rx And Otc
Abuse Of Rx And OtcAbuse Of Rx And Otc
Abuse Of Rx And Otc
 
Drug identification and behavioral ill effects
Drug identification and behavioral ill effectsDrug identification and behavioral ill effects
Drug identification and behavioral ill effects
 

Andere mochten auch

Speical Ed. Presentation (Ed)
Speical Ed. Presentation (Ed)Speical Ed. Presentation (Ed)
Speical Ed. Presentation (Ed)guest190e0d
 
Alcohol dependence syndrome
Alcohol dependence syndrome Alcohol dependence syndrome
Alcohol dependence syndrome krishna thokala
 
Ch11sexualdis2
Ch11sexualdis2Ch11sexualdis2
Ch11sexualdis2cjtomps
 
Managing the Risks - Drug Use and Abuse - Presentation 3 of 9
Managing the Risks - Drug Use and Abuse - Presentation 3 of 9Managing the Risks - Drug Use and Abuse - Presentation 3 of 9
Managing the Risks - Drug Use and Abuse - Presentation 3 of 9t_lewis
 
Family Orientation summer 2015
Family Orientation summer 2015Family Orientation summer 2015
Family Orientation summer 2015golfdoc52
 
Stigma Resistance in Eating Disorders
Stigma Resistance in Eating DisordersStigma Resistance in Eating Disorders
Stigma Resistance in Eating DisordersScoti Riff
 
Drugs and Alcohol
Drugs and AlcoholDrugs and Alcohol
Drugs and Alcoholkyleblohm
 
Management of MDD (based on Malaysia CPG, may 2007)
Management of MDD (based on Malaysia CPG, may 2007)Management of MDD (based on Malaysia CPG, may 2007)
Management of MDD (based on Malaysia CPG, may 2007)snich
 
Substance abuse and dependency issues pp
Substance abuse and dependency issues ppSubstance abuse and dependency issues pp
Substance abuse and dependency issues ppuyvillage
 
Caregiver Burnout slideshare
Caregiver Burnout slideshareCaregiver Burnout slideshare
Caregiver Burnout slideshareJon Brody
 
SUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREA
SUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREASUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREA
SUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREADr Anoop G MBBS BCCPM
 
Highlight on bipolar depression mohamed sedky 2014
Highlight on bipolar depression  mohamed sedky  2014Highlight on bipolar depression  mohamed sedky  2014
Highlight on bipolar depression mohamed sedky 2014Mohamed Sedky
 

Andere mochten auch (20)

Speical Ed. Presentation (Ed)
Speical Ed. Presentation (Ed)Speical Ed. Presentation (Ed)
Speical Ed. Presentation (Ed)
 
Coach leal
Coach lealCoach leal
Coach leal
 
Alcohol dependence syndrome
Alcohol dependence syndrome Alcohol dependence syndrome
Alcohol dependence syndrome
 
Chapter 5 (revised)
Chapter 5 (revised)Chapter 5 (revised)
Chapter 5 (revised)
 
Ch11sexualdis2
Ch11sexualdis2Ch11sexualdis2
Ch11sexualdis2
 
Texas Survey of Substance use Among College Students 2013
Texas Survey of Substance use Among College Students 2013Texas Survey of Substance use Among College Students 2013
Texas Survey of Substance use Among College Students 2013
 
Managing the Risks - Drug Use and Abuse - Presentation 3 of 9
Managing the Risks - Drug Use and Abuse - Presentation 3 of 9Managing the Risks - Drug Use and Abuse - Presentation 3 of 9
Managing the Risks - Drug Use and Abuse - Presentation 3 of 9
 
Family Orientation summer 2015
Family Orientation summer 2015Family Orientation summer 2015
Family Orientation summer 2015
 
Stigma Resistance in Eating Disorders
Stigma Resistance in Eating DisordersStigma Resistance in Eating Disorders
Stigma Resistance in Eating Disorders
 
Burn the Burnout
Burn the BurnoutBurn the Burnout
Burn the Burnout
 
Drugs and Alcohol
Drugs and AlcoholDrugs and Alcohol
Drugs and Alcohol
 
Management of MDD (based on Malaysia CPG, may 2007)
Management of MDD (based on Malaysia CPG, may 2007)Management of MDD (based on Malaysia CPG, may 2007)
Management of MDD (based on Malaysia CPG, may 2007)
 
Substance abuse and dependency issues pp
Substance abuse and dependency issues ppSubstance abuse and dependency issues pp
Substance abuse and dependency issues pp
 
Substance Abuse
Substance AbuseSubstance Abuse
Substance Abuse
 
Caregiver Burnout slideshare
Caregiver Burnout slideshareCaregiver Burnout slideshare
Caregiver Burnout slideshare
 
SUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREA
SUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREASUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREA
SUBSTANCE ABUSE AWARENESS AND SCREENING AMONG SCHOOL CHILDREN IN A TRIBAL AREA
 
Highlight on bipolar depression mohamed sedky 2014
Highlight on bipolar depression  mohamed sedky  2014Highlight on bipolar depression  mohamed sedky  2014
Highlight on bipolar depression mohamed sedky 2014
 
How to Address Physician Burnout
How to Address Physician BurnoutHow to Address Physician Burnout
How to Address Physician Burnout
 
Adolescents and substance abuse ucaya
Adolescents and substance abuse ucayaAdolescents and substance abuse ucaya
Adolescents and substance abuse ucaya
 
Substance abuse
Substance abuseSubstance abuse
Substance abuse
 

Ähnlich wie Substance abuse prof. fareed minhas

Lecture 2 Subatance Abuse
Lecture 2 Subatance AbuseLecture 2 Subatance Abuse
Lecture 2 Subatance AbuseMiami Dade
 
UNIT 9 SUBSTANCE USE DISORDER.pptx
UNIT 9 SUBSTANCE USE DISORDER.pptxUNIT 9 SUBSTANCE USE DISORDER.pptx
UNIT 9 SUBSTANCE USE DISORDER.pptxDhiviSiva1
 
Drug identification and behavioral ill effects
Drug identification and behavioral ill effectsDrug identification and behavioral ill effects
Drug identification and behavioral ill effectsJoeben Bade
 
Mood disorder bipolar order 8
Mood disorder   bipolar order 8Mood disorder   bipolar order 8
Mood disorder bipolar order 8rfranquiz1
 
Making Decisions about Drugs and Alcohol
Making Decisions about Drugs and AlcoholMaking Decisions about Drugs and Alcohol
Making Decisions about Drugs and Alcoholtbrame
 
Psychopharmacology-copy.pptx
Psychopharmacology-copy.pptxPsychopharmacology-copy.pptx
Psychopharmacology-copy.pptxDexterNicolas2
 
Psychoactive substance use disorder.addikt.ppt
Psychoactive substance use disorder.addikt.pptPsychoactive substance use disorder.addikt.ppt
Psychoactive substance use disorder.addikt.pptMercdeszLengyel
 
Substance Abuse, Psychiatric Nursing, B. Sc (N) PPT
Substance Abuse, Psychiatric Nursing, B. Sc (N) PPTSubstance Abuse, Psychiatric Nursing, B. Sc (N) PPT
Substance Abuse, Psychiatric Nursing, B. Sc (N) PPTNithiy Uday
 
2. Substance related disorder.ppt
2. Substance related disorder.ppt2. Substance related disorder.ppt
2. Substance related disorder.pptashenafigezahegn2
 
drug_alcohol_awareness.pptx
drug_alcohol_awareness.pptxdrug_alcohol_awareness.pptx
drug_alcohol_awareness.pptxUmmeAhmad3
 
Discontinuation syndrome
Discontinuation syndromeDiscontinuation syndrome
Discontinuation syndromeSalman Kareem
 
Anti depressants and mood stabilizers
Anti depressants and mood stabilizersAnti depressants and mood stabilizers
Anti depressants and mood stabilizersUniversity of Miami
 

Ähnlich wie Substance abuse prof. fareed minhas (20)

Unit12 substance abuse
Unit12 substance abuseUnit12 substance abuse
Unit12 substance abuse
 
Lecture 2 Subatance Abuse
Lecture 2 Subatance AbuseLecture 2 Subatance Abuse
Lecture 2 Subatance Abuse
 
Pharma Nervous Day 2.pptx
Pharma Nervous Day 2.pptxPharma Nervous Day 2.pptx
Pharma Nervous Day 2.pptx
 
UNIT 9 SUBSTANCE USE DISORDER.pptx
UNIT 9 SUBSTANCE USE DISORDER.pptxUNIT 9 SUBSTANCE USE DISORDER.pptx
UNIT 9 SUBSTANCE USE DISORDER.pptx
 
Drug identification and behavioral ill effects
Drug identification and behavioral ill effectsDrug identification and behavioral ill effects
Drug identification and behavioral ill effects
 
Mood disorder bipolar order 8
Mood disorder   bipolar order 8Mood disorder   bipolar order 8
Mood disorder bipolar order 8
 
Making Decisions about Drugs and Alcohol
Making Decisions about Drugs and AlcoholMaking Decisions about Drugs and Alcohol
Making Decisions about Drugs and Alcohol
 
Psychopharmacology-copy.pptx
Psychopharmacology-copy.pptxPsychopharmacology-copy.pptx
Psychopharmacology-copy.pptx
 
Psychoactive substance use disorder.addikt.ppt
Psychoactive substance use disorder.addikt.pptPsychoactive substance use disorder.addikt.ppt
Psychoactive substance use disorder.addikt.ppt
 
Substance Abuse, Psychiatric Nursing, B. Sc (N) PPT
Substance Abuse, Psychiatric Nursing, B. Sc (N) PPTSubstance Abuse, Psychiatric Nursing, B. Sc (N) PPT
Substance Abuse, Psychiatric Nursing, B. Sc (N) PPT
 
2. Substance related disorder.ppt
2. Substance related disorder.ppt2. Substance related disorder.ppt
2. Substance related disorder.ppt
 
Drug Abuse
Drug AbuseDrug Abuse
Drug Abuse
 
Ppt drugs
Ppt drugsPpt drugs
Ppt drugs
 
Alcohol
AlcoholAlcohol
Alcohol
 
Drugs
DrugsDrugs
Drugs
 
Substance abuse[2]
Substance abuse[2]Substance abuse[2]
Substance abuse[2]
 
Substance abuse1
Substance abuse1Substance abuse1
Substance abuse1
 
drug_alcohol_awareness.pptx
drug_alcohol_awareness.pptxdrug_alcohol_awareness.pptx
drug_alcohol_awareness.pptx
 
Discontinuation syndrome
Discontinuation syndromeDiscontinuation syndrome
Discontinuation syndrome
 
Anti depressants and mood stabilizers
Anti depressants and mood stabilizersAnti depressants and mood stabilizers
Anti depressants and mood stabilizers
 

Mehr von Rawalpindi Medical College (20)

Pertussis
PertussisPertussis
Pertussis
 
Nephrotic syndrome.
Nephrotic syndrome.Nephrotic syndrome.
Nephrotic syndrome.
 
Symptomtology of cardiovascular diseases
Symptomtology of cardiovascular diseasesSymptomtology of cardiovascular diseases
Symptomtology of cardiovascular diseases
 
Symptomatology-GIT-1
Symptomatology-GIT-1Symptomatology-GIT-1
Symptomatology-GIT-1
 
Symptomatology-GIT
Symptomatology-GITSymptomatology-GIT
Symptomatology-GIT
 
Symptomalogy in RENAL impairement
Symptomalogy in RENAL impairementSymptomalogy in RENAL impairement
Symptomalogy in RENAL impairement
 
History taking
History takingHistory taking
History taking
 
Right bundle branch block
Right bundle branch blockRight bundle branch block
Right bundle branch block
 
Right and left ventricular hypertrophy
Right and left ventricular hypertrophyRight and left ventricular hypertrophy
Right and left ventricular hypertrophy
 
Rheumatoid arthritis 2
Rheumatoid arthritis 2Rheumatoid arthritis 2
Rheumatoid arthritis 2
 
Systemic lupus erythematosus
Systemic lupus erythematosusSystemic lupus erythematosus
Systemic lupus erythematosus
 
Supraventricular tachyarrythmias
Supraventricular tachyarrythmiasSupraventricular tachyarrythmias
Supraventricular tachyarrythmias
 
Supraventricular tacchycardias
Supraventricular tacchycardias Supraventricular tacchycardias
Supraventricular tacchycardias
 
Skin-
Skin-Skin-
Skin-
 
Skin
Skin  Skin
Skin
 
Sick sinus syndrome-2
Sick sinus syndrome-2Sick sinus syndrome-2
Sick sinus syndrome-2
 
Sick sinus syndrome
Sick sinus syndrome Sick sinus syndrome
Sick sinus syndrome
 
X rays
X raysX rays
X rays
 
Ventricular arrhythmias
Ventricular arrhythmias Ventricular arrhythmias
Ventricular arrhythmias
 
Ventricular tachyarrhythmias
Ventricular tachyarrhythmias Ventricular tachyarrhythmias
Ventricular tachyarrhythmias
 

Kürzlich hochgeladen

3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptxmary850239
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationMJDuyan
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptxraviapr7
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxMYDA ANGELICA SUAN
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?TechSoup
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxEduSkills OECD
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfTechSoup
 
Presentation on the Basics of Writing. Writing a Paragraph
Presentation on the Basics of Writing. Writing a ParagraphPresentation on the Basics of Writing. Writing a Paragraph
Presentation on the Basics of Writing. Writing a ParagraphNetziValdelomar1
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...Nguyen Thanh Tu Collection
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17Celine George
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.raviapr7
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesCeline George
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptxSandy Millin
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxDr. Asif Anas
 

Kürzlich hochgeladen (20)

3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptx
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive Education
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptx
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
 
Presentation on the Basics of Writing. Writing a Paragraph
Presentation on the Basics of Writing. Writing a ParagraphPresentation on the Basics of Writing. Writing a Paragraph
Presentation on the Basics of Writing. Writing a Paragraph
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 Sales
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptx
 

Substance abuse prof. fareed minhas

  • 1. Prof. Fareed A.Minhas Head, Institute of Psychiatry Rawalpindi Medical College Rawalpindi
  • 2. Substance use disorder (DSM IV) Disorders due to psychoactive drug use (ICD 10) Conditions arising from the abuse of alcohol, psychoactive drugs and other chemicals such as volatile solvents
  • 3. DSM IV ICD 10 Intoxication Intoxication Abuse Harmful use Dependence Dependence syndrome Withdrawal Withdrawal state Withdrawal delirium Withdrawal with delirium Psychotic disorders Psychotic disorder Dementia Amnestic Disorder Amnestic syndrome Mood disorders Residual and late- Anxiety disorders -onset psychotic disorder Sexual dysfunctions Other mental and
  • 4. INTOXICATION – transient syndrome due to recent substance ingestion that produces clinically significant psychological and physical impairment ABUSE – maladaptive patterns of substance use that impair health DEPENDENCE – certain physiological and psychological phenomena induced by repeated taking of a substance (strong desire, neglect to other sources of satisfaction, development of tolerance and a physical withdrawal state)
  • 5. TOLERANCE – state in which, after repeated administration, a drug produces a decreased effect or increasing doses are required to produce the same effect WITHDRAWAL – state is a group of symptoms and signs occurring when a drug is reduced in amount or withdrawn, lasting for a limited time ESCALATION – refers to a phenomenon when a person taking so called softer drugs moves on to harder drugs
  • 6. DSM IV ICD 10 Alcohol Alcohol Amphetamines Caffeine Other stimulants such as caffeine Cannabis Cannabinoids Cocaine Cocaine Hallucinogens Hallucinogens Inhalents Volatile solvents Nicotine Tobacco Opioids Opioids Phencyclidine Sedatives/Hypnotics Sedatives/Hypnotics Multiple drug use
  • 8. EXTENT OF THE PROBLEM – - Atleast 300,000 ppl in UK have this problem - Ppl with drinking problems have a 2 to 3 percent greater chance of dying - 1 in 5 admissions in acute medical wards in UK is directly or indirectly related to alcohol - Admissions to psychiatric hospitals for this purpose have increased 25 fold TERMINOLOGY OF DRINKING HEAVY BINGE DRINKERS PROBLEM DRINKERS DRINKERS
  • 9. DETECTION – History Absenteeism from work Unexplained dyspepsia or GI bleeds Admissions for accidents Fits, turns or falls Signs Plethoric face with/without telangiectases Blood shot conjuctivae Smell of stale alcohol Facial resemblance to Cushing’s Syndrome Marked tremors and other signs of disease
  • 10. ‘At risk’ factors Marital discord Days off work An affected relative having similar problems High-risk occupations eg. Salesmen Associated physical/mental conditions Markers Gamma-glutamyl transpeptidase Mean corpuscular volume (MCV) Carbohydrate-deficient transferrin HDL Cholesterol Blood/Urinary Alcohol
  • 11. Rapid reinstatement Of syndrome on drinking After a period of abstinence Relief from withdrawal By further drinking Withdrawal symptoms The subjective Awareness of a Compulsion to drink ALCOHOL DEPENDENCE SYNDROME Increased tolerance To alcohol. Need for More to achieve Same results A narrowing of the Drinking repertoire Primacy of drinking Over other activities
  • 12. SYMPTOMS OF ALCOHOL DEPENDENCE – Unable to keep a drink limit/Difficulty avoiding getting drunk Spending considerable time drinking Missing meals/Memory lapses, blackouts Restless without drink/Trembling after drinking Organizing day around drink Morning retching and vomiting Sweating at night/Withdrawal fits Morning drinking/Increased tolerance Hallucinations/ frank delirium tremens DIAGNOSTIC CRITERIA OF ALCOHOL WITHDRAWAL
  • 13. Any THREE of the following : Tremor of outstretched hands, tongue or eyelids Sweating Nausea / retching/ vomiting Tachycardia or hypertension Anxiety Psychomotor agitation Headache Insomnia Malaise or weakness Transient visual, auditory or tactile hallucinations/illusions Grandmal convulsions
  • 14. TREATMENT – Raise awareness of the problem Increase motivation to change Withdraw alcohol (controlled drinking) Support and advice CBT (Social skills, relapse prevention) Marital therapy Medication (Diazepam/chlormethiazole/Disulfiram or Acamprosate)
  • 15.  Psychological dependence  Glue-sniffing – adolescents. Tolerance develops in weeks or months  Intoxication characterized by euphoria, excitement, floating sensation, dizziness, slurred speech and ataxia  Acute intoxication – amnesia + visual hallucinations  There is risk of tissue damage including that to bone marrow, brain, liver and kidneys which can prove fatal
  • 16.  Derived directly from opium poppy: Morphine/Codeine  Semi-synthetic  Heroine / Diacetylmorphine Synthetic  Methadone/Meperidine/Dihydrocodeine  Uses  Pain relief; suppression of cough; treatment of acute myocardial infarction and also diarrhea  Effects  Pleasant mood and a euphoric detachment  Causes of death in narcotics addicts  Heart disease (including infective endocarditis) Tuberculosis Glomerulonephritis Tetanus/Malaria/Hepatitis B
  • 17.  NARCOTIC ABSTINENCE SYNDROME – Yawning/Rhinorrhea/Lacrimation Pupillary dilatation Sweating/Piloerection/Restlessness 12 – 16 HRS AFTER DOSE Muscle twitches/Aches and pains Abdominal cramps/Vomiting/Diarrhea Hypertension Insomnia/Anorexia/Agitation Profuse sweating/Weight loss 24 – 72 HRS AFTER LAST OPIATE DOSE
  • 18. Abrupt withdrawal is highly dangerous. May result in a mental disorder, similar to alcohol withdrawal, may lead to seizure & sometimes to death.   Withdrawal symptoms may not appear for several days. Anxiety, restlessness, and disturbed sleep anorexia, nausea.   May progress to vomiting, hypotension, pyrexia, tremulousness, major Seizures, disorientation & hallucinations.
  • 19.  Elevate mood, increase wakefulness, give an enhanced sense of mental and physical energy  Pleasurable stimulation & excitement potential of misuse  Cocaine, amphetamines, Synthetic (Phenmetrazine diethylpropon), Khat, Caffeine   
  • 20.  Effects similar to these Amphetamines  Strong Psychological dependence  Excitation,dilated pupils, tremulousness  Dizziness and sometimes convulsions  Confusion, depression, paranoid psychosis and formication
  • 21.  Chlordiazepoxide (Librium), Diazepam (Valium), Lorazepam (Ativan) and Nitrazepam (Mogadon)  Cause: Sedation, anxiety relief and Muscle relaxation Withdrawal Symptoms: Anxiety, restlessness, tachycardia and sensory disturbances
  • 22. Produce strange, intense, & transcendental effects,which gives them ‘recreational’ popularity Peyote, mescaline, ‘Magic mushroom’ LSD:lysergic acid diethyl-amide Do not give rise to dependence in true sense, nonetheless use is intensely hazardous
  • 23. Effects vary with dose, persons expectation , mood, & social setting Exaggerates pre-existing mood: exhilaration, depression or anxiety Increased enjoyment of aesthetic experience & distortion of time & space Reddening of the eyes, dry mouth, irritation of respiratory treat & coughing
  • 24.  No definite withdrawal Syndrome  No evidence of Tolerance. No serious side effects amongst intermittent users  No evidence of teratogenecity. Not safe in first trimester  Psychosis: disagreement
  • 25. PRE-COMTEMPLATION: Misuser doesn’t see the problem; others recognize it CONTEMPLATION: Individual weighs pros/cons. Considers change is needed DECISION POINT: Where the decision is made to act on this issue ACTION USER: Choose necessary strategy for change
  • 26. MAINTENANCE GAINS: Are maintained and consolidated RELAPSE: Return to previous pattern of behavior
  • 27. 1.DETOXIFICATION 2.INSISTENCE ON ABSTINENCE 3.INVOLVEMENT OF FAMILY 4.TOXICOLOGY SCREENS (periodic urine screens are often essential in identifying relapse and noncompliance) 5.SELF-HELP GROUPS
  • 28. 6. SANCTIONED TREATMENT (patient forced to remain in therapy by a legal sanction e.g. drivers/professional license) 7. CONTINGENCY CONTRACTING (This approach provides a powerful negative contingency for leaving treatment or relapsing or a positive contingency for remaining drug free)