Psychiatry Course for Physical Therapy: Withdrawal Syndrome

Substance-Related Disorders

• A substance-specific syndrome occurs after stopping or reducing the amount of a drug used regularly over a prolonged period, characterized by physiologic signs and symptoms, and psychological changes.

Tolerance

• Phenomenon where repeated administration of a drug leads to decreased effect, requiring increasingly larger doses to obtain the original effect.
• Cross-tolerance refers to the ability of one drug to be substituted for another, producing the same physiologic and psychological effect.

Diagnosis of Substance Dependence

• Need for markedly increased amounts of the substance.
• Diminished effect.
• Characteristic withdrawal syndrome.
• Taking the substance in larger amounts or over a longer period.
• Unable to cut down or control substance use.
• Significant amount of time spent in activities necessary to obtain the substance.
• Behavioral/psychological changes due to effects on CNS developing after ingestion.

Withdrawal

• Substance-specific syndrome characterized by problematic behavioral change due to stopping or reducing prolonged substance use.
• Physiological and psychological components with significant distress in social, occupational, or other important areas of functioning.

Other Characteristics of Substance Dependence

• Persisting with substance use despite clear evidence of harmful consequences.
• Continued use despite awareness of harm.

Classifications of Substances

• No specific information provided.

Investigations

• Routine investigations (hepatitis, HIV markers, liver, kidney functions).
• Structured and semi-structured interview to confirm diagnosis.
• Investigation to prepare the patient for treatment (ECG, CBC, Chest X-ray).

Substance-Specific Information

Alcohol

• Blood Alcohol Level (BAL) - 0.08g/dl.
• Mild and moderate intoxication symptoms:
  • Impaired attention, poor motor coordination.
  • Dystharthria, ataxia, nystagmus, slurred speech.
  • Prolonged reaction time, flushed face, orthostatic hypotension.
  • Hematemesis and stupor.
• Pathological intoxication:
  • Excited, psychotic state following minimal consumption in susceptible individuals.

Uncomplicated Alcohol Withdrawal

• Coarse tremors of hands, tongue, eyelids.
• At least one of the following:
  • Nausea or vomiting.
  • Malaise or weakness.
  • Autonomic hyperactivity.
  • Anxiety, depressed mood or irritability.
  • Transient hallucination or illusions.
  • Headache, insomnia.

Opiates

• Patients rarely seek treatment for intoxication.
• Overdose symptoms:
  • Respiratory and CNS depression.
  • Depression.
  • Gastric hypomotility with ileus.
  • Non-cardiogenic pulmonary edema.
• Withdrawal symptoms:
  • Lacrimation, rhinorrhea.
  • Diaphoresis, yawing, sneezing.
  • Malaise, irritability, nausea, and vomiting.