What are Mental and Behavioral Disorders Due to Substance Abuse?
This group includes disorders, the severity of which varies from uncomplicated intoxication to severe psychotic disorders and dementia, but at the same time they can all be explained by the use of one or more psychoactive substances. The particular substance used often determines the entire clinic, for example, the picture of intoxication, psychosis, although dementia as a result of the use of various substances may be similar. Disturbances due to the use of alcohol (F10), opioids (F11), cannabioids (F12), sedatives and hypnotics (F13), cocaine (F14), other stimulants, including caffeine (F15), hallucinogens (F16), tobacco (F17) , volatile solvents (F18), the combined use of drugs and other psychoactive substances (F19), the latter implies chaotic drug use.
The nature of the psychoactive substance used can be clarified on the basis of the patient’s statement, laboratory tests, objective clinical trial data, the patient’s drug availability, and third-party reports. It is advisable to obtain data from several sources. When using more than one type of psychoactive substance, the diagnosis should be established in accordance with the most important of the substances used or the most frequently used.
In the pathogenesis of dependence on psychoactive substances, there is a clinical, biochemical and social link. The clinical link includes a peculiarity of euphoria, which is different for different substances, which can explain fixation on a particular substance and preference for a drug, regularity of use, the extinction of the first effect and a change in tolerance, a change in consumption patterns (for example, from tablets to injections), the disappearance of protective reactions, due to a change in the forms of intoxication, obsessive drive and physical dependence. The biochemical link is determined by genetic causes, the number of specific receptors with which the substance binds, and the level of neurohormones. The social link is associated with the role of the family, group, social and economic organization, a special environment, such as bohemian.
Symptoms of Mental and Behavioral Disorders Due to Substance Abuse
Acute intoxication (F1x.0).
Acute intoxication is a transient condition that occurs following the administration of a psychoactive substance, leading to a breakdown of consciousness, cognitive functions, perception, emotions, or other psychophysiological functions and reactions.
The diagnosis of intoxication is basic only when intoxication is not accompanied by more persistent disorders.
The level and severity of intoxication depends on the dose, concomitant organic disease, social circumstances (for example, the situation at holidays, carnivals), as well as the time elapsed after using the substance.
Symptoms of intoxication may depend on the type of substance. So, the effect of cannabis and hallucinogens is difficult to predict, the effect of alcohol in small doses is stimulating, in large – sedative.
To determine the presence of complications in acute intoxication, it is indicated whether there are complications and whether the symptoms depend on the dose, in particular, whether there was an additional trauma or personal injury that affects the degree of acute intoxication, and whether there were other medical complications, for example, bloody vomiting, aspiration of vomit, delirium, perceptual disturbances, coma or convulsions. All complications significantly affect the clinic of intoxication and change the therapeutic tactics, they make it difficult to determine the depth of intoxication. With intoxication with small doses of alcohol, the development of pathological intoxication is possible, in which there is a violation of orientation with inadequate actions, including aggressive ones.
Harmful use (F1x.1).
Somatic symptoms of intoxication (for example, hepatitis, myocarditis) or mental disorders (for example, secondary depression after alcoholization or epileptic seizures) are considered to be harmful consequences of the use of a psychoactive substance. However, as a result of consumption, the patient damages not only his psyche or physical condition, but also damages the social environment. His family relationships, social success suffer, he can be aggressive and commit criminal acts, which in most cases of judicial practice arise against the background of intoxication or withdrawal. Social damage is also expressed in the fact that people who use psychoactive substances themselves are often the distributors of these substances.
Addiction Syndrome (F1x.2).
The syndrome of dependence on psychoactive substances consists of symptoms of physiological, behavioral and cognitive phenomena in which the use of a substance or class of substances begins to dominate the individual’s value system and crowds out other interests. The main characteristic of addiction syndrome is the desire to take a psychoactive substance. It is said that in the physiological sense (physical dependence), the need to take a substance is due to the experience of somatic well-being, which can be achieved only under this condition. Behavioral and cognitive (mental dependence) need is due to the fact that the patient is not able to think, work, relieve stress, anxiety without taking this substance.
The syndrome is characterized by both a pronounced desire and the need to take a psychoactive substance, since otherwise painful withdrawal symptoms occur. The patient is not able to control the dose of the substance taken, the beginning of its use, the end. So, a patient with alcoholism begins to drink before the proposed holiday and continues to drink after it ends, moving from one type of alcoholic beverage to another. The dependence syndrome includes the presence of withdrawal conditions after discontinuation. This often motivates the patient to take a substance that is no longer considered as a means of euphoria, but as an opportunity to get rid of withdrawal conditions. The dependence is characterized by an increase in tolerance, that is, for the previous narcotic effect, an ever higher dose is required every time. As a result of the addiction syndrome, all other interests that are not related to the substance are supplanted and become insignificant, and it takes longer to use it itself, as well as to restore health after the substance has expired. The patient continues to use the substance, despite obvious harmful consequences, such as liver damage, depressive states after periods of heavy use of the substance, decreased intellectual functions, and a deterioration in the economic situation due to drug use. That is, the patient initially realizes, and then ceases to be aware of the harmful effects of addiction and is completely in the grip of his habit. During use, during the formation of the addiction syndrome, the repertoire of substance consumption changes, more often it narrows. Dependence can also be considered not only the use of this substance, but also the desire to use it. The patient begins to realize his abnormal attraction when he tries to get rid of the use or only limit the intake of the substance. These attempts may be due to the fact that he does not have the means to purchase the next dose, or under pressure from others, he must limit himself.
Addiction syndrome may occur with respect to a particular substance, class of substances, or a wider spectrum of different substances. So, some patients immediately start using any available drugs without any system; upon withdrawal, they experience anxiety, agitation and / or physical signs of withdrawal syndrome, which are difficult to associate with any one substance. Some addicts are fixed on only one substance, while others are considered as a means of eliminating the withdrawal syndrome. Although the dependence syndrome is quite distinct, nevertheless, the patient at the moment may have abstinence for personal reasons, for example, psychological or social. Other patients temporarily stop taking the drug, although they are tempted to take the drug because they are in prison or in the clinic. Some patients do not take a psychoactive substance, despite the craving for it, because they take methadone or naltrexone (antaxone) for opiate addiction, or smokers chew nicotine chewing gum, or are forced by the environment to go to support psychotherapeutic sessions. After coding sessions, patients with alcoholism may also continue to be attracted to alcohol, but do not accept it due to fear of death or loss of health. But still, with the dependence syndrome, the patient often continues to actively and constantly take the drug. The form of addiction, which proceeds impulsively, is accompanied by a narrowing of consciousness, is indicated when drinking alcohol as dipsomania. This dependence is close to the circle of affective disorders and often masks depression, but it is also regarded as the equivalent of epileptic paroxysm.
Cancel status (F1x.3).
Withdrawal conditions include a group of symptoms of various combinations and severity, manifested when the substance is completely or partially stopped after repeated, usually prolonged and / or high doses, of the substance. The onset and course of withdrawal syndrome is limited in time and corresponds to the type of substance and the dose immediately preceding abstinence. Generally, withdrawal conditions develop less than 24 hours after the last dose. They consist of physiological, behavioral and cognitive symptoms. During the period of cancellation, convulsions are possible.
Cancellation syndrome is one of the manifestations of the addiction syndrome and can be the main diagnosis if it is sufficiently pronounced and is the direct reason for going to the doctor.
Physical disorders may vary depending on the substance used, but more often it is a question of vegetative reactions, articular, gastrointestinal, cardiovascular disorders. Mental disorders, such as anxiety, anxiety, irritability, weakness, depression, sleep disorders, are also characteristic of withdrawal syndrome. Typically, the patient indicates that withdrawal is relieved by subsequent use of the substance. Sometimes withdrawal syndrome occurs without prior use as a kind of reflex, which has previously been repeatedly fixed. For example, with alcoholism, when the patient has not consumed alcohol already for a year, psychic equivalents of withdrawal syndrome after acute stress may occur.
Cancellation status with delirium (F1x.4).
The condition of withdrawal may be accompanied by delirium, exactly the same as described in F05. That is, after a period of anxiety and anxiety with vegetative symptoms and sleep disturbances, disorientation occurs at the place and time with an influx of terrifying visual hallucinations, with fear and excitement. After the last intake of a psychoactive substance, it may take from 24 hours to 3 days. This delirium may be accompanied by generalized tonic-clonic seizures.
Psychotic Disorder (F1x.5).
The disorder that occurs during or immediately after the use of a psychoactive substance is characterized by vivid hallucinations (usually auditory, but often affecting more than one sphere of feelings), false recognition, delirium and / or ideas of an attitude (often paranoid or persecutory), affect (from intense fear to ecstasy). Consciousness is usually clear, although there may be some degree of confusion that does not turn into severe confusion. The disorder usually goes away within 1 month, sometimes partially, and completely – within 6 months. It is important that a psychotic disorder develops during or immediately after the use of a psychoactive substance (usually within 48 hours), its symptoms are very variable depending on the type of substance and the person who uses it. So, in individuals with high intelligence, continuous control of their experiences is possible.
Difficulties arise when it comes to taking substances with a primary hallucinogenic effect. In this case, acute intoxication is diagnosed, since perceptual disorders themselves may not occur during the withdrawal period, but as a result of the hallucinogens themselves.
The clinic of a psychotic disorder may be schizophrenic, delusional, hallucinatory or polymorphic, but may include depression, manic states. For example, psychotic disorders resulting from the use of cannabioids are fairly accurate exogenous models of schizophrenia.
Amnestic syndrome (F1x.6).
By this syndrome is understood a chronic pronounced impaired memory of recent events; the memory of distant events is sometimes disturbed, while the direct reproduction of these events is preserved. Typically a violation of the sense of time and order of events, as well as the ability to assimilate new material. Patients often indicate current dates forward or backward. Confabulations are possible, but not required. The main symptoms are fixative disorders of memory and a disorientation of orientation over time in the absence of cognitive impairment, while there should be objective evidence of chronic use of psychoactive substances in the history or from the words of relatives. Typically, a person is characterized by features of addiction, insincerity, apathetic features.
Residual psychotic disorder and psychotic disorder with a late (delayed) debut (F1x.7).
Some psychotic and other mental disorders resulting from the use of psychoactive substances are not observed directly during intoxication or withdrawal, but later, sometimes after a few months. In this case, the anamnesis according to the patient, the data of objective research and information from the words of relatives, as well as some features of the clinic suggest that we are talking about the consequences of abuse. This may be a change in the general characteristics of a person, behavior, habits, or fragmentary psychoses. It is sometimes difficult to prove that these disorders are caused by past intoxication, since other mental disorders are possible that occur in a person with a history of history. To prove this connection, it is important to establish whether residual disorder is an amplification of the previous state or whether it occurs against the background of a normal psyche. Patients with narcotic experience sometimes experience reminiscence episodes of the period of drug use, for example, dreams about injections or situations of use, euphoria that bring back memories of the past. Typical personality and behavioral disorders, which often are no different from organic personality disorders (F07.0), organic cognitive disorders or meet the general criteria for dementia.