Substance-independent co-dependence
Introduction
Introduction to non-dependent substances Non-dependent substance-dependent dependence refers to the mental illness associated with the cause of alcohol dependence, alcoholism opioids, sedative sleeping anesthetics, stimulants and other psychoactive substances (pesticide carbon monoxide, heavy metals, and other substance poisoning) The application of psychoactive substances such as obstacles may result in changes in psychophysiological behaviors or reaction patterns (nausea, vomiting, palpitations, inability to focus on dullness, etc.), and at the same time, the mental activity is significantly reduced or the social function is significantly reduced. Acute poisoning or withdrawal may be Chronic poisoning in the presence of disturbance of consciousness or mental illness can lead to personality changes in amnesia syndrome and dementia. After the application of psychoactive substances, it immediately produces psychological, physiological symptoms, changes in behavior or reaction patterns (nausea, vomiting, palpitations, inattention, dullness, etc.), while at the same time significantly reducing mental activity or significantly reducing social function. Acute poisoning or withdrawal can lead to disturbances of consciousness or psychosis. Chronic poisoning can lead to personality changes, amnesia syndrome and dementia. basic knowledge Sickness ratio: 0.001%-0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: malnutrition
Cause
Non-dependent substances associated with etiology
Social factors (35%):
The socio-cultural background and social life play a very important role in drug abuse and dependence. Currently, the internationally widely abused narcotic drugs and psychotropic substances have been vigilant against this international public nuisance since the implementation of the policy of opening up to the outside world in China. Invasion of our country, but because of its international nature, in some areas of China, there are poisoning, drug abuse and drug traffickers. The social and cultural background often determines the acceptability of some drugs and psychoactive substances, such as smoking cigarettes. Many countries consider it a hobby, and drinking is a wine culture. As a result, nicotine and ethanol dependence have increased year by year in some countries. Due to social attitudes, there is a gender difference in drug abuse and dependence. Over the years, alcoholism and drug abuse have occurred. The population is far more male than female, and the reason may be that women who drink alcohol and drugs are less likely to be understood by people.
Family factor (20%):
Imitate family members and get knowledge of using drugs from there, the influence of peers, the age of first-time use of drugs often occurs during the psychological developmental susceptibility period (adolescent period). This is a sub-cultural group, and secondly, due to improper medical use or The convenience of the profession also leads to dependence on narcotics and psychotropic substances.
Individual quality factors (15%):
In addition to factors such as society, culture, education, family, economy, ethnicity, occupation, and customs, there are also internal factors such as genetics, metabolism, neurobiochemistry, and individual factors such as mental state and mental state. In an individual, various factors often cause and influence each other and influence each other. The mental state has an important influence on the formation and development of drug dependence. For example, some psychologists believe that drug users have certain special personality characteristics, such as maladaptiveness and excessive Sensitive, impulsive, poor tolerance to the outside world, disregarding interpersonal relationships and social obligations, etc. are potential sources of drug abuse. 424 schools in the United States surveyed students aged 16-19, indicating drug abuse among students suffering from depression. The proportion is significantly higher than normal. At the same time, children with a family history of depression are more susceptible to alcohol and drugs. The role of family environment or physical factors is unclear, but whether drug dependent people have a special personality tendency There are still differences, and many dependents are in the stage of juvenile or youthful maturity, except for physiological development in this period. In addition to fierce changes, its psychological state is also in an unstable period, which is susceptible to alcohol or drug dependence due to various external environmental factors. Many abusers, especially adolescents, have violated the law before taking drugs, and individual quality factors are still It is different in response to drugs. Some patients have euphoria after the first injection of morphine, and some healthy people are unpleasant: nausea, vomiting, dizziness, and rapid bowel movements. Some studies have shown that the more Drugs that produce a "good" feeling are more likely to cause dependence, and the opportunity for drug availability is also an important factor. The outcome of drug dependence is often the result of interaction between psychological and social factors, biological factors and environmental factors.
Psychological factors (20%):
(1) Personal characteristics: anti-social, poor emotional regulation, impulsive, lack of effective defense mechanism, and the pursuit of immediate personality characteristics.
(2) Psychological strengthening of drugs:
1 Positive reinforcement: Most addictive substances have a positive positive effect.
2 negative reinforcement: addictive substances have the effect of relieving negative emotions.
(3) Psychopathological factors: People with mental illness take addictive drugs to relieve symptoms.
Biological factors (10%):
(1) Drug dependence and abuse have a family genetic predisposition.
(2) Individuals have different rates of metabolism, tolerance, and susceptibility to addiction.
Pathogenesis
Mechanisms for drug dependence:
1. Receptor theory Because a peptide substance is proposed in animal brain and human cerebrospinal fluid, a morphine-like effect is called morphine like factor (MLF), or endogenous morphine receptor agonist. It may be a central nervous system. In addition, a morphine receptor with a specific affinity for morphine drugs is found in the brain. The morphine acts through binding, and a special antagonist is also found in the brain. Naloxone, a morphine receptor blocker, observed 18 morphine drugs and found that their binding affinity to the receptor is parallel to the analgesic effect in the human body, with the exception of codeine, codeine In the human body, the analgesic effect is 1/6 of morphine, but the receptor binding affinity is less than 1/2000. This may be due to the fact that there is no obvious analgesic effect of codeine itself. It became a function after it became morphine. Recently, Teschemacher discovered another peptide from the pituitary of cattle. The molecular weight is 1750. It has morphine activity, called endorphin. The chemical properties of intrinsic peptides and the above morphine-like factors. different, The release factor produced by the hypothalamus is similar, so it is considered to be another morphine receptor agonist present in the pituitary. In addition, Ungar proposes low molecular peptides from the brain of drug-resistant rats and injects it into other animals. Drug-resistant transplantation phenomenon.
Advances in research in this field have led researchers to speculate that the rapid formation of drug dependence may be related to the specific affinity of exogenous morphine and morphine receptors, which, after being blocked, causes a sharp increase in drug resistance. Some individuals (ie, those with a tendency to rely on) have relatively many receptors that are sensitive to a certain substance, so they are likely to form a dependence upon contact with such substances.
2. Metabolic resistance and cell resistance Metabolic resistance refers to the rapid metabolism of the drug, the decrease in the concentration in the tissue, the effect is weakened, and the effective time is shortened. For example, after giving morphine for 8 hours, the morphine content in the brain is measured, and there is resistance. Sex animals are lower than normal animals. Cell tolerance refers to the adaptation of nerve cells. The nerve cells can only work normally if they contain high concentrations of drugs in the blood. The mechanism of sexual change is still unclear. Barbiturates are in the liver and are inactivated by the oxidation of drug-metabolizing enzymes in hepatocyte microsomes. These drugs can stimulate the synthesis of enzymes and accelerate the metabolic process. Increased metabolic rate is caused in part by adaptive changes in central nervous cells.
3. The effect of bioactive amines showed that the update rate of serotonin (5-HT) in the brain increased with the emergence of drug resistance after injection of morphine, and inhibited the brain of rats with chloropropionine (PCPA). 5-HT synthesis, with the decrease of 5-HT content, hyperalgesia, the sedative effect of the drug is not obvious at this time, drug resistance and physical dependence are also easy to occur, therefore, the metabolism of 5-HT is considered to be involved in the drug. The formation of dependence, some people think that the resistance of morphine increased with catecholamines, the rats slowly put morphine into the brain, the concentration of catecholamines in the brain increased, stayed for a few weeks after stopping the administration, and then returned to normal, inhibiting the rats The drug of the norepinephrine (NE) synthase dopamine -hydroxylase (DH) decreases the content of NE in the brain. At this time, the analgesic effect of morphine is strengthened, indicating that the monoamine neurotransmitter participates in the town. The formation of pain and dependence, the 1988 review of the journal Science in the United States believes that the effect of drugs on the brain may be due to (codeine, etc.) drugs blocking the pathway of dopamine re-uptake back to nerve cells, resulting in A relatively large amount of dopamine stimulates the relevant cells, resulting in effects such as intoxication and euphoria.
4. Withdrawal syndrome and disability sensitization After the nerve is cut off by drugs or surgery, denervation sensitization may occur in the center or around, which may cause denervation after nerve input is blocked. When morphine receptors are blocked by morphine for a long time, the drug resistance increases, but also because the drug dependence blocks the sensitization of the receptor, so that withdrawal syndrome occurs during drug withdrawal. Another explanation After the activity of certain neurons is blocked by an anesthetic, the unaffected neurons are compensatoryly enhanced, and thus hyperexcitability occurs after stopping the drug.
5. The role of neurological and neuroendocrine In recent years, some people have proposed the concept of the brain's "reward system" or rewarding the center, and linked this concept to the formation of euphoria and dependence produced after medication. The reward system is not clearly defined in humans. It is generally considered to be related to the midbrain limbic system such as the ventral nucleus, the olfactory tubercle, and the central amygdala. The neuroendocrine system has direct or indirect regulation of various behavioral activities. Many experiments since the 1970s have revealed the relationship between pituitary, hypothalamic hormones and various brain functions. For example, oxytocin (OXT) can reduce the formation of morphine dependence and tolerance in experimental animals, and OXT can also change. The effects of murine on morphine, heroin, fentanyl and other drug-enhancing effects, Zimmerman et al found that ACTH and related peptides in the central nervous system and morphine antagonistic results, confirmed that pituitary hormones can antagonize morphine analgesia.
Prevention
Non-dependent substance associated with prevention
The focus of preventive dependence on non-dependent substances is: attach importance to and strengthen scientific and educational propaganda; strict drug administration; strengthen psychological treatment, reduce life events, abuse of family and environmental adverse effects, and focus on strengthening publicity for high-risk groups And management.
Now, in the case of several drugs that are mainly abused in Japan, the treatment and rehabilitation of MA abusers and drug abuse countermeasures, we will take control measures against drug abuse in Japan.
1. The main drug of abuse
(1) Amphetamine (mainly methamphetamine): The abuse of MA first occurred during World War II, mainly used by Japanese combatants and workers in arsenals to enhance combat effectiveness and relieve fatigue, less than a year after the end of World War II. During the time, MA quickly flowed into the society and there was the first abuse of MA. At that time, the Japanese were under great pressure both mentally and physically, especially from the pressure caused by hunger and war failure. MA was excited. The central nervous system suppresses appetite and temporarily relieves these stresses. In addition, the use of MA is not controlled at that time. Therefore, the abuse of MA is rapidly becoming popular in Japan. With the increase in the demand for MA, illegal production, small-scale factory of synthetic MA family size As a result, in the late 1940s, the number of crimes and violence related to the abuse of MA increased significantly, and serious social problems occurred. For this reason, MAs for non-medical use were banned in 1951, but this did not control the abuse of MA. Trends, on the contrary, the number of illegally produced MAs has increased significantly over the same period, and the number of people involved in MA crimes has reached a historical peak (53,221), so the government in 1954 The law has been amended and the punishment has been increased, and the number of abusers has declined rapidly. This situation continued until the end of the 1970s, followed by the abuse of the second pandemic by MA, and the prevalence of MA abuse and the first The times were different, the age of the abusers tended to age, and the number of abusers among adolescents increased. According to the survey, 19,666 people were arrested for abusing amphetamine in 1996, with the highest proportion in the 20-29 age group (42.1%). ), followed by the 30-39 age group (26.8%); the ratio of male to female is 81:19, and nearly half (49.6%) is unemployed. It is interesting to note that among those arrested for abuse of MA There are more than 200 high school students.
(2) Abuse of volatile solvents: The abuse of volatile solvents in Japan began in the 1970s. Adolescents are the main abusers. The substance of abuse is mainly toluene. Compared with other substances of abuse, the abuse of volatile solvents and the behavior of abusers are negligent. It is more closely related to criminal behavior. In 1994, more than 10,000 people were arrested for committing crimes due to the abuse of volatile solvents. In 1997 (6,000 people) decreased.
(3) Cannabis: Cannabis abuse ranks third in Japan. The number of abusers has increased in recent years. Most of the abusers are young people, of which the age group of 20-29 years old accounts for 51.0%. The occupations of abusers are mainly services. In the art industry, in the past 10 years, the number of people related to marijuana has been about 1,500 a year.
(4) Heroin: Heroin was popular in some big cities in Japan (such as Fukuoka City) in the 1950s. In recent years, the number of heroin abusers has decreased by about 100 per year. This is a very special phenomenon in Japan. The reason is not clear. Although the number of heroin abusers is decreasing every year, the possibility of heroin abuse outbreaks in the future is not ruled out.
(5) Other drugs: Abuse of occasional reports of hallucinogens (such as LSD), non-medical use of analgesics, sedative hypnotics and cough syrup (including dihydrocodeine). In recent years, cocaine abusers have been found. The number of cocaine seizures has increased year by year, but it has not yet erupted.
2.MA abuse and treatment
(1) MA abuse method: In Japan, the most common way of MA abuse is intravenous injection and oral administration. The study found that MA abuse shows a regular circulation state. This cycle state includes three stages: the first stage, the abuser concentrates Frequent use of MA for a few days; Stage 2, after 2 to 3 days, feeling weak, lethargy; Stage 3, the next 3 to 5 days, appetite is strong, craving for medication, then using MA again, enter again A cycle.
(2) The symptoms of poisoning and withdrawal of MA: MA poisoning may have the following symptoms: emotional "high", increased motor nerve activity and hyperreflexia, no fatigue, sweating, dry mouth, elevated blood pressure, pulse speed Loss of appetite, dilated pupils, etc., long-term abuse, there will be delusions, hallucinations and language barriers, withdrawal symptoms, depression, decreased motor activity, fatigue, decreased blood pressure and pulse, no appetite and other psychiatric symptoms.
(3) Treatment and rehabilitation of abusers of MA: In Japan, the treatment of abusers of MA mainly uses psychotherapy, which makes the abusers get rid of the abuse of drug abuse, and also supplements with drug treatment, such as the use of longer-acting fluoride. Halperidol, or anxiolytics such as diazepam and antidepressants such as imipramine (imipramine) for the treatment of mental state and cravings, psychotherapy can be a rehabilitation and return to society for patients with MA Lay a good foundation.
3. Countermeasures to control drug abuse
(1) Administrative measures to control drug abuse: The administrative measures to control drug abuse are mainly to combat illegal drug trafficking and eliminate the abuse of drug abuse. The Ministry of Health and Welfare (MHW) is the law that regulates drug abuse. In order to ensure the effective implementation of various policies to prevent drug abuse, the Japanese government established the Headquarters for Drug Abuse Control in the Prime Ministers Office in 1970, and was appointed by the Prime Minister. In January 1997, the agency was led by the Cabinet Minister. Coordinate work, set up branches in various localities, work closely with local governments to ensure the implementation of laws and regulations, and control drug abuse countermeasures mainly include preventive education, law enforcement, rescue and treatment of addicts, and activities related to drug abuse control. In the implementation of the above activities and laws, it is necessary to cooperate with the national policy institutions, the Narcotics Control Office and the Ministry of Finance, MHW mainly manages and treats drug addicts; the Ministry of Justice is responsible for behavioral correction training; the Ministry of Education is responsible for schools. Preventive education; the Prime Ministers Office and MHW jointly organize control Substance abuse and publicity work.
In 1963, the Narcotic Drugs Management Act was amended to establish an advisory service system for narcotic drug addicts to help addicts recover and guide them to participate in community education activities. 19,000 people have benefited from the prevention of amphetamine abuse. system.
(2) Laws and regulations:
1 Narcotic Drugs The Law on the Administration of Narcotic Drugs and Psychotropic Substances stipulates that the import, export, production, sale, management and revocation of medical narcotic drugs are strictly controlled by MHW. All activities are prohibited without the permission of MHW or relevant departments. Drugs must be replaced with an anesthetic transport license and an anesthetic hold permit. In medical care, the anesthetic manager must keep a prescription for the narcotic drug prescribed by the doctor.
The Law on the Administration of Narcotic Drugs and Psychotropic Substances has strict penalties for the illegal trade in narcotic drugs, such as: the maximum penalty for the sale of heroin is life imprisonment; the use of drugs can be punishable by imprisonment for more than 10 years, and the law also provides for the establishment of compulsory treatment institutions. Treatment of narcotic drug addicts.
2 Amphetamine: The Doping Control Act imposes strict regulations on stimulants (amphetamine, methamphetamine and its hydrochloride) and their APIs (8 substances such as ephedrine and methylephedrine), such as prohibiting excitement Import and export of drugs, restrictions on the sale of stimulants, medical or scientific stimulants directly from the production department.
There are also strict penalties for illegal trade in stimulants, such as: the sale of stimulants can be punishable by life imprisonment; the use of stimulants can be punishable by imprisonment for more than 10 years, and the Mental Health Act provides for the establishment of medical institutions for amphetamine addicts. treatment.
3 Cannabis: The Cannabis Management Act stipulates that the use of cannabis is strictly prohibited, except for scientific research.
4 Psychoactive drugs: In Japan, the number of people who abuse psychoactive drugs (sedative hypnotics, anxiolytics, analgesics, etc.) has increased in recent years. In order to prevent the abuse of psychoactive drugs and control the illegal trade of drugs, the Japanese government revised in July 1990. The Narcotic Drugs Management Act was renamed the Law on the Administration of Narcotic Drugs and Psychotropic Substances, adding the following provisions:
A. The sale and use of psychoactive substances must be licensed and registered;
B. Only the medical sector and licensed personnel have the right to use psychoactive drugs;
C. Those who produce and import psychoactive drugs must record their business;
D. Each psychoactive drug import and export business must have an official approval.
5 Raw materials for the production of narcotic drugs and psychotropic substances: The government has enacted the Law on the Production of Raw Materials for Narcotic Drugs and Psychotropic Substances, which was implemented in July 1992. The law stipulates that the production, import and export of narcotic drugs and psychotropic substances must be filed for filing. The export of raw materials is marked, and the law has established control measures for 18 kinds of raw materials, including 8 special raw materials for the manufacture of narcotic drugs and psychotropic substances, such as lysergic acid.
6 Others: According to the 1988 United Nations Convention against Illegal Smuggling of Narcotic Drugs and Psychotropic Substances, the Japanese government has enacted new relevant laws, including the confiscation of illegal smuggling proceeds and penalties for money laundering.
(3) Measures to prevent drug abuse: Japan's drug abuse prevention mainly adopts two measures of reducing supply and reducing demand. In terms of reducing supply, it mainly adopts production control and combats illegal trafficking and smuggling activities, such as: to prevent illegal cultivation. Wild cannabis and opium, nationwide Eradication of wild cannabis and opium activities from May 1st to June 30th, local governments also participate in and support this activity, reducing demand mainly through extensive prevention of the public Publicity and education and treatment and rehabilitation of abusers are implemented. To this end, MHW launches the Anti-drug Abuse Campaign every year, and conducts extensive prevention and education activities from October 1st to November 30th each year. In 1993, it cooperated. 6.26 On the International Anti-Drug Day, a national drug abuse prevention publicity campaign entitled No! Never! was launched. In 1996, this activity lasted from June 22 to July 21. During the event, there were quite a few The government and non-governmental organizations actively participated. On June 23rd alone, there were more than 600 publicity activities on the street for publicity activities. In order to facilitate people's consultation, MHW also The official Doping Counseling Activity Station was established and the Drug Abuse Prevention Center (1987) was established. The Center cooperated with relevant domestic institutions to actively carry out the basic knowledge of drug abuse and its harmful activities. In 1993, the Center launched a fundraising campaign. Activities and funding of drug abuse prevention activities in developing countries through UNDCP.
Complication
Non-dependent substances associated with complications Complications malnutrition
On the one hand, due to irregular daily life, malnutrition and low immunity; on the other hand, dependence on non-dependent substances is easy to be complicated with other infectious diseases.
Symptom
Non-dependent substances associated with symptoms Symptoms Common symptoms of mobile phone dependence Suspected suspicion irritability Network dependence Emotion dependence Dependency Weak response Unresponsive network syndrome
1. Barbiturates and other sedative sleeping pills rely on barbiturates and other sedative sleeping pills because of their resistance and dependence (mental dependence, physical dependence) are regulated by the International Psychotropic Substance Convention, but because it is clinical The indispensable and widely used drugs are legally prescribed drugs, and there are many varieties, so the potential danger of formation dependence is greater, among which barbiturates and methaqualone (hypnone), Grummet (guide Sleep energy), the dependence of chloral hydrate is the most common. The use of barbiturates has been used for more than 70 years. It has been reported since the 1920s. It is believed that the short-acting barbiturates It is easy to form dependent and has rapid tolerance, and its tolerance and dependence occur in parallel, such as pentobarbital and saponin (speed sleep), the maximum daily dose is 400mg or 600mg, respectively, using 6~ Dependence can be formed in 8 weeks.
After taking barbiturates, you can relieve tension and gain euphoria, resulting in a strong desire for cravings, even to the extent that it is not possible to take medicine. Its mental dependence is stronger than morphine, cocaine, amphetamines, due to increased drug resistance, dose Increase, such as long-term repeated use of large doses will produce physical dependence, although the drug resistance is increased, but unlike heroin, heroin can withstand 1000 times the initial dose after repeated use, barbiturate drugs after drug withdrawal The medicinal properties also disappeared rapidly. It has been reported in the literature that the daily dose of sagobarbital below 400 mg does not cause physical dependence, and the dose is generally 4 to 50 times the therapeutic amount (equivalent to 0.4 to 5 g/d). Shen Yucun (1980) Reported doses of barbiturates and other sedative sleeping pills are generally 5 to 20 times the amount of treatment, 1 patient with barcobarbital dependence, scopolamine 2.0 g / d, or even 4.0 g / d Acute poisoning has occurred. Patients are usually taken orally several times, and even chewed slowly to enjoy their enjoyment.
Among the non-barbital sleeping pills, glutamine, methaqualone, chloral hydrate, and clopramide (phenazone) can all lead to dependence. Among them, methaqualone has the highest dependence, so many countries have already Stop production and ban imports.
These drugs enter the body and are quickly absorbed. They are distributed in various tissues of the whole body. The speed of entering the brain tissue depends on the fat solubility. Scobarbital is more fat-soluble and has a faster effective time. Barbiturates In the liver, the action of drug-metabolizing enzymes in the hepatocyte microsomes causes the drug to oxidize and fail. The oxides may be in a free state or combined with sulfuric acid and discharged from the urine. The development of dependence and drug resistance is not as complete as opioids. Sexual formation is due in part to accelerated decomposition of the drug, in part due to changes in the adaptation of central nervous cells, whose somatic dependence is formed by a moderate moderate inhibition of the central nervous system.
Long-term repeated use of these drugs can occur in varying degrees of chronic poisoning symptoms, and can involve various systems of the body.
(1) Psychiatric symptoms: typical acute psychiatric symptoms are conscious disturbances and hypomania, manifested as irritability, unintentional chaos, speech excitement, euphoria but fatigue, lasting days or weeks, and Unresponsive, ataxia, impaired attention or memory.
1 Acute poisoning: Patients who are dependent on sedative sleeping pills for a long time may have acute psychiatric symptoms during the period of periodic and large doses of medication. The most typical symptoms are disturbance of consciousness and hypomania. The disturbance of consciousness may only be manifested as restlessness and purposelessness. It can also be expressed as a complex state of consciousness. It lasts for a short period of time, hours to days. The madness and excitement are more characteristic symptoms. It is difficult to distinguish between the clinical and the manic state of bipolar disorder. The difference lies in the drug nature. Patients with frivolous madness are prone to fatigue, speech excitement, euphoria, but no phonological intentions, may be accompanied by partial forgetting and transient, accompanied by neurological signs: such as tremor, slurred speech, unstable gait If there is a discriminating significance, the course of disease lasts for several days to several weeks. If the patient is accompanied by obvious mental retardation, the appearance can be very similar to paralytic dementia.
2 Chronic poisoning: Personality changes and obvious intellectual disabilities can occur in long-term large-scale users. Personality changes mainly show loss of initiative and loss of responsibility to the family and society. Finding medicines becomes the central task of life, and doing everything possible to steal drugs and deceive drugs. Or family life in disregard of a large number of drugs, patients generally try to conceal their history of medication, denying dependence or recognition of dependence but the number of medications, the disease has been lying, until withdrawal symptoms appear, can not bear to the family or doctor If you ask for medicine, some patients will try to bring drugs into the ward or use the guests to send medicines to their families. Therefore, these patients should be carefully examined during hospitalization. After hospitalization, attention should be paid to eliminating various sources of drug sources. For example, patients should not be allowed to have drugs. Opportunities to contact with drugs, visitors should also eliminate the source when purchasing drugs. This should be paid attention to frequently. If the patient is full of energy and energy during the drug withdrawal process, he should pay attention to check whether he has taken the medicine.
(2) Physical and neurological symptoms and signs: patients with weight loss, weakness; loss of appetite, gastrointestinal dysfunction; skin dull, dull complexion, sweating, sweating when nervous, skin scratching reaction positive, sexual function is obvious Low or disappear, often accompanied by toxic hepatitis.
(3) Withdrawal syndrome: usually occurs 1 to 3 days after stopping the drug. The greater the dose dependent, the stronger the sedative effect of the drug, the more severe the withdrawal symptoms, the symptoms of general discomfort, palpitation, tearing, and low erectility. Blood pressure, there may be seizures, a small number of patients may have hallucinations, delusions, excitement, impulsiveness, speech disorder, suspicion and other symptoms of severe psychosis, can last for 1 to 2 weeks, the literature reports, serving Scobarbital (speed can Sleep) 0.4g / d, the symptoms are mild after stopping the drug, and 0.8g / d can occur upright hypotension. Debilitation, tremor, anxiety and other heavier discomfort, about 75% of patients have convulsions, 6 % patients have convulsions, usually recovered in 2 to 3 weeks, and the following types are common:
1 autonomic symptoms: light body discomfort, discomfort, palpitation, tears, dizziness, severe incontinence, clinically easy to be misdiagnosed with general neurosis.
2 epileptic seizures: often appear 2 to 4 days after stopping the drug, clinically and epilepsy is not easy to identify, completely forgotten after the attack, 1 case of patients with scopolamine (speed sleep) dependent on multiple epilepsy after drug withdrawal After the onset, in the process of slow drug reduction after hospitalization, epileptic seizures occurred again. EEG showed that there were paroxysmal high-wavelength slow waves in each lead. Taking anti-epileptic drug control, the EEG returned to normal after 1 week. The basic rhythm of EEG during withdrawal is slow wave, paroxysmal slow wave, high amplitude slow wave, sometimes with spine slow wave synthesis, light stimulation can have photoreaction, and there may be abdominal muscle during the drug reduction process. Symptoms such as muscle twitching.
3 hallucinations, symptoms of schizophrenia and disturbance of consciousness: hallucinations are regarded as the main and vivid images, such as seeing active animals, open flowers in parks, gathering people, etc., people around are also hidden, large doses Patients with withdrawal or even reduction of medication may have excitement, impulsiveness, disordered speech, suspiciousness and other symptoms of severe psychosis or paralysis. The general symptoms appear 5 to 8 days after withdrawal, lasting 3 to 7 days or 2 weeks, afterwards Different degrees of forgetting are clinically differentiated from schizophrenia or alcohol-induced tremors. After this period, there are emotional instability that lasts for weeks or months, and it is easy to take the medicine again.
2. Anxiolytics rely on clinically applied anti-anxiety drugs, dependent anti-anxiety drugs, such as: chlordiazepine (limonine), diazepam, estazolam, nitrazepam (nitrodiazepine), clinical The application is very extensive, and the effect is more obvious, but at the same time some people can experience the pleasure, so it is easy to form dependence. The first drug to be found is methylpropionate (Pyrenetong), in the early 1960s, benzodiazepine The use of benzodiazepines is becoming more widespread, with the use of barbiturates, non-barbital and other classes of anti-anxiety drugs in the range of use and total dosage, anti-anxiety drugs such as chlorinated nitrogen, tranquility, and comfort Cases with dependence, such as Ning, Diazepam, estazolam, and nitrazepam, have been reported at home and abroad.
According to All gulander (1978), 55 cases of hypnotics, anxiolytic dependent patients, reported that benzodiazepine-dependent doses are at least five times the therapeutic amount, Marks J. (1978) (1980) reported benzodiazepines The highest daily dose of 1.5 to 4 times can be relied upon for a few months. Recently, it has been reported that the use of commonly used amounts can also form a dependency. For example, one case of Nitrozin Research Institute takes 10 mg per day. In 10 years of patients, gastrocnemius tendon appeared on the night of withdrawal, and it is estimated that 45% of long-term continuous medication may cause physical dependence.
(1) Chronic poisoning symptoms: general body weight loss after continuous medication, fatigue, weakness, pale skin, dull skin, diarrhea, nausea and vomiting, low sexual function and insomnia, restlessness, slow response, inattention, irritability Symptoms such as depression, mental retardation is not obvious but there is a certain degree of personality change, the weaker will be weak and easy to provoke, the severe personality is the same as the personality change caused by barbiturates, the nervous system signs are: low muscle tone, The reflection is low or disappears, the gait is unstable, etc., and serious seizures may occur.
(2) Withdrawal Syndrome: After stopping the drug, there are often symptoms such as anxiety, insomnia, sweating, tremor, anorexia, etc. Patients who are dependent on anxiety drugs often feel less uncomfortable during the day, less likely to feel uncomfortable, mentally depressed or excited, and obvious spirit. Symptoms often appear after 1 to 3 days of withdrawal, showing anxiety, staying up all night, irritability, euphoria, excitement, tremors, muscle twitching, headache, gastrointestinal dysfunction and anorexia, disintegration of personality, perceptual allergy, illusion delusion Epilepsy, also present in a state of paralysis, usually disappears after 2 to 4 weeks, clinical manifestations are similar to the symptoms of barbiturate withdrawal, but severe withdrawal symptoms are less, and the body dependence time of different benzodiazepines And its severity, such as lorazepam (lorazopium) and alprazolam (triazolam), which are easily excreted from the body, require less time to produce somatic dependence, and slower discharge The long time required for flurazepam (flurazepam) and the frequency and intensity of dependence are also related to the speed of excretion.
A case of methylalanine-dependent patients in the Beijing University of Technology, the first episode of seizure occurred immediately after the first withdrawal, and after a few days of drug withdrawal, there was disorder, excitement, impulsiveness, etc., which lasted for 1 week and was completely forgotten afterwards. .
3. Other analgesic dependence Since the advent of morphine, clinicians have been using morphine for a strong analgesic effect, and have always been plagued by their dependence. Pethidine methadone has been used clinically for more than 100 years. He Zuoxin (pentazocine), fentanyl, etc., the analgesic effect and dependence can not be clearly separated, and the new analgesic effect of analgesia can reach 1/3 to 1/5 of morphine. If there are many reports that can lead to dependence, it has not only mental dependence but also physical dependence. The symptoms of withdrawal are sweating, tremor, aversion to cold, tendon, nausea, vomiting, etc., but the degree is much weaker than morphine. .
Dihydroetorphine hydrochloride (DHE) is the first Chinese-sponsored narcotic analgesic approved by the government. It has been used clinically for more than 10 years as an analgesic. Opioid-dependent drugs, but reports of formation dependence are rapidly increasing, with withdrawal symptoms similar to heroin and morphine, with tears, yawning, restlessness, general discomfort, joint and muscle pain, etc. Some symptoms are severe with heroin The symptoms of withdrawal are similar and have been discontinued in drug rehabilitation.
In addition, in the domestic drug use investigation, it has also been found that the abuse of antipyretic and analgesic drugs, such as aspirin, compound aspirin or other salicylate preparations, which cause dependence, should be taken seriously.
4. Amphetamine-dependent amphetamines have typical psychostimulatory effects. Amphetamine is the earliest clinically used in the treatment of narcolepsy and Parkinson's disease after encephalitis. The literature records during World War II. In order to eliminate fatigue, soldiers in some countries have taken great energy to take this medicine. It is still abused in some countries and has developed into a serious social problem. China is still one of the drugs for clinical application. The time of taking medicine is short, and the dependent person is still rare. Because it can improve mental excitement and relieve fatigue, some people take long-term use to maintain a strong spirit, thereby forming dependence or amphetamine psychosis. Massive use can cause coma or even death.
Amphetamine can cause central nervous system excitability, reduce drowsiness and fatigue, make patients alert, euphoric, central and surrounding sympathetic nerves, can inhibit the recovery of dopamine at the synaptic site, so that the free dopamine content in the catenary site is increased, A small amount of 5 ~ 10mg oral can relieve fatigue, improve mental excitability, the general effect can be maintained for about 4h, followed by fatigue and drowsiness, etc., such as daily small doses quickly produce drug resistance, usually amphetamine treatment dose of 10 ~ 15mg Some patients with /d tolerance can use more than 1g per day. There is cross-body dependence between amphetamines. The degree of dependence increases with the frequency of medication. The increase of dosage is an important factor to enhance the dependence of amphetamine. The effective dose and the lethal dose are very different, so severe acute poisoning is rare. In acute poisoning, there may be an increase in blood pressure, sweating or nausea, vomiting, etc., and a large amount of use may cause mental confusion, hallucinations, severe circulatory failure, coma and even death.
(1) Chronic poisoning symptoms: chronic poisoning caused by long-term use, may have facial redness, pupil dilation, rapid heart rate, increased blood pressure, dizziness, insomnia, increased speech, nervousness, increased reflexes, less food, less sleep, no mental activity Sexuality, in addition to hallucinations, delusions, anxiety, panic attacks and increased sexual desire and other mental symptoms, can appear symptoms of paranoid psychosis or physical failure, and can be suicidal or murder and other violent behaviors under the illusion, delusion.
(2) Withdrawal symptoms: After the drug is stopped, there is a feeling of general fatigue and emotional changes. If the drug is stopped, there will be very serious withdrawal symptoms. The patient has a very intense pain experience, anxiety, horrible nightmare, and suicide is not uncommon. There may also be disorientation or even disturbance of consciousness; headache, sweating, cold and sudden heat; severe muscle contracture, characteristic gastrointestinal paralysis, so that patients can not eat, exacerbating the patient's malnutrition, withdrawal symptoms have night Aggravation and the tendency to cause paralysis.
4872h12
(3)(methylamphetamine)30100mg/d3()
2()
5.(cocaine)18622
11(Magnan)()
(flash back)1
(Grinspoon1975)500mg1.2g
6.(marijuana)37mg1420mg
;;2
7.
(1)(khat)Kathine
(2)(hallucinogens)
(3)2060()
2060
(4)(phencyclidinePCP);
8.20001560Jean Nicot(nicotine);;;
162032
371984291551.961533.88%61.0l%7.04%19931540.70%69.70%11.20%
(1);
(nicotinic acetylcholine receptorsnAChRs)nAChRs
nAChRs5511(2-62-2)nAChRs344223456237
10(knockoutmouse)247
224242
(cotinine)P450(CYP)C-2h20h
1h42%
CYPC-CYP2A6CYP2D63CYP2A6(wild-type)CYP2A6*1CYP2A6*2CYP2A6*31160%80%CYP2A6CYP2A6(1CYP2A6)20%CYP2A610%1
(2)40070%251,000
400020(dimethylnitrosamine)(diethylnitrosamine)(hydrazine)(vinylcholoride)(acrolein)(95%N0)(pyridine)(CO)30(pyrene)1-(1-methylindol)9-(9-methylcarbazole)(-naphthylamine)
CO
CO(Hb)CO-Hb
3
(3)
Wolpe
A.(aversion therapy)()3a.(electronic aversion therapy)()b.(rapid smoking)(6s110min)Glasgow664%Smith
52%Ganesan190%c.(covert aversion therapy)Cautela1052%
B.13(progressive relaxation)(tension control)(biofeedback)
C.(stimulus control)(social learning theory)23203
1510/d;
2103/d;
320
a.;b.;c.;d.11012
BeckMc-Farland585.5%137.2%
(multi-component therapy)Glasgow110%
A.
(2mg4mg)30.5mg1.0mg1.5mg24h1
121222
Raw69138%4914%Clavel126%115%Schneider()
B.()
2-Glassman1984Glassman30.15mg0.3mg7161%6920%627%5%
111(69.0%39.5%);;3
7%
C.(Bupropion)100mg150mg300mg71150mg/d300mg/d300mg1
OckenceShiffman;()
Goldstein
A.
B.
C.
D.
E.
Examine
Diagnosis
(1)
(2)
(3)
Diagnostic criteria
(1)()
(2)()
1
(3);
(4)()
(5)
