Clinic. Hallucinogens (psychedelics, psychotomimetics) are not a very successful designation for a team of over 100 natural and synthetic drugs. The most well-known of the natural ones are psilocybin, derived from mushrooms, and mescaline, produced from a certain type of cactus; Lysergic acid diethylamide (LSD), dipropyltryptamine (DPT) and 3,4-methylenedioxymethamphetamine (MDMA, also known as Extasy) are synthetic. Hallucinogens interfere with the metabolism of catecholamines, dopamine, acetylcholine, serotonin and GABA, causing the disinhibition of the activity of the occipital regions of the brain and limbic structures. For some drugs, there may be zones of specifically sensitive receptors in the brain.
Psilocybin has long been used in religious rituals of American Indians. The use of hallucinogens is largely susceptible to sociocultural influences. Their greatest popularity in the United States and Europe falls on the 60-70-ies, when they were considered one of the symbols of the youth subculture.
The quality and duration of subjective sensations when taking depends on the type of drug. Thus, affective changes are more characteristic of the action of MDMA; the widest range of perceptual disorders is characteristic of LSD. The effect occurs within an hour after oral administration and lasts 8-12 hours; with other drugs, the effect lasts from several hours to several days.
Psychological manifestations are largely determined by the personal characteristics of the user, his expectations and micro-social factors, but LSD almost always gives deep violations of perception, affect and thinking. In some cases, the effect of the drug is subjectively perceived as a manifestation of mental illness, accompanied by panic reactions. The intensity of perception of smells and tastes increases, the colors are perceived as richer, the texture and outlines of objects are more distinct, the emotional perception of music deepens. Marked so-called. synesthesia: colors may be perceived as sounding, sounds may be perceived as visible. Observed disorders of the body scheme, violations of the perception of space and time. Own Self is perceived dissolved in the surrounding world, separated from the body, floating in mystical ecstasy. Visual hallucinations predominate, often in the form of geometric shapes and figures. The intensity and changeability of emotions increases, various variants of affect can be felt simultaneously. Non-verbal perception becomes more significant, suggestibility increases sharply. A general increase in the severity of perception can cause a subjective feeling of internal organs, the emergence of long-forgotten memories. Usually there is a deepening of introspection, philosophical ideas, religious feelings, after which there remains a false idea of increasing the creative potential of one’s own personality, of its cardinal changes.
The most typical complication is the so-called. “Bad trip” (bad trip), similar to a panic reaction with intoxication with cannabinoids, usually accompanied by psychotic symptoms lasting up to several weeks or longer. It occurs in approximately 25% of users. It is also possible flashback (return to the past), lasting from a few seconds to several hours, occurring outside the drug intake and provoked by a stressful state, the use of cannabinoids. Sometimes they can be called arbitrarily. In some cases, hallucinogens provoke endogenous psychosis. Anxiety-depressive syndromes with suicidal behavior are also a complication. The most susceptible are persons with anxious, unstable, schizoid personality traits and in a prepsychotic state.
Prolonged addiction rarely occurs due to the lack of reliable euphoria and the unpredictability of each episode of intoxication. There is no physical dependence, withdrawal syndrome. Tolerance develops quickly, disappearing just as quickly, within 2-3 days.
The diagnosis of acute intoxication is made on the basis of common criteria for F1x.0, as well as: 1) the presence in the clinical picture of at least one of the following signs: a) fear, anxiety, b) visual, auditory or tactile illusions and hallucinations with an increase in the perception acuteness and concentration, c) depersonalization, derealization, d) paranoid ideas, relationship ideas, e) affective instability, e) increased activity, g) impulsive behavior, h) concentration disturbances, and) a decrease in mental productivity; 2) at least two of the following symptoms: a) increased frequency, as well as increased heartbeat, b) alternation of profuse sweat and cold feeling, c) tremor, d) blurred vision, e) pupillary dilation, e) coordination disorder.
Treatment. In acute intoxication, emotional support and encouragement are usually sufficient, although in case of severe anxiety, the appointment of anxiolytics may be necessary, and sometimes – butyrophenones (phenothiazines should be avoided, since they can potentiate the anticholinergic effect).
F17 Mental and behavioral disorders due to tobacco use
Clinic. The average cigarette contains 0.5 mg of the active substance of tobacco – nicotine. A conditionally lethal dose is 60 mg. Physiological effects include narrowing of peripheral vessels, increased peristalsis, increased release of catecholamine, norepinephrine and epinephrine, a general decrease in metabolism, and tremor. In smokers, women have a low birth weight.
Social factors influence consumption: in adolescents, this may be a manifestation of reactions of protest, emancipation, the desire to appear as adults, conformity to the subculture of their peers. In adults, reinforcement is provided by pleasant associations with situations of feasts, sex; trade advertising plays a significant role.
Smokers are distinguished by a certain set of personality traits: greater impulsive behavior, a lower level of education, a higher frequency of divorces, greater extroversion, anxiety, ill will, and a tendency to alcohol abuse. Nicotine stimulates the hypothalamic pleasure center, which may explain the appearance of addiction. The euphoric effect is somewhat similar to the action of cocaine and opiates. The calming effect is proportional to the duration of the pause between smoking.
In addition to the main signs, the state of acute intoxication may include increased salivation, abdominal pain, diarrhea, headaches, dizziness. Smoking can complicate psychiatric medication, increasing liver metabolism and reducing the level of antipsychotics and antidepressants in the blood. Dependency, primarily psychological, develops quickly, about 85% of people continue to smoke after the first cigarette. To nicotine produced tolerance.
The withdrawal syndrome develops within 1.5-2 hours after the last use, reaches a peak during the first days and lasts for several weeks or longer. The core symptom of withdrawal — craving for smoking — can persist for many years of abstinence in the absence of other signs of withdrawal. Drowsiness during the day is combined with the difficulty of falling asleep. There is a slowing of the heartbeat, a decrease in blood pressure and motor activity. The temporal stereotype and mechanisms of recurrence are similar to those in the use of alcohol and opiates. Relapse is observed in 80% of smokers in the first 2 years of abstinence. Recurrence is promoted by a high level of social stress, social maladjustment, low self-esteem.
The diagnosis of acute intoxication is made on the basis of the criteria common to Flx.0, as well as: 1) the presence of at least one of the following symptoms: a) insomnia, b) fancy dreams, c) affective instability, d) derealization, e) reduced mental productivity; 2) at least one of the following symptoms: a) nausea, vomiting, b) profuse sweating, c) tachycardia, d) cardiac arrhythmia.
The diagnosis of withdrawal syndrome is made on the basis of common criteria for Flx.3, as well as the presence of at least two of the following symptoms: a) craving for tobacco use, b) malaise, weakness, c) anxiety, d) dysphoria, e) irritability or anxiety, e) insomnia, g) increased appetite, h) cough, and) ulceration of the oral mucosa, k) decreased concentration.
Treatment. Many therapeutic approaches are used, none of which have demonstrated advantages over the other. The most commonly used are various forms of suggestion (the so-called “coding”, acupuncture), aversive behavioral therapy, replacement therapy (chewing gum with nicotine to alleviate the withdrawal syndrome, or lobeline, giving a nicotine-related effect). In the period of cancellation, anxiolytic therapy is advisable. Success is promoted by the presence of support from relatives and a group of abstinent smokers, fear of the somatic consequences of smoking (lung cancer, CHD).
Smokers seeking help are the most therapeutically resistant, treatment programs yield not more than 20% of successful cases; at the same time, 95% of abstinents did not receive medical care, leaving it unclear how or why they stopped smoking. Prognostically unfavorable factors are unsatisfactory social adaptation, female gender, a high level of use before therapy.
F18 Mental and behavioral disorders due to the use of volatile solvents
Clinic. For narcotic purposes, the following volatile solvents are used: gasoline, lacquer solvents, various types of glue, cleaning liquids, aerosols (especially paints), amyl and butyl nitrates. Nitric oxide, ester, is specifically used by health professionals who have access to these substances and are a contingent that is fundamentally different from the main users. The overwhelming majority of users are children and adolescents from 6 to 16 years of age from low-income strata of society.
Inhalation is carried out directly from the packaging or with a cloth moistened with a substance or a plastic bag that is pulled over the head. Intoxication occurs in 5 minutes and lasts 15-30 minutes. During intoxication, the euphorizing effect is replaced by inhibition.
In addition to the main, signs of acute intoxication can be an overestimation of one’s own personality, a feeling of invulnerability, superior strength, a feeling of soaring, dizziness, disturbances in spatial perception, and certain psychotic symptoms. Possible amnesia period of intoxication. Rod aggressive behavior leads to frequent offenses; decrease in mental productivity is accompanied by difficulties in learning.
Among the somatic effects may be nausea, loss of appetite, decrease in tendon reflexes. Death may occur as a result of central respiratory arrest, cardiac arrhythmias and accidents. Somatic effects affect the bone marrow, kidneys, liver, peripheral neuritis. There is an increase in tolerance, although there is no convincing evidence of the presence of withdrawal syndrome. The use of volatile substances, being, as a rule, a transient disorder, often ends with a transition to other forms of drug addiction or alcoholism.
Diagnosis. Traces of volatile solvents (as well as hallucinogens) are not detected in the urine by laboratory methods. Tangible signs of use can be hyperemia of the skin in the nasal area, conjunctivitis, inflammation of the mucous membranes of the upper respiratory tract, peculiar smell from the mouth, traces of the substance on the face, hands and clothes. The diagnosis of acute intoxication is made on the basis of the criteria common to F1x.0 and: 1) the presence of at least one of the following mental symptoms: a) apathy, indifference, b) conflict, aggressive behavior, c) affective instability, d) reduced focus of thinking, d ) impaired concentration and memory, e) psychomotor inhibition, g) decreased mental productivity; 2) as well as at least one of the following neurological signs: a) unsteadiness of gait, b) Romberg’s negative test, c) blurred speech, d) nystagmus, d) impairment of consciousness (eg, stupor, coma), e) muscular weakness, g) blurred vision, diplopia.