PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
SUBSTANCE USE RELATED DISORDERS
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
ALCOHOL RELATED DISORDERS
• DECREASE LIFE SPAN BY 10 YEARS TO 15 ALCOHOL
• 22,OOO DEATHS/YEAR
• 2 MILLION NON FATAL INJURIES • SINGLE DRINK EQUAL TO 12 G ALCOHOL
• BEER –HALF OF ALCOHOL CONSUMPTION • 12 OUNCES OF BEER
• LIQUOR -1/3 • METABOLISM IN ONE HOUR 15 TO 20 MG/DL
• 50% HOMICIDES;25% SUICIDES • Stomach absorption;SI
• Pyloric valve closure
EPIDEMIOLOGY FOR ALCOHOL RELATED DISORDERS • Peak blood conc.45 to 60 min. after ingestion
• Food delays absorption
• Rapid drinking decrease time to peak
• ALL SOCIOECONOMIC CLASS
concentration
• 70% OF ADULTS WITH COLLEGE DEGRESS ARE
• MELLANBY EFFECT
CURRENT DRINKERS; 40% WITH LESS
EDUCATION METABOLISM
• BINGE ALCOHOL USE SIMILAR ACROSS
DIFFERENT LEVELS OF EDUCATION • ALCOHOL-ACETALDEHYDE (ALCDH)ACETIC
• MEN > WOMEN ACID (ALDDH)
• 90% OXIDIZED IN THE LIVER;10% ECRETED
UNCHANGED INKIDNEYS AND LUNGS
CO MORBID DISORDERS
• CHRONIC ALCOHOLISM –UPREGULATION OF
ENZYMES
• ANTISOCIAL PERSONALITY DISORDER
• WOMEN,ASIANS,LOWER ENZYMES
• DEPRESSION- 30 T0 40% (WOMEN)
• ANXIETY DISORDER
• SUICIDE EFFECTS ON THE BRAIN
ETIOLOGY • NO SINGLE MOLECULAR TARGET
• “INTERCALATION IN MEMBRANES OF
• 60% GENETIC NEURONS”-FLUIDITY, STIFFNESS
• CHILDHOOD HISTORY OF ADHD, CONDUCT • RECEPTORS ENHANCED BY ALCOHOL-
DISORDER 5HT3,GABA A,NIC. ACH
• EEG,EVOKED POTENTIAL (P300) • INHITED RECEPTORS- GLUTAMATE,CALCIUM
• IDENTICAL TWIN/ADOPTIVE STUDIES CHANNEL
• 40% ENVIRONMENTAL
• PSYCHOLOGICAL THEORY BEHAVIORAL EFFECTS
• REDUCE TENSION • 0.05%- THOUGHT,JUDGMENT&RESTRAINT
• INC. FEELINGS OF POWER LOOSENED
• DEC.PSYCHOLOGICAL PAIN
• 0.1%-CLUMSY MOTOR ACTS
• PSYCHODYNAMIC THEORY
• 0.2%-DEPRESSED MOTOR AREA,CONTROL OF
• DECREASE UNCONSCIOUS STRESS LEVEL
• FIXATED TO ORAL STAGE EMOTIONAL BEHAVIOR
• BEHAVIORAL THEORY • 0.3%CONFUSION,
• EXPECTATIONS ABT. REWARDING EFFECTS OF • STUPOROUS
DRINKING • 0.4 TO 0.5%-COMA
• > RESPIRATORY DEPRESSION
Kringkeedoo
PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
SLEEP • DEMENTIA
• DECREASE REM,DEC.DEEP SLEEP, SLEEP • PERSISTING AMNESTIC D/O
FRAGMENTATION • PSYCHOTIC D/OWITH DELUSIONS
PHYSIOLOGICAL EFFECTS SUBTYPES OF ALCOHOL DEPENDENCE
• FATTY LIVER • TYPE A- MILD DEPENDENCE, Late onset
• ALCOHOLIC HEPATITIS • TYPE B-SEVERE DEPENDENCE, early onset
• HEPATIC CIRRHOSIS • Antisocial alcoholism
• ESOPHAGITIS • Developmentally cumulative
• GASTRITIS • Negative effect alcoholism
• ACHLORHYDRIA • Developmentally limited alcoholism
• GASTRIC ULCER
• PANCREATIC CANCER
• FAILED NUTRIENT ABSORPTION
• HYPERTENSION
• INC. RISK MI,CVD
• INC. RESTING CO,HR,O2 CONSUMPTION
• INC.
HEAD,NECK,ESOPHAGEAL,STOMACH,HEPATIC,C
OLONIC,LUNG CANCER
• HYPOGLYCEMIA
• MYOPATHY
ALCOHOL RELATED DISORDERS
• ALCOHOL USE DISORDERS
1. ALCOHOL DEPENDENCE
2. ALCOHOL ABUSE
• ALCOHOL INDUCED DISORDERS
1. ALCOHOL INTOXICATION
2. ALCOHOL WITHDRAWAL
• ALCOHOL INDUCED
1. PSYCHOTIC DISORDER
2. MOOD DISORDER
3. ANXIETY DISORDER
4. SEXUAL DYSFUNCTION
5. PERCEPTUAL D/O
• INTOXICATION DELIRIUM
• WITHDRAWAL DELIRIUM
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
NEUROLOGICAL AND MEDICAL COMPLICATIONS OF
ALCOHOL USE
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
NEUROPHARMACOLOGY
• HALF LIFE 3 TO 10 HOURS
• TIME OF PEAK CONC. 30 TO 60 MG
• ANTAGONIST OF ADENOSINE RECEPTORS
• INHIBIT Gi protein inc. cAMP in neurons
• Dopamine and NE
• Global cerebral vasoconstriction
• ?rebound, coronary artery
CAFFEINE RELATED DISORDERS
• A CUP- 100 TO 150 MG
• TEA – 30 TO 100 MG
• CHOCOLATE BAR- 25 T0 35 MG
• SOFT DRINKS- 25 TO 50 MG
• DECAF- 2 TO 4 MG
• COMORBID USE OF SEDATIVE AND HYPNOTIC
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
AMPHETAMINE RELATED DISORDERS(STIMULANT)
METAMPHETAMINE
METHYLPHENIDATE
EPHEDRINE
PSEUDOEPHEDRINE
PHENYLPROPANOLAMINE
PHENTERMINE
MODAFINIL
NEUROPHARMACOLOGY
• RELEASE DOPAMINE
• VENTRAL TEGMENTAL
AREACEREBRALCORTEX AND LIMBIC AREA
• DESIGNER AMPHETAMINE
• DA,NE,SEROTONIN
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
CANNABIS RELATED DISORDER
• NEUROBIOLOGY TETRAHYDROCANNABINOL
• G PROTEIN LINKED RECEPTOR (Gi)
• Monoamine and gaba
• Euphoria peak in 30 min then 2 to 4 hrs
• ? Reward center
• Amotivational syndrome,cognitive impairment
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
NICOTINE RELATED DISORDER
NEUROBIOLOGY
• LUNG CANCER, EMPHYSEMA,
CARDIOVASCULAR DISEASE
• SECONDHAND SMOKE
• SCHIZOPHRENIA-REDUCE SENSITIVITY TO
OUTSIDE STIMULI;INCREASE CONCENTRATION
• AGONIST OF NICOTINIC ACH RECEPTORS
• BRAIN 15 SEC. HALF LIFE 2HOURS
• ACTIVATE THE REWARD CENTER
• INCREASE NE,E, VASOPRESSIN,
ENDORPHIN,ACTH AND CORTISOL
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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011
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