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JOURNAL READING

MENTAL DISORDER DUE TO OPIOID AND ALKOHOL

Supervisor : dr. Iwan Sys, Sp. KJ


Oleh : Novita Agustina
(201420401011084)

SMF ILMU KEDOKTERAN JIWA


FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG
2016

Alcohol Research & Health


Diagnosing Co-Morbid Drug Use in Patients With Alcohol Use
Disorders

Bachaar Arnaout, M.D., and Ismene L. Petrakis, M.D. Vol. 31,


No. 2, 2008

Comorbidity of mental disorders and substance use:


A brief guide for the primary care clinician
Drug and Alcohol Services South Australia 2008

THE PRESCRIPTION OPIOID AND HEROIN


CRISIS: A PUBLIC HEALTH APPROACH TO AN
Guidelines for the Psychosocially
EPIDEMIC OF ADDICTION
Assisted Pharmacological Treatment
of Opioid Dependence
World Health Organization 2009
www.annualreviews.org

Pharmacological treatment of mental


disorders in primary health care

World Health Organization 2009

DEFINITION

OPIOIDS
(Heroin,codeine,morphine,oxycodone,hydromorphone,
buprenorphine,pethidine,dextropropoxyphene,methadone,tramadol).
Opioid dependence is characterized by a cluster of cognitive, behavioural and
physiological features. The International Classification of Diseases, 10th
edition (ICD-10) identifies six such features:
a strong desire or sense of compulsion to take opioids
difficulties in controlling opioid use
a physiological withdrawal state
tolerance
progressive neglect of alternative pleasures or interests
because of opioid use
persisting with opioid use despite clear evidence of overtly
harmful consequences.

Symptoms of dependence include tolerance, withdrawal,


drinking more than intended, giving up social, occupational
or recreational activities because of drinking, and continued
drinking despite knowledge of having a persistent or
recurrent problem.
The depressive effects of alcohol make it a significant risk
factor in the development of mental health problems,
particularly depression. If dependence is established, then
withdrawal effects include nausea and vomiting,agitation,
tremor, sweating, hallucinations, and seizures.

EPIDEMIOLOGY

According to the National Survey on Drug Use and Health


(NSDUH), in 2012 about669,000 Americans reported using
heroin. This trend appears to be driven largely by young
adults aged 1825 among whom there have been the
greatest increases.

Alcohol dependence is common, affecting approximately 6.5%


of men and 1.5% of women. It often develops in early
adulthood, but can start at any age after repeated continued
exposure to alcohol beverages.
The prevalence of alcohol dependence varies in different
countries according to the prevalence and patterns of alcohol
consumption, but in some countries, the 12-month
prevalence of alcohol dependence among adult men is as
high as 10-15%.
In Australia, the 12 month prevalence of harmful use of
alcohol is 3.0% while the prevalence of dependence is 3.5%.
Men are twice as likely to experience dependence compared
with women.

NEUROBIOLOGICAL ASPECTS OF
OPIOID
DEPENDENCE

The opioid effects of analgesia, euphoria and sedation are


mediated primarily by the mu receptor. Opioids induce
dopamine release indirectly by decreasing gammaaminobutyric acid (GABA) inhibition. They also induce
dopamine release directly, by interacting with opioid
receptors in the nucleus accumbens.

The effect of chronic opioid exposure on opioid receptor levels has


not been well defined in humans. Tolerance develops through
multiple mechanisms, including an acute desensitization of the
opioid receptor (which develops within minutes of opioid use and
resolves within hours after use), and a long-term desensitization
of the opioid receptor (which persists for several days after
removal of opioid agonists). Changes also occur in the number of
opioid receptors[25], and there is compensatory up-regulation of
the cyclic adenosine monophosphate (cAMP) producing enzymes.
When the opioid is withdrawn, the cAMP cascade becomes
overactive, leading to the noradrenergic storm seen clinically
as opioid withdrawal, which may create a drive to reinstate
substance use. The intensely dysphoric withdrawal syndrome is
characterized by watery eyes, runny nose, yawning, sweating,
restlessness, irritability, tremor, nausea, vomiting, diarrhoea,
increased blood pressure, chills, cramps and muscles aches; it
can last seven days or even longer.

EFFECTS OF HEROIN USE

TREATMENTS
Three types of medications include:
1. Opioid agonist maintenance treatment,
which activate opioid receptors
2. Partial agonists which also activate opioid
receptors but produce a smaller response
3. Antagonists, which block the receptor and
interfere with the rewarding effects of opioids.

TREATMENTS
Oral methadone liquid and sublingual buprenorphine tablets are the medications
most widely used for opioid.

Methadone (Dolophine or Methadose) is a slow-acting opioid agonist.


Methadone is taken orally so that it reaches the brain slowly, dampening the
high that occurs with other routes of administration while preventing
withdrawal symptoms. The initial methadone dose should be 60-120 mg.
Naltrexone can be useful in preventing relapse in those who have withdrawn from
opioids, particularly in those who are already motivated to abstain from opioid
use. Following opioid withdrawal, patients who are motivated to abstain from
opioid use should be advised to consider naltrexone to prevent relapse.
Buprenorphine (Subutex) is a partial opioid agonist. Buprenorphine relieves
drug cravings without producing the high or dangerous side effects of other
opioids. Suboxone is a novel formulation of buprenorphine that is taken orally or
sublingually and contains naloxone (an opioid antagonist) to prevent attempts to
get high by injecting the medication.

Psychosocial treatment
Psychosocial interventions including cognitive and
behavioural approaches and contingency management
techniques can add to the effectiveness of treatment, if
combined with agonist maintenance treatment and
medications for assisting opioid withdrawal. Psychosocial
services should be made available to all patients, although
those who do not take up the offer should not be denied
effective pharmacological treatment.

MANAGEMENT

MANAGEMENT

MANAGEMENT

MANAGEMENT

THANK YOU