PSYCHIATRIC DISORDERS: SUBSTANCE ABUSE

Ria Maria Theresa

RMT/FKUPNVJ

Substance Abuse
A maladaptive pattern of use leading to impairment, in at least one of the following, occurring within a 12-month period:
 recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home  recurrent substance use in situations in which it is physically hazardous  recurrent substance-related legal problems  continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
RMT/FKUPNVJ

DSM-IV-TR Criteria for Substance Withdrawal
 The development of a substance-specific syndrome due to the cessation of (or reduction

in) substance use that has been heavy and prolonged.  The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
RMT/FKUPNVJ

DSM-IV-TR Criteria for Substance Intoxication  The development of a reversible substance-specific syndrome due to recent ingestion of (or exposure to) a substance. mood lability. belligerence.g. Note: Different substances may produce similar or identical syndromes. RMT/FKUPNVJ .  Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system (e. impaired judgment.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.. impaired social or occupational functioning) and develop during or shortly after use of the substance. cognitive impairment.

school.. occurring within a 12-month period:  recurrent substance use resulting in a failure to fulfill major role obligations at work. or expulsions from school. driving an automobile or operating a machine when impaired by substance use) RMT/FKUPNVJ . repeated absences or poor work performance related to substance use.g.. or home (e.g.DSM-IV-TR Criteria for Substance Abuse  A maladaptive pattern of substance use leading to clinically significant impairment or distress. suspensions. as manifested by one (or more) of the following. neglect of children or household)  recurrent substance use in situations in which it is physically hazardous (e. substance-related absences.

. arguments with spouse about consequences of intoxication. RMT/FKUPNVJ .g. physical fights)  The symptoms have never met the criteria for Substance Dependence for this class of substance.g.. arrests for substance-related disorderly conduct)  continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e. recurrent substance-related legal problems (e.

leading to clinically significant impairment or distress. as manifested by three (or more) of the following. as defined by either of the following:  a need for markedly increased amounts of the substance to achieve intoxication or desired effect  markedly diminished effect with continued use of the same amount of the substance RMT/FKUPNVJ . occurring at any time in the same 12-month period: tolerance.DSM-IV-TR Diagnostic Criteria for Substance Dependence  A maladaptive pattern of substance use.

or recreational activities are given up or reduced because of substance use  the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance RMT/FKUPNVJ . use the substance. occurring at any time in the same 12-month period:  tolerance  withdrawal  the substance is often taken in larger amounts or over a longer period than was intended  there is a persistent desire or unsuccessful efforts to cut down or control substance use  a great deal of time is spent in activities necessary to obtain the substance. occupational. or recover from its effects  important social. leading to impairment as manifested by three (or more) of the following.Substance Dependence A maladaptive pattern of use.

 withdrawal. as manifested by either of the following:  the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)  the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms  the substance is often taken in larger amounts or over a longer period than was intended  there is a persistent desire or unsuccessful efforts to cut down or control substance use RMT/FKUPNVJ .

occupational.. or continued drinking despite recognition that an ulcer was made worse by alcohol consumption) RMT/FKUPNVJ .g. or recreational activities are given up or reduced because of substance use  the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e. use the substance (e.g.. visiting multiple doctors or driving long distances).g.. chain-smoking). or recover from its effects  important social. a great deal of time is spent in activities necessary to obtain the substance (e. current cocaine use despite recognition of cocaine-induced depression.

confusion. impaired balance and coordination Consequences: cough. slowed thinking and reaction time. smoked Effects: euphoria. increased heart rate. anxiety. panic attacks RMT/FKUPNVJ .Cannabinoids Hashish. impaired memory and learning. frequent respiratory infections. Marijuana  swallowed.

neither Item 1 nor 2 is present) Course specifiers (see Table 12. either Item 1 or 2 is present) Without Physiological Dependence: no evidence of tolerance or withdrawal (i. Specify if: With Physiological Dependence: evidence of tolerance or withdrawal (i.e.e..1-5 for definitions): Early Full Remission Early Partial Remission Sustained Full Remission Sustained Partial Remission On Agonist Therapy In a Controlled Environment RMT/FKUPNVJ ..

in a manner that deviates from approved social or medical patterns. usually by selfadministration. the cessation of which results in a specific syndrome. Misuse Similar to abuse. Abuse Use of any drug. Physical dependence indicates an altered physiologic state caused by repeated administration of a drug. but usually applies to drugs prescribed by physicians that are not used properly.Terms Used in Dependence and Abuse  Dependence The repeated use of a drug or chemical substance. RMT/FKUPNVJ . with or without physical dependence.

and behavioral. but it is a useful term in common usage. or occupational functioning. Intoxication A reversible syndrome caused by a specific substance (e. orientation. social. the deprivation of which gives rise to symptoms of distress and an irresistible urge to use the agent again and which leads also to physical and mental deterioration. judgment. RMT/FKUPNVJ . alcohol) that affects one or more of the following mental functions: memory. Addiction The repeated and increased use of a substance.. mood. having been replaced by the term dependence. The term is no longer included in the official nomenclature.g.

feeling. The syndrome is characterized by physiologic signs and symptoms in addition to psychological changes. RMT/FKUPNVJ . such as disturbances in thinking. Also called abstinence syndrome or discontinuation syndrome. and behavior. Withdrawal A substance-specific syndrome that occurs after stopping or reducing the amount of the drug or substance that has been used regularly over a prolonged period of time.

g. Tolerance Phenomenon in which. Cross-tolerance Refers to the ability of one drug to be substituted for another. Also known as cross-dependence RMT/FKUPNVJ . a given dose of drug produces a decreased effect or increasingly larger doses must be administered to obtain the effect observed with the original dose. each usually producing the same physiologic and psychological effect (e. Behavioral tolerance reflects the ability of the person to perform tasks despite the effects of the drug.. diazepam and barbiturates). after repeated administration.

Neuroadaptation accounts for the phenomenon of tolerance. Cellular or pharmacodynamic adaptation refers to the ability of the nervous system to function despite high blood levels of the offending substance. Pharmacokinetic adaptation refers to adaptation of the metabolizing system in the body. RMT/FKUPNVJ . Neuroadaptation Neurochemical or neurophysiologic changes in the body that result from the repeated administration of a drug.

which is a person who facilitates the abuser's addictive behavior (e. providing drugs directly or money to buy drugs). Related to the term enabler.g. RMT/FKUPNVJ .. Enabling also includes the unwillingness of a family member to accept addiction as a medical-psychiatric disorder or to deny that person is abusing a substance. Codependence Term used to refer to family members affected by or influencing the behavior of the substance abuser.

feeling of wellbeing. impaired coordination. lowered blood pressure. confusion. GHB. Benzodiazepines. death RMT/FKUPNVJ . respiratory depression and arrest. lowered inhibitions. Quaalude   swallowed. memory.Depressants  Barbiturates. injected  Effects: reduced anxiety. judgment. poor concentration  Consequences: fatigue. Rohypnol. slowed pulse and breathing.

snorted  Effects: increased heart rate and blood pressure. nausea/vomiting. depression RMT/FKUPNVJ . numbness. impaired motor function. swallowed. aggression  Consequences: memory loss. smoked. delirium.Dissociative Anesthetics  Ketamine. panic. PCP  How Consumed: Injected.

numbness. nausea  Consequences: persisting perception disorder (flashbacks) RMT/FKUPNVJ . tremors. sleeplessness.Hallucinogens  LSD. altered states of perception and feeling. heart rate. Mushrooms  How Consumed: swallowed. Mescaline. weakness. smoked  Effects: increased body temperature. loss of appetite. blood pressure.

swallowed. Oxycodone. respiratory depression and arrest. euphoria. Hydrocodone  How Consumed: injected. drowsiness  Consequences: nausea. smoked. constipation. snorted  Effects: pain relief. morphine. death RMT/FKUPNVJ . unconsciousness. heroin. confusion. coma.Opiods  Codeine. opium. sedation.

cocaine. reduced appetite. heart failure. insomnia RMT/FKUPNVJ . smoked. increased mental alertness  Consequences: rapid or irregular heart beat. blood pressure. nicotine. snorted. energy. metabolism.Stimulants  Amphetamine. weight loss. swallowed  Effects: increased heart rate. Ritalin  How Consumed: injected. MDMA. nervousness. feelings of exhilaration. methamphetamine.

during this period. the dependence criteria were met for substances as a group but not for any specific substance. Further. RMT/FKUPNVJ .DSM-IV-TR Criteria for Polysubstance Dependence  This diagnosis is reserved for behavior during the same 12-month period in which the person was repeatedly using at least three groups of substances (not including caffeine and nicotine). but no single substance has predominated.

RMT/FKUPNVJ . and feelings of anxiety. violent behavior. escalating levels of alcohol consumption can produce tolerance as well as such intense adaptation of the body that cessation of use can precipitate a withdrawal syndrome usually marked by insomnia. and.Alcohol-Related Disorders  Alcohol intoxication can cause irritability. hallucinations and delusions. evidence of hyperactivity of the autonomic nervous system. in rare instances.  Long-term. feelings of depression.

Epidemiological Data for Alcohol-Related Disorders Race and Ethnicity Gender Region and Urbanicity Whitesthe highest rate Men > Alcohol use is highest in western states and lowest in southern states -About 70 percent of adults with college degrees -40 percent of those with less than a high school education. . Education Socioeconomic Class -all socioeconomic classes.

common in men with an alcohol-related disorder RMT/FKUPNVJ . .A relation between antisocial personality disorder and alcohol-related disorders has frequently been reported.Antisocial Personality Disorder .

Mood Disorders  30 to 40 percent of persons with an alcoholrelated disorder meet the diagnostic criteria for major depressive disorder  Depression is more common in women than in men with these disorders  family history of alcohol abuse  risk for suicide RMT/FKUPNVJ .

Anxiety Disorders  25 to 50 percent of all persons with alcoholrelated disorders also meet the diagnostic criteria for an anxiety disorder  Phobias and panic disorder are particularly frequent comorbid diagnoses in these patients RMT/FKUPNVJ .

Suicide  the prevalence of suicide among persons with alcohol-related disorders range from 10 to 15 percent RMT/FKUPNVJ .

DSM-IV-TR Alcohol-Related Disorders  Alcohol use disorders Alcohol dependence Alcohol abuse Alcohol-induced disorders Alcohol intoxication Alcohol withdrawal Specify if: With perceptual disturbances RMT/FKUPNVJ .

with delusions Specify if: With onset during intoxication With onset during withdrawal RMT/FKUPNVJ .Alcohol intoxication delirium Alcohol withdrawal delirium Alcohol-induced persisting dementia Alcohol-induced persisting amnestic disorder Alcohol-induced psychotic disorder.

Alcohol-induced psychotic disorder. with hallucinations Specify if: With onset during intoxication With onset during withdrawal Alcohol-induced mood disorder Specify if: With onset during intoxication With onset during withdrawal RMT/FKUPNVJ .

Alcohol-induced anxiety disorder Specify if: With onset during intoxication With onset during withdrawal Alcohol-induced sexual dysfunction Specify if: With onset during intoxication RMT/FKUPNVJ .

Alcohol-induced sleep disorder Specify if: With onset during intoxication With onset during withdrawal Alcohol disorder not otherwise specified RMT/FKUPNVJ .

g. alcohol ingestion.  Clinically significant maladaptive behavioral or psychological changes (e. impaired social or occupational functioning) that developed during. impaired judgment. mood lability. or shortly after.. RMT/FKUPNVJ .DSM-IV-TR Diagnostic Criteria for Alcohol Intoxication  Recent ingestion of alcohol. inappropriate sexual or aggressive behavior.

developing during. alcohol use:       slurred speech incoordination unsteady gait nystagmus impairment in attention or memory stupor or coma  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. or shortly after. One (or more) of the following signs. RMT/FKUPNVJ .

sweating or pulse rate greater        than 100) increased hand tremor insomnia nausea or vomiting transient visual.DSM-IV-TR Diagnostic Criteria for Alcohol Withdrawal  Cessation of (or reduction in) alcohol use that has been heavy and prolonged. tactile..g. or auditory hallucinations or illusions psychomotor agitation anxiety grand mal seizures RMT/FKUPNVJ .  Two (or more) of the following. developing within several hours to a few days after Criterion A:  autonomic hyperactivity (e.

 The symptoms in Criterion B cause clinically significant distress or impairment in social. or other important areas of functioning.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specify if: With perceptual disturbances RMT/FKUPNVJ . occupational.

4-6 hr subsequent doses must be 2-10 mg every individualized 4-6 hr and titrated RMT/FKUPNVJ .Drug Therapy for Alcohol Intoxication and Withdrawal Clinical Problem Drug Route Dosage 25-100 mg every 4-6 hr Comment Tremulousness Chlordiazepoxide Oral and mild to moderate Diazepam Oral agitation Hallucinosis Lorazepam Oral Initial dose can be repeated every 2 hr until 5-20 mg every patient is calm.

0 mg/min RMT/FKUPNVJ .5 mg/kg at 12. subsequent doses must be individualized and titrated Delirium tremens Lorazepam Intravenous 0.5 mg/min Withdrawal seizures Diazepam Intravenous 0.Extreme agitation Chlordiazepoxide Intravenous 0.5 mg/min Give until patient is calm.15 mg/kg at 2.1 mg/kg at 2.

As a general class. RMT/FKUPNVJ . crystal. and the amphetamine-like compound methylphenidate (Ritalin). methamphetamine (Desoxyn). crystal meth.Amphetamine (or Amphetamine-like)-Related Disorders  The major amphetamines currently available and used in the United States are dextroamphetamine (Dexedrine). and speed. a mixed dextroamphetamine-amphetamine salt (Adderall).  These drugs go by such street names as ice.

tension.  Clinically significant maladaptive behavioral or psychological changes (e.. anxiety. interpersonal sensitivity. or anger. methylphenidate). euphoria or affective blunting.g. or impaired social or occupational functioning) that developed during. impaired judgment.g. changes in sociability.. use of amphetamine or a related substance. stereotyped behaviors.DSM-IV-TR Diagnostic Criteria for Amphetamine Intoxication  Recent use of amphetamine or a related substance (e. RMT/FKUPNVJ . hypervigilance. or shortly after.

respiratory depression. developing during. seizures. or shortly after. use of amphetamine or a related substance:         tachycardia or bradycardia apillary dilation elevated or lowered blood pressure perspiration or chills nausea or vomiting evidence of weight loss psychomotor agitation or retardation muscular weakness. or coma RMT/FKUPNVJ . dyskinesias. chest pain. dystonias. or cardiac arrhythmias  confusion. Two (or more) of the following.

 The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specify if: With perceptual disturbances RMT/FKUPNVJ .

 Dysphoric mood and two (or more) of the following physiological changes. unpleasant dreams insomnia or hypersomnia increased appetite psychomotor retardation or agitation RMT/FKUPNVJ . developing within a few hours to several days after Criterion A:      fatigue vivid.DSM-IV-TR Diagnostic Criteria for Amphetamine Withdrawal  Cessation of (or reduction in) amphetamine (or a related substance) use that has been heavy and prolonged.

RMT/FKUPNVJ . or other important areas of functioning. occupational.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. The symptoms in Criterion B cause clinically significant distress or impairment in social.

amphetamine-induced mood disorder. RMT/FKUPNVJ . amphetamine intoxication delirium. amphetamine abuse. amphetamine-induced sexual dysfunction. amphetamine-induced anxiety disorder. amphetamine withdrawal. amphetamine intoxication.DSM-IV-TR Diagnostic Criteria for AmphetamineRelated Disorder Not Otherwise Specified  The amphetamine-related disorder not otherwise specified category is for disorders associated with the use of amphetamine (or a related substance) that are not classifiable as amphetamine dependence. amphetamine-induced psychotic disorder. or amphetamine-induced sleep disorder.

g. caffeine intoxication. and caffeine-induced sleep disorder).Caffeine-Related Disorders  Caffeine is the most widely consumed psychoactive substance in the world  several caffeine-related disorders (e. such as caffeine withdrawal and caffeine dependence. caffeine-induced anxiety disorder. but they can also be of clinical interest. RMT/FKUPNVJ .. are not official diagnoses in DSM-IV-TR.  Other caffeine-related disorders.

DSM-IV-TR Diagnostic Criteria for Caffeine Intoxication
 Recent consumption of caffeine, usually in excess of 250 mg (e.g.,

more than 2-3 cups of brewed coffee).  Five (or more) of the following signs, developing during, or shortly after, caffeine use:
           

restlessness nervousness excitement insomnia flushed face diuresis gastrointestinal disturbance muscle twitching rambling flow of thought and speech tachycardia or cardiac arrhythmia periods of inexhaustibility psychomotor agitation
RMT/FKUPNVJ

 The symptoms in Criterion B cause clinically

significant distress or impairment in social, occupational, or other important areas of functioning.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (e.g., an Anxiety Disorder).

RMT/FKUPNVJ

DSM-IV-TR Research Criteria for Caffeine Withdrawal

 Prolonged daily use of caffeine.  Abrupt cessation of caffeine use, or reduction

in the amount of caffeine used, closely followed by headache and one (or more) of the following symptoms:
 marked fatigue or drowsiness
 marked anxiety or depression  nausea or vomiting

RMT/FKUPNVJ

RMT/FKUPNVJ . or other important areas of functioning.  The symptoms are not due to the direct physiological effects of a general medical condition (e.g. viral illness) and are not better accounted for by another mental disorder.. The symptoms in Criterion B cause clinically significant distress or impairment in social. migraine. occupational.

Cannabis-Related Disorders
DSM-IV-TR Cannabis-Related Disorders Cannabis use disorders Cannabis dependence Cannabis abuse Cannabis-induced disorders Cannabis intoxication Specify if: With perceptual disturbances Cannabis intoxication delirium

RMT/FKUPNVJ

 Cannabis-induced psychotic disorder, with delusions

Specify if: With onset during intoxication Cannabis-induced psychotic disorder, with hallucinations Specify if: With onset during intoxication Cannabis-induced anxiety disorder Specify if: With onset during intoxication Cannabis-related disorder not otherwise specified
RMT/FKUPNVJ

DSM-IV-TR Diagnostic Criteria for Cannabis Intoxication

 Recent use of cannabis.  Clinically significant maladaptive behavioral

or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use.

RMT/FKUPNVJ

developing within 2 hours of cannabis use:     conjunctival injection increased appetite dry mouth tachycardia  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.  Specify if: With perceptual disturbances RMT/FKUPNVJ . Two (or more) of the following signs.

or impaired social or occupational functioning) that developed during.g. use of cocaine. or anger. stereotyped behaviors.  Clinically significant maladaptive behavioral or psychological changes (e. tension.DSM-IV-TR Diagnostic Criteria for Cocaine Intoxication  Recent use of cocaine.. anxiety. impaired judgment. hypervigilance. or shortly after. interpersonal sensitivity. changes in sociability. euphoria or affective blunting. RMT/FKUPNVJ .

chest pain. respiratory depression. developing during. seizures. or shortly after. dystonias. or cardiac arrhythmias  confusion. Two (or more) of the following. or coma RMT/FKUPNVJ . cocaine use:         tachycardia or bradycardia pupillary dilation elevated or lowered blood pressure perspiration or chills nausea or vomiting evidence of weight loss psychomotor agitation or retardation muscular weakness. dyskinesias.

 Specify if: With perceptual disturbances RMT/FKUPNVJ . The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

unpleasant dreams insomnia or hypersomnia increased appetite psychomotor retardation or agitation RMT/FKUPNVJ .  Dysphoric mood and two (or more) of the following physiological changes. developing within a few hours to several days after Criterion A:      fatigue vivid.DSM-IV-TR Diagnostic Criteria for Cocaine Withdrawal  Cessation of (or reduction in) cocaine use that has been heavy and prolonged.

RMT/FKUPNVJ . occupational. or other important areas of functioning.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. The symptoms in Criterion B cause clinically significant distress or impairment in social.

Hallucinogen-Related Disorders  lysergic acid diethylamide (LSD)  Mescaline  Methylene-dioxyam-phetamine (MDA)  Methylenedi-oxymetham-phetamine (MDMA  Psilocybin  Morning glory  Nutmeg and mace RMT/FKUPNVJ .

DSM-IV-TR Hallucinogen-Related Disorders  Hallucinogen use disorders Hallucinogen dependence Hallucinogen abuse Hallucinogen-induced disorders Hallucinogen intoxication Hallucinogen persisting perception disorder (flashbacks) Hallucinogen intoxication delirium Hallucinogen-induced psychotic disorder. with delusions Specify if: With onset during intoxication RMT/FKUPNVJ .

with hallucinations Specify if: With onset during intoxication Hallucinogen-induced mood disorder Specify if: With onset during intoxication Hallucinogen-induced anxiety disorder Specify if: With onset during intoxication Hallucinogen-related disorder not otherwise specified RMT/FKUPNVJ . Hallucinogen-induced psychotic disorder.

illusions. impaired judgment. hallucinogen use. or impaired social or occupational functioning) that developed during.g. ideas of reference. RMT/FKUPNVJ ... paranoid ideation. hallucinogen use.g. fear of losing one's mind. depersonalization. derealization.  Clinically significant maladaptive behavioral or psychological changes (e. or shortly after.DSM-IV-TR Diagnostic Criteria for Hallucinogen Intoxication  Recent use of a hallucinogen. subjective intensification of perceptions. or shortly after. hallucinations. marked anxiety or depression. synesthesias) that developed during.  Perceptual changes occurring in a state of full wakefulness and alertness (e.

or shortly after. developing during. hallucinogen use:        pupillary dilation tachycardia sweating palpitations blurring of vision tremors incoordination  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Two (or more) of the following signs. RMT/FKUPNVJ .

. halos around objects. RMT/FKUPNVJ . flashes of color. and micropsia). following cessation of use of a hallucinogen.g. geometric hallucinations.DSM-IV-TR Diagnostic Criteria for Hallucinogen Persisting Perception Disorder (Flashbacks)  The reexperiencing. false perceptions of movement in the peripheral visual fields. intensified colors. positive afterimages. macropsia. of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e. trails of images of moving objects.

delirium.. visual epilepsies) and are not better accounted for by another mental disorder (e. schizophrenia) or hypnopompic hallucinations.. or other important areas of functioning. anatomical lesions and infections of the brain. The symptoms in Criterion A cause clinically significant distress or impairment in social.g. occupational.  The symptoms are not due to a general medical condition (e. RMT/FKUPNVJ . dementia.g.

Inhalant-Related Disorders  toluene  n-hexane  methyl butyl ketone  Trichloroethylene  Trichloroethane  Dichloromethane  Gasoline and butane RMT/FKUPNVJ .

DSM-IV-TR Inhalant-Related Disorders  Inhalant use disorders Inhalant dependence Inhalant abuse Inhalant-induced disorders Inhalant intoxication Inhalant intoxication delirium Inhalant-induced persisting dementia Inhalant-induced psychotic disorder. with delusions Specify if: With onset during intoxication RMT/FKUPNVJ .

 Inhalant-induced psychotic disorder. with hallucinations Specify if: With onset during intoxication Inhalant-induced mood disorder Specify if: With onset during intoxication Inhalant-induced anxiety disorder Specify if: With onset during intoxication Inhalant-related disorder not otherwise specified RMT/FKUPNVJ .

use of or exposure to volatile inhalants. belligerence. high- dose exposure to volatile inhalants (excluding anesthetic gases and short-acting vasodilators). impaired social or occupational functioning) that developed during..DSM-IV-TR Diagnostic Criteria for Inhalant Intoxication  Recent intentional use or short-term.g. impaired judgment. or shortly after. apathy.  Clinically significant maladaptive behavioral or psychological changes (e. RMT/FKUPNVJ . assaultiveness.

 Two (or more) of the following signs. RMT/FKUPNVJ . inhalant use or exposure:              dizziness nystagmus incoordination slurred speech unsteady gait lethargy depressed reflexes psychomotor retardation tremor generalized muscle weakness blurred vision or diplopia stupor or coma euphoria  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. developing during. or shortly after.

Nicotine-Related Disorders  Nicotine is one of the most highly addictive and heavily used drugs in the United States and around the world. emphysema. and cardiovascular disease  and secondhand smoke is associated with lung cancer in adults and respiratory illness in children RMT/FKUPNVJ .  It causes lung cancer.

DSM-IV-TR Nicotine-Related Disorders  Nicotine use disorder Nicotine dependence Nicotine-induced disorder Nicotine withdrawal Nicotine-related disorder not otherwise specified RMT/FKUPNVJ .

DSM-IV-TR Diagnostic Criteria for Nicotine Withdrawal  Daily use of nicotine for at least several weeks. frustration. followed within 24 hours by four (or more) of the following signs:         dysphoric or depressed mood insomnia irritability. or anger anxiety difficulty concentrating restlessness decreased heart rate increased appetite or weight gain RMT/FKUPNVJ . or reduction in the amount of nicotine used.  Abrupt cessation of nicotine use.

 The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder RMT/FKUPNVJ . or other important areas of functioning. occupational. The symptoms in Criterion B cause clinically significant distress or impairment in social.

Meperidine (pethidine) Fentanyl Codeine .Levorphanol . Buprenorphine . Methadone .Nalbuphine .Drocode (dihydrocodeine) . . Pentazocine . Oxycodone (dihydrohydroxycodeinone). Hydrocodone (dihydrocodeinone) . Oxymorphone (dihydrohydroxymorphinone) . Propoxyphene .Hydromorphone (dihydromorphinone).Opioid-Related Disorders  Morphine Heroin (diacetylmorphine) . RMT/FKUPNVJ . Butorphanol .

or impaired social or occupational functioning) that developed during. psychomotor agitation or retardation. dysphoria. RMT/FKUPNVJ . impaired judgment.g. opioid use.. initial euphoria followed by apathy.  Clinically significant maladaptive behavioral or psychological changes (e. or shortly after.DSM-IV-TR Diagnostic Criteria for Opioid Intoxication  Recent use of an opioid.

developing during. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs. RMT/FKUPNVJ . opioid use:  drowsiness or coma  slurred speech  impairment in attention or memory  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. or shortly after.

or sweating diarrhea yawning fever insomnia RMT/FKUPNVJ .DSM-IV-TR Diagnostic Criteria for Opioid Withdrawal  Either of the following:  cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer)  administration of an opioid antagonist after a period of opioid use  Three (or more) of the following. developing within minutes to several days after Criterion A:          dysphoric mood nausea or vomiting muscle aches lacrimation or rhinorrhea pupillary dilation. piloerection.

or other important areas of functioning.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. occupational. The symptoms in Criterion B cause clinically significant distress or impairment in social. RMT/FKUPNVJ .

produce daytime sedation just as do sedatives and anxiolytics. but sedatives and anxiolytics given in sufficiently high doses also produce sleep. the same can be said of anxiolytics. however. (2) hypnotics are drugs used to induce sleep. RMT/FKUPNVJ .Sedative-. and (3) hypnotics in low doses. instead of inducing sleep. Hypnotic-. or AnxiolyticRelated Disorders (1) sedatives are drugs that reduce subjective tension and induce mental calmness.

g.  Clinically significant maladaptive behavioral or psychological changes (e.DSM-IV-TR Diagnostic Criteria for Sedative. mood lability. RMT/FKUPNVJ .. or shortly after. Hypnotic. sedative. impaired social or occupational functioning) that developed during. or Anxiolytic Intoxication  Recent use of a sedative. hypnotic. inappropriate sexual or aggressive behavior. hypnotic. or anxiolytic. or anxiolytic use. impaired judgment.

sedative. One (or more) of the following signs. or anxiolytic use:       slurred speech incoordination unsteady gait nystagmus impairment in attention or memory stupor or coma  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. or shortly after. RMT/FKUPNVJ . hypnotic. developing during.

g. Hypnotic. or anxiolytic use that has been heavy and prolonged. or auditory hallucinations or illusions psychomotor agitation anxiety grand mal seizures RMT/FKUPNVJ . hypnotic. or Anxiolytic Withdrawal  Cessation of (or reduction in) sedative..DSM-IV-TR Diagnostic Criteria for Sedative. developing within several hours to a few days after criterion A:  autonomic hyperactivity (e. sweating or pulse rate greater        than 100) increased hand tremor insomnia nausea or vomiting transient visual.  Two (or more) of the following. tactile.

occupational. or other important areas of functioning. The symptoms in criterion B cause clinically significant distress or impairment in social.  The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. RMT/FKUPNVJ .

Anabolic-Androgenic Steroid Abuse RMT/FKUPNVJ .

Related Disorders RMT/FKUPNVJ .Other Substance.

TERIMA KASIH RMT/FKUPNVJ .

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