Mental disorders due to psychoactive substances
Introduction
Introduction to mental disorders caused by psychoactive substances Mental disorders associated with psychoactive substances (referred to as substances) can be divided into two categories: one is the use of psychoactive substances (substance dependence disorder and substance abuse), and the other is caused by psychoactive substances, including: mental Active substance poisoning, withdrawal of psychoactive substances, paralysis caused by psychoactive substances, persistent dementia caused by psychoactive substances, persistent amnesia caused by psychoactive substances, psychotic disorders caused by psychoactive substances, spirit Mood disorders caused by active substances, anxiety disorders caused by psychoactive substances, sexual dysfunction caused by psychoactive substances, and sleep disorders caused by psychoactive substances. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications:
Cause
Causes of mental disorders caused by psychoactive substances
Etiology
The factors that cause drug addiction are not single, and are related to drug availability, genetic quality and personality susceptibility as well as sociocultural factors.
Some drug addicts, especially young people, have a certain degree of personality and moral disorder before taking the drug, such as poor academic performance, truancy or discipline, some people with mental illness or personality disorder, or unpleasant experiences in childhood.
Social culture has an impact on the occurrence of drug addiction. The application of addiction drugs in society is tolerant. Drug addiction is prone to flooding. For example, cannabis is widely prevalent in North America, and social pressure within the group also has an impact, such as pressure between intimate partners.
Medical and pharmacists get drugs late and can become a good class.
[Pathogenesis]
Mechanisms for drug dependence:
1 Metabolic resistance and cell resistance, metabolic resistance refers to the rapid metabolism of drugs, decreased concentration in tissues, weakened effect, shortened effective time, cell resistance refers to the presence of nerve cells This kind of adaptive change causes the nerve cells to work normally only if the blood contains high concentrations of drugs. The mechanism of this cell adaptive change is still unclear.
2 Receptor theory, a morphine receptor with a specific affinity for morphine drugs and an endogenous morphine receptor agonist are found in the brain, so it is speculated that the rapid formation of drug dependence may be related to the specificity of exogenous morphine and morphine receptors. Affinity is related, and the latter is blocked, causing a sharp increase in drug resistance.
3 The withdrawal sensitization hypothesis of withdrawal syndrome, when the morphine receptor is blocked by morphine for a long time, the drug resistance is increased, but also because the addiction drug blocks the receptor, and the sensitization of disuse occurs, so that Withdrawal syndrome occurred during withdrawal.
4 Biogenic amine theory, research data prove that monoamine neurotransmitters participate in the mechanism of analgesia and addiction, and the rate of 5-HT renewal in the brain increases with the emergence of drug resistance after injection of morphine.
Prevention
Prevention of mental disorders caused by psychoactive substances
To prevent the occurrence of drug addiction, it is necessary to take comprehensive measures to implement multi-sectoral (health, public security, justice, business, etc.) collaboration to control the production, sales, and clinical use of addictive drugs, and to disseminate relevant knowledge among medical personnel. Improve vigilance and early identification of sleeping pills, anxiolytics, and morphine addiction to reduce the incidence of addiction. In areas where drug addiction has become widespread, it is necessary to widely publicize the dangers of drug addiction among the masses to mobilize Social forces, assist relevant departments and implement various measures.
Primary care diagnosis and related factors:
1. Defects in self-care ability: (due to mental disorders, the performance is indulged in drinking cravings throughout the day, without trimming, clothing is not complete, unkempt, and self-care ability is reduced or lost.)
2, the risk of violent behavior: against others, (alcohol or drug poisoning; alcohol or drug poisoning secondary excitement; illusion, delusion or bad emotions, performance often impulsive, wounding, destruction behavior Or anger.)
3, there is the risk of falls: (related to nervous system damage, performance is not stable, limb tremors, falls and falls.)
4, water and electrolyte imbalance: (with long-term drinking, to replace the wine, causing severe malnutrition, performance loss, dehydration, severe metabolic acidosis.)
5, there is the risk of suicide, self-injury: (related to the patient's bad mood, manifested as depression, anxiety.)
6, sleep pattern disorder: (related to long-term damage to the central nervous system, showing insomnia.)
7, social dysfunction
8. Lack of nutrition: (below the body's required amount is related to refusal to eat, anorexia; replacing food with alcohol or drugs; chronic alcohol, malabsorption caused by drug abuse.)
9. Capture behavior: (related to changes in nervous system adaptation).
10, acute disturbance of consciousness, (related to alcohol addiction, drug addiction, serious poisoning and extreme excitement.)
11, manic episodes: (related to brain damage)
12. Anxiety (related to severe dysfunction in the commissioning institution; related to unmet need; withdrawal symptoms; more anxiety when using psychoactive substances to harm themselves.)
13. Illusion delusion
14. Social disorders: (Physiological aspects: tremors due to withdrawal response, illusion, disorientation; behavior is not accepted, values are not accepted by society; dependence and social withdrawal; psychoactive abuse causes individuals and surroundings People are alienated and increase individual isolation and low self-esteem.)
15. Cognition, perceptual change: (caused by severe poisoning of alcohol or drugs; tremor and perceptual change; central system excitement causes excessive sensitivity.)
16. Self-concept disorder: low self-esteem (slow self-development; poor family system function; lack of positive feedback, often failing.)
17. Lack of knowledge: (lack of interest in learning; low self-esteem; denying the need for information; denying the dangers implied by the abuse of psychoactive substances; poor social support systems.)
Complication
Mental disorders caused by psychoactive substances Complications
The patient's apparent pain or social, occupational or other important social function impairments, accompanied by perceptual impairment: in the absence of innocence, the illusion or hearing, visual or illusion of complete reality testing.
Here are some examples of physiological process changes caused by various drug abuses:
1. Anesthetics - Physical integrity is affected by intravenous injections, often leaving traces of local or systemic infections.
2. Alcohol - In addition to malnutrition, long-term heavy drinking causes gastrointestinal damage, causing stomach ulcers and other diseases.
3. Cocaine - Because cocaine is mostly sucked by the nose, people with heavy drug addiction usually have necrotic perforation of the nasal septum.
4. Hallucinogens - There is some evidence that continued LSD (Ethyl lysergic acid) and PCP (Phenylcyclopiperidine) can cause chromosome damage or deformity.
5. Cannabis - smoking marijuana will reduce lung capacity, and in severe cases may even suffer from lung cancer.
Symptom
Symptoms of mental disorders caused by psychoactive substances Common symptoms Drug dependence mental disorders Personality changes psychoactive substances... Easy irritating drug dependence consciousness disorder Dream illusion love frustration syndrome pornography
Clinical type of drug dependence
First, morphine dependence
Opium, including opium, alkaloids extracted from opium, morphine, its derivatives heroin, synthetic chitosan, methadone and pantazocine. In addition to analgesia, such drugs can cause euphoria and addiction. Commonly used doses can be addicted for 2 weeks, with strong mental dependence, physical dependence and drug resistance. The doctor's highest dose of morphine is 0.03g each time, 0.1g per day. Literature, morphine addicts can be used up to 0.5 ~ 1.0g.
Clinical manifestations Heroin addiction is a common type of medical work in China since the 1990s. Since 1992, the Sixth Hospital of Beijing Medical University has received more than 20 cases. There are more males, aged 19 to 38 years old, of which 70% are self-employed. The first time heroin was used as a friend, out of curiosity. 90% of patients reported dizziness, nausea and even vomiting after taking heroin for the first time. After 3 to 6 days of intermittent smoking, all cases experienced pleasure. The inhalation method was originally aspiration, also known as flying. The heroin powder was added to cigarettes, and most of the drug users changed to hot. Also known as "chasing the dragon", the heroin powder is placed on a tin foil for heating, and the smoke is sucked in with a straw. The time of addiction is related to the frequency, amount and mode of drug use of patients, and the average drug addiction is 1 month later. At this time, there is only one thing that the patient is craving in life: do everything possible to get drugs.
Psychiatric symptoms are: low mood, depression, irritability; high emotional and active after taking addiction drugs. Personality changes are extremely serious: selfishness, lying, sophistry, not caring about others, and losing sense of responsibility to society. Memory declines, concentration is difficult to concentrate, creativity and initiative are reduced. Insomnia, poor sleep quality, and circadian rhythm are reversed. Smart barriers are not obvious.
Somatic symptoms: poor general nutritional status, loss of appetite, excessive sweating, constipation, weight loss, dry skin, loss of libido. Male patients have impotence, loss of libido, female menstrual disorders, amenorrhea. Vascular movement: visible blush, dizziness, cold sweat, elevated or decreased body temperature, palpitations, tachycardia. In addition, there are elevated white blood cells and lower blood sugar levels.
Nervous system examination: visible tremor, movement and gait instability, speech difficulties, Romberg sign positive, stenosis, hyperreflexia, can also be found in sucking reflex, palmar reflex, Hoffman sign positive and hyperesthesia. Some patients have mild abnormalities in EEG, increased beta activity, or increased activity.
Withdrawal syndrome: The symptoms of opioid withdrawal are very painful. After 6 to 8 hours of drug breakup, anxiety, yawning, hooliganism, chills and pain in different parts of the body, insomnia, the patient can not sleep at all, sleeping pills are invalid. The patient is in pain, pleading for medication, and threatening to lie if not given. After withdrawal, the patients showed transient disturbances of varying degrees, which were characterized by lethargy, and severe cases of temporary paralysis. They were generally prominent in 24 to 36 hours of withdrawal, and significantly reduced after 1 to 2 days or 2 to 3 days. . When the consciousness is unclear, it is often accompanied by psychomotor uneasiness and incitement. Sometimes accompanied by vivid and vivid hallucinations.
Symptoms of autonomic nerves are obvious: nausea and vomiting, generalized hyperalgesia, enlarged pupils, and fever and sweating. Muscle convulsions are common. The above symptoms are generally relieved after 72 hours of drug withdrawal. However, mental symptoms: anxiety, insomnia and other symptoms last for 1 to 2 weeks or longer.
After the physical withdrawal symptoms are significantly alleviated, the mental dependence symptoms, "thinking addiction drugs" can still be very obvious. At this point, the medical staff should be very vigilant and should not let the patient "organize."
Second, barbiturates and other sedative sleeping pills addiction
With the wide application of sleeping pills and sedatives in clinical practice, addicts are not uncommon. Among them, those with fast sleep and sleeping ketone addicts are more common. Barbiturates can relieve tension and are prone to mental dependence. Due to the emergence of drug resistance, the dose is increasing day by day, and it can produce body dependence after repeated use for a long time. According to reports in the literature, the daily dose of fast sleep is below 0.4g, which is not easy to cause physical dependence. The daily dose is 0.6g. Taking one month can cause physical dependence and withdrawal symptoms.
Patients with clinical manifestations of long-term use of large amounts of sleeping pills may experience chronic poisoning symptoms of varying degrees. A high-dose barbiturate can cause disturbance of consciousness and mild mania, which lasts for hours to days, accompanied by signs of nervous system such as tremors, unclear words, and unstable gait. Long-term heavy use can lead to intelligent obstacles: memory, computing power, and comprehension are significantly reduced, thinking problems are difficult, and work and study ability can be reduced. After drug addiction, personality changes occur: unscrupulous drugs, fraudulent drugs, family life, denial of addiction, lying face to face, until withdrawal symptoms appear, can not bear to ask family and doctors to plead for medication. The patient loses initiative and loses responsibility for the family and society.
Somatic symptoms: visible weight loss, weakness, loss of appetite, gastrointestinal dysfunction; complexion gray, easy to sweat, skin scratch response, sexual function is significantly lower or disappear. Often accompanied by toxic hepatitis. Signs of the nervous system: visible tongue, hand tremor, sputum reflex, sputum sputum and pyramidal tract sign, palmar reflex and sputum reflex positive.
Withdrawal syndrome: usually occurs after 1 to 3 days of withdrawal. The greater the dose of addiction, the stronger the sedative effect of the drug and the heavier the withdrawal symptoms. Lighter people have general discomfort, discomfort, palpitation, dizziness and other similar neurological symptoms. In severe cases, there is generalized muscle twitching, epileptic seizures or hallucinations, similar to schizophrenia symptoms and disturbances of consciousness: excitement, impulsiveness, disordered words, suspiciousness and hallucinations.
Third, anti-anxiety drug addiction
The earliest addictive anti-anxiety drug is the Sleeping. In the past 10 to 20 years, with the wide application of benzodiazepine derivatives in clinical practice, due to improper use, excessive dose, long duration, etc., there have been addiction cases such as chlordiazepoxide and diazepam. Among them, Mian Ertong has the highest drug resistance and addictive dose, and has been classified as a banned addictive drug in many countries. The author has observed 2 patients with amnestic addiction, taking 20 to 40 tablets daily. It has also been reported that the general therapeutic amount is the addict, which may be related to the quality of the patient.
Clinical manifestations of anti-anxiety drugs can cause weight loss, weakness, pale complexion, dull skin and poor sexual function in long-term and large doses. The general intelligence barrier is not obvious. Symptoms of the nervous system include: low muscle tone, low or no sputum reflexes, and unstable gait. After addiction, there is a certain degree of personality change. Light temperament is easy to provoke and weak will. The heavy ones lie, conceal the condition, and resort to the emergency room to scam drugs.
Withdrawal Syndrome: Addicted patients often take less time during the day, which means they feel uncomfortable. Obvious mental symptoms often appear 1 to 3 days after stopping the drug: transient hallucinations, excitement, euphoria, and complete sleeplessness. The clinical manifestations were similar to the symptoms of barbiturate hypnotic withdrawal. Visible epileptic seizures.
Fourth, other addictive drugs
There are amphetamine, Indian marijuana and cocaine.
Amphetamine is a central nervous system stimulant that reduces drowsiness and fatigue. A small amount of oral 5 ~ 10mg, can relieve fatigue, improve mental and excitability. The general action time is maintained for 4 hours. Followed by fatigue and lethargy. Take small doses daily and quickly develop resistance. In the withdrawal syndrome, depression is the most common, and the symptoms reach the peak at 48-72 hours after stopping the drug, and then gradually reduce. Severe mental symptoms persist for several weeks. Tricyclic antidepressants are effective.
Long-term, large doses of amphetamine can cause amphetamine psychosis. The clinical symptoms are very similar to the paranoid type of schizophrenia: in the case of clear consciousness, the victim is delusional and the concept is invoked. However, the duration is short, and it will disappear after several days of stopping the drug. Antipsychotic drugs such as phenothiazine and butyrylbenzene are effective.
Indian cannabis is an ancient addict that is second only to opium. It is more prevalent in the Near East and Central Asia. It is taken orally, smoked and chewed. North American marijuana (marihuana) has also become popular in the United States and Western Europe for more than a decade. Cannabis has moderate mental dependence and low drug resistance. Inhalation of 7mg can cause euphoria, and 14 to 20mg of obvious mental symptoms.
After a large anesthesia, I feel very happy, energetic, ecstatic, and confident. There can be illusions and perceived complex barriers, excitement and fear. Followed by depression, restlessness, ataxia, ending with sleep.
Cocaine is an alkaloid proposed from the South American shrub coca leaf. It has a local anesthetic effect and is a central stimulant and euphoric agent. Local residents chew these leaves to relieve fatigue and improve mood. Common methods are subcutaneous injection and inhalation. The clinical manifestations are very similar to amphetamine; there is a strong mental dependence.
Examine
Examination of mental disorders caused by psychoactive substances
Medical History Collection
The history of medical history includes the history of drug abuse, the type of drugs used, the daily dose of drugs, the number of daily drug abuses, the mode of drug use, the presence or absence of drug resistance, the number of drug abuses and detoxification methods, the presence or absence of multiple drug abuse and physical illness.
[ Body examination ]
In addition to routine examinations, the physical examination of drug users must also pay attention to the presence or absence of needles left by injecting drugs. The veins of the forearm and lower limbs are obviously more; those who regularly take drugs may have congestion and ulceration of the nasal septum, and even perforation; People who use opioids will have dilated pupils when they are not using drugs in time. Because pupils cannot be adjusted by light, drug users are afraid of light, and often wear sunglasses. Those who have just taken drugs will have pupils shrinking, such as needle-like pupils. Characteristics of overdose.
Laboratory examination
In addition to routine examinations, it must include electrocardiogram examination, liver function examination, blood, urine routine examination, chest radiography or fluoroscopy, and qualitative testing of naloxone-adhesive test or opioid urine test strip for patients who cannot be diagnosed.
[Mental check]
A detailed mental examination is performed to exclude other mental disorders. When there is a concomitant disease, the nurses should be treated at the same time. The nurses collect the patient's relevant health information through observation, interviews, physical and mental examinations.
Nurses collect assessments of patient-related health information through observations, interviews, physical and mental examinations.
1. Activity process
When assessing the effects of alcohol and medicine on the central nervous system, the patient's behavior will be affected. In the poisoned patients, there is no slowness of movement, inconsistency and gait instability, and even trauma or fracture due to a fall collision.
Assess whether the sleep and awake patterns are disordered, whether there is a stupid sleep state and insomnia when the substance abused or dependent on the patient affects the central nervous system.
Assess whether the type of entertainment activity has changed. Since the patient spends all his time buying medicine, taking medicine, or finding ways to find medicine (or wine), he must give up the original entertainment.
Assess whether the self-care ability is affected, and when the patient's judgment is impaired, his personal hygiene and wearing modifications will be worse.
2. Cognitive process
Assess whether there is a change in choice, judgment, memory and thinking process during the severe poisoning stage. As to whether this change will continue after material withdrawal, depending on whether the substance has destroyed brain tissue, such as long-term Alcohol abusers, even after years of abstinence, still have cognitive decline. Many studies have recently explored the long-term effects of smoking cannabis on human cognitive processes.
Evaluate whether the patient has a change in attention because central nervous system inhibitors cause inattention, while central nervous stimulants cause excessive sensitivity.
Assessing patients with unconscious changes usually occurs in patients taking hallucinogens. People who drink a lot of alcohol for a long time will also have a change in perception when they tremble with tremors, such as auditory hallucinations, hallucinations. And other symptoms.
3. Ecological process
Assessing the ability of a substance to depend on the patient's ability to stay will change.
4. Emotional process
Evaluate the initial goal of the medication, such as the use of anesthesia to create a "normal" feeling; the use of sedative hypnotics to feel a sense of tranquility; and the use of central nervous system stimulants in order to have a sense of euphoria.
Assessing the withdrawal of any substance can cause anxiety and even reach the level of panic.
Assess whether the patient feels guilty, sad, or ashamed of his or her behavior during the medication period.
5. Interpersonal interaction process
Assessing changes in the behavior/impulsive process, if the patient does not want to have withdrawal, he or she has to find a way to get the substance, which may indicate that he will lie, steal, attack, prostitution, etc., although these behaviors are his original dislike. When material poisoning seriously affects the central nervous system, patients are prone to accidents and are potentially dangerous to themselves and others.
Evaluate changes in the family's operational processes, because the family is a system. If there is a substance dependent, it will lead to disorder of family function and hinder the healthy development of family members.
Assessing material dependence A major change in the role of a patient is usually due to drop out of school or loss of work, resulting in a family breakdown.
Assessing the social ability, when the substance abuse affects the central nervous system function, the active relationship between the patient and others is reduced, and social isolation or withdrawal is also a common phenomenon.
6. Physiological processes
To assess whether there is a change in nutritional status, almost everyone who abuses or depends on the substance, regardless of how long it takes, will have malnutrition changes, and it will also easily affect other physiological processes.
Diagnosis
Diagnosis and diagnosis of mental disorders caused by psychoactive substances
Diagnostic criteria for drug dependence
1. A history of long-term or repeated use of psychoactive substances.
2. There is a strong desire and tolerance for psychoactive substances, so at least two of the following conditions: 1 can not get rid of the desire to use this substance; 2 the will to extract this substance is significantly enhanced; 3 to use this Substance and often give up other activities or hobbies; 4 knowing that this substance is harmful, but still continue to use it, or defend itself, or want to use it or not, but can't do it or fail repeatedly; 5 experience pleasure when using; 6 pairs This substance is more tolerant; 7 withdrawal syndrome occurs after discontinuation.
Diagnostic criteria for withdrawal syndrome
1. Have a history of psychoactive substance dependence.
2. After discontinuing or using less dependent psychoactive substances, at least three of the following psychiatric symptoms occur:
1 emotional changes; such as anxiety, depression, irritability, irritability, etc.;
2 disturbance of consciousness;
3 insomnia;
4 tired, tired of sleep;
5 exercise excitement or inhibition;
6 attention is not concentrated;
7 memory loss;
8 judgment decline;
9 hallucinations or illusions;
10 delusions; (11) personality changes.
3. At least two of the following physical symptoms or signs:
1 nausea and vomiting;
2 muscles or pain in the body;
3 pupil changes;
4 runny nose or tears or yawn;
5 abdominal pain, diarrhea;
6 dry heat or elevated body temperature;
7 serious discomfort;
8 twitching.
4. The nature and severity of the symptoms depend on the type and dose of the psychoactive substance, and once again, the withdrawal syndrome can quickly disappear.
Differential diagnosis
Exclusion of general medical conditions (eg, brain structural damage and infection, visual epilepsy), and exclusion of other mental disorders (eg, deafness, dementia, schizophrenia), pre-sleeping hallucinations.
