Substance Related Disorders (Group F) Presentation PDF

SUBSTANCE RELATED DISORDERS PRESENTED BY GROUP F Laiba Shinwari Syeda Sabahat Batool Amna Batool Meerab Ehsan  SUBSTANCE ABUSE & ALCOHOL AND CAFFEINE DISORDERS Presented by Laiba Shinwari Introduction of Substance...

SUBSTANCE RELATED DISORDERS PRESENTED BY GROUP F Laiba Shinwari Syeda Sabahat Batool Amna Batool Meerab Ehsan  SUBSTANCE ABUSE & ALCOHOL AND CAFFEINE DISORDERS Presented by Laiba Shinwari Introduction of Substance abuse Substance Abuse Disorder (SUD) refers to a condition in which the use of one or more substances leads to clinically significant impairment or distress. key features of drug abuse  1. Problematic use  2. Lack of control  3. Craving  4. Neglecting responsbilties  5. Tolerance  6. Withdrawal  7. Risky behaviour  8. Ignoring consequences Time Criterion for Substance Use Disorders  To diagnose a substance use disorder, problematic patterns of use must occur within a 12-month period and meet at least two of the diagnostic criteria outlined in the DSM-5-TR. Common types of drugs abuse 1. Alchohol use disorder 2. Caffeine use disorders 3. Opioid use disorder 4. Stimulant disorder 5. Cannabis disorder 6. Sedative, hypnotic, Anxiolytic use disorder 7. Hallucinogen use order 8. Tobacoo use disorder Alcohol related disorder Alcohol-related disorders refer to a range of conditions that result from the excessive or problematic consumption of alcohol. These disorders can have profound effects on physical, mental, and social well-being. Below are some of the most common alcohol-related disorders:  1. Alcohol use disorder  2. alcohol intoxication  3. alcohol withdrawal  4. Alcohol induced mental disorder  5. unspecified alcohol related disorder Alcohol contain 335 ml 44ml 148 ml All three alcholohic drinks contain 18 ml of pure ethanol  alcohol use disorde symptoms  The symptoms of alcohol use vary depending on the frequency, quantity consumed, and individual factors. Symptoms can range from mild, occasional drinking effects to signs of alcohol use disorder (AUD). Below are the common symptoms, grouped into short-term effects, long-term consequences, and signs of dependence or disorder:  Short-Term Symptoms of Alcohol Use  These occur during or shortly after drinking alcohol:  Physical Symptoms:  Slurred speech  Impaired motor coordination  Flushed skin  Nausea or vomiting  Headache or dizziness  Cognitive and Emotional Symptoms:  Poor judgment and decision-making  Mood swings (e.g., euphoria, irritability, or aggression)  Impaired memory and concentration  Behavioral Symptoms:  Risky behaviors (e.g., driving under the influence, unsafe sexual activities)  Long-Term Symptoms of Alcohol Use  These develop with frequent, heavy drinking over time:  Physical Health Issues:  Liver damage (e.g., fatty liver, cirrhosis)  High blood pressure and heart disease  Weakened immune system Alcohol Use Disorder (AUD) in DSM- 5-TR: Alcohol Use Disorder (AUD) is when someone drinks alcohol in a way that causes problems in their life, health, or relationships. It includes behaviors like not being able to control drinking, needing more alcohol to feel the same effects, or continuing to drink even when it causes harm. * Criteria for Diagnosis * To be diagnosed with AUD, a person must meet at least 2 out of 11 criteria within a 12-month period. These criteria include: * 1.Drinking more or longer than intended. * 2.Wanting to cut down or stop drinking but being unable to. * 3.Spending a lot of time drinking or recovering from its effects. * 4.Craving alcohol (strong urge to drink). * 5.Not fulfilling responsibilities at work, school, or home because of drinking. * 6.Continuing to drink even when it causes relationship problems. * 7.Giving up important activities because of drinking. * 8.Drinking in dangerous situations (e.g., driving). * 9.Continuing to drink despite physical or mental health problems caused or worsened by alcohol. * 10.Needing more alcohol to feel the same effect (tolerance). * 11.Feeling sick or uncomfortable when not drinking (withdrawal). Specifiers  Severity Specifiers  1.Based on the number of symptoms within the past 12 months:  1.Mild: 2-3 symptoms.  2.Moderate: 4-5 symptoms.  3.Severe: 6 or more symptoms.  Remission Specifiers  1.Early Remission: No AUD symptoms for 3 to 12 months (except cravings).  2.Sustained Remission:2.No AUD symptoms for 12 months or more (except cravings). Etiology  1.Biological Factors Genetics: Brain Chemistry Tolerance 2. Psychological Factors Coping Mechanism 3. Social and Environmental Factors Family and Peer Influence Cultural Acceptance Stressful Life Events Prevalence & Differential diagnosis Prevalence AUD is common worldwide. In the United States, about 5-10% of adults and 2-5% of teenagers have AUD in a given year. It’s more common in men than women. Rates vary by country, with higher rates in some places where alcohol is widely available or socially accepted. Differential diagnosis Differential Diagnosis (How to Tell AUD Apart from Similar Conditions) Nonpathological Alcohol Use: Some people drink occasionally without causing harm or meeting AUD criteria. Other Mental Health Disorders: Conditions like depression or anxiety might cause similar symptoms, but alcohol isn't the root cause. Comorbidity People with AUD often have other mental or physical health issues, including: Mental Health Disorders: Depression, anxiety, PTSD Physical Conditions: Liver disease(Fatty Liver), cardiovascular problems, and digestive disorders. Alcohol intoxication Alcohol intoxication disorder happens when someone drinks so much alcohol that it causes noticeable mental, physical, and behavioral changes. It's usually temporary but can lead to serious problems. Diagnostic Criteria To diagnose alcohol intoxication, the following must occur: A. Recent Alcohol Use: The person has recently consumed alcohol. B. Significant Problems: Their behavior or mental state changes significantly due to alcohol (e.g., poor judgment, aggression, slurred speech). C. Physical Symptoms: At least one of these: Slurred speech. Poor coordination. Unsteady walking. Involuntary eye movements (nystagmus). Impaired attention or memory. Prevalence & Etiology Prevalence Very common Almost everyone who drinks alcohol excessively can experience alcohol intoxication at some point. Higher in young adults and binge drinkers: People aged 18-29 and those who drink a lot at once (binge drink) are most likely to experience this. Etiology 1.Biological Factors: Genetics Brain Chemistry 2. Psychological Factors: Stress or Emotional Issues 3. Environmental Factors: Social and Cultural Influence Availability Differential Diagnosis Other Substance Intoxication For example, intoxication drugs like cannabis. Neurological Conditions: Brain injuries, strokes, or other medical conditions that impair coordination or speech. Mental Disorders: Mood swings or behavioral changes caused by psychiatric conditions.  Alcohol Withdrawal Disorder Alcohol withdrawal disorder happens when a person who has been drinking heavily for a long time suddenly reduces or stops drinking. Their body reacts with uncomfortable and sometimes dangerous symptoms as it adjusts to the lack of alcohol. Criteria To diagnose Alcohol Withdrawal Disorder, these must happen: A. Recent stop or reduction in heavy drinking: The person has been drinking a lot for a long time and then stops or reduces alcohol use. B. Withdrawal symptoms appear shortly after: Symptoms usually develop within hours to a few days after stopping. At least two of the following symptoms must occur: Sweating or rapid heartbeat. Tremors (shaking hands or body). Trouble sleeping (insomnia). Nausea or vomiting. Visual, auditory, or tactile hallucinations (seeing, hearing, or feeling things that aren't real). Agitation or restlessness. Anxiety. Seizures. C. Symptoms cause major problems: These symptoms must cause distress or interfere with work, relationships, or other activities. D. Not due to something else: Symptoms can’t be explained by another medical condition or drug. Specifiers & Etiology Specifiers With Perceptual Disturbances This is added when the person experiences hallucinations (e.g., seeing or hearing things) during withdrawal. Etiology Main Causes: Chronic Alcohol Use Physical Dependence: Brain Chemistry Changes: Prevalence Alcohol Withdrawal Disorder is common among people who drink heavily, especially those with Alcohol Use Disorder. About 50% of heavy drinkers experience withdrawal symptoms when they stop. Alcohol-Induced Mental Disorder  Alcohol-Induced Mental Disorder happens when alcohol use causes temporary or long-term psychological symptoms like depression, anxiety, or psychosis. These symptoms are directly related to alcohol use and may appear during intoxication, withdrawal, or after prolonged heavy drinking.  Criteria  To diagnose an Alcohol-Induced Mental Disorder:  A. Symptoms develop during or shortly after alcohol use: The person experiences mental health symptoms (e.g., mood, anxiety, psychosis) while drinking or during withdrawal.  B. Symptoms match a known mental disorder: The symptoms align with the criteria for a specific disorder (e.g., depressive, anxiety, or psychotic disorder).  C. Alcohol is the cause: Symptoms must be directly caused by alcohol use and not by another mental health condition.  D. Significant distress or impairment: Symptoms cause major problems in daily life, work, or relationships.  E. Symptoms are not better explained by something else: They can’t be due to another substance, medical condition, or mental disorder. Differential Diagnosis & Comorbidity Differential Diagnosis Other Substance Withdrawals: Symptoms like shaking, anxiety, and hallucinations may also happen with withdrawal Medical Conditions: Seizures, anxiety, or hallucinations could be caused by epilepsy, infections, or other illnesses. Psychotic Disorders: Hallucinations from schizophrenia or other psychoses differ from alcohol withdrawal hallucinations. Comorbidity Alcohol Use Disorder: Most people with Alcohol Withdrawal Disorder also have Alcohol Use Disorder. Other Mental Disorders: Anxiety, depression, and sleep disorders often occur alongside withdrawal. Physical Health Problems:Chronic heavy drinkers may have liver disease, malnutrition, or other medical issues. Etiology Direct Effects on the Brain: Alcohol changes how the brain chemicals (neurotransmitters) work. Alcohol's Toxic Effects: Drinking too much alcohol damages brain cells and nerves. Withdrawal Effects: When someone stops or reduces heavy drinking, the brain struggles to adjust. This can cause anxiety, depression, or even hallucinations Differential Diagnosis & Comorbidity Differential diagnosis Other Substance-Induced Disorders: Symptoms may be caused by other drugs, like sedatives or stimulants. Medical Conditions: Brain injury, or infections can cause similar symptoms. Comorbidity Alcohol Use Disorder: Most people with alcohol-induced disorders also have Alcohol Use Disorder. Other Mental Health Conditions: Anxiety, depression, and trauma-related disorders are common. Physical Health Issues: Chronic heavy drinking may lead to liver disease, or neurological damage, which can complicate mental health. Unspecified Alcohol-Related Disorder It is a diagnosis used when a person has symptoms related to alcohol use that cause distress or problems in their life, but the symptoms don't fully fit the criteria for any specific alcohol-related disorder in the DSM-5-TR. This diagnosis is often used when there's not enough information available to make a more specific diagnosis, such as in emergency settings. It allows doctors or clinicians to acknowledge the impact of alcohol use while more information is gathered. Treatment Behavioral Therapy: Goal: To help people change their drinking habits. Types of Therapy: Cognitive-Behavioral Therapy (CBT): Helps people understand and change their thinking and behaviors related to drinking. Motivational Enhancement Therapy (MET): Encourages individuals to recognize the need for change and motivates them to cut down or stop drinking. Medication: Naltrexone Family Support Caffeine Related Disorder Caffeine-related disorders in the DSM-5-TR describe problems caused by too much caffeine or difficulty managing caffeine use. These disorders include: Caffeine Intoxication Disorder Caffeine Intoxication Disorder occurs when a person consumes too much caffeine at once, leading to a range of physical and mental symptoms. Criteria * To be diagnosed with Caffeine Intoxication Disorder, a person must meet these criteria: * A. Excessive caffeine consumption: The person drinks a large amount of caffeine (usually more than 250 mg, or about 2-3 cups of coffee). * B. Symptoms: At least five of the following symptoms appear: * Restlessness or feeling nervous. * A fast or irregular heartbeat. * Upset stomach or nausea. * Muscle tremors or shakes. * Difficulty sleeping. * Headache. * Feeling flushed (warm or red skin). * Increased urination. * A sense of being overly alert or anxious. * C. Distress or problems: These symptoms must cause significant problems in daily life, work, or relationships. Etiology of Caffeine Intoxication Disorder: Excessive Consumption: Typical amount: Consuming more than 250 mg of caffeine (about 2-3 cups of coffee) can lead to symptoms. Sensitivity to Caffeine: Some people are more sensitive to caffeine, meaning even lower amounts can cause symptoms like anxiety, restlessness Tolerance and Dependence: People who consume caffeine regularly may develop a tolerance (needing more to feel the effects). If they consume a high amount suddenly, they might experience intoxication symptoms. Risk and Prognostic Factors High caffeine consumption: People who regularly consume large amounts of caffeine (e.g., more than 500-600 mg per day, or 4-6 cups of coffee) are at greater risk. Sensitivity to caffeine: Some people are more sensitive to caffeine and may experience symptoms with lower amounts. Mental health history: People with anxiety or sleep disorders might be more prone to experiencing symptoms of caffeine intoxication. Differential Diagnosis Anxiety Disorders: The symptoms of nervousness, and rapid heartbeat can be similar to anxiety, but caffeine-induced anxiety typically improves as the caffeine is processed. Sleep Disorders: Difficulty sleeping caused by caffeine can be confused with other sleep- related conditions. Comorbidity Anxiety Disorders: People with anxiety disorders may be more likely to experience caffeine intoxication because caffeine can increase anxiety symptoms. Sleep Problems: People with insomnia or other sleep disorders may also experience worse symptoms if they drink too much caffeine.  Caffeine Withdrawal Disorder It happens when someone who regularly consumes caffeine suddenly stops or reduces their caffeine intake. This can lead to uncomfortable symptoms as the body adjusts. Criteria To diagnose Caffeine Withdrawal Disorder, the person must have the following: A. Reduced caffeine use: The person has been consuming caffeine regularly and then stops or reduces their caffeine intake. B. Symptoms: At least three of the following symptoms occur within 24 hours of reducing or stopping caffeine:  Headache.  Fatigue or tiredness.  Difficulty concentrating.  Irritability or mood changes.  Low energy or feeling sluggish.  C. Distress or problems: These symptoms cause significant distress or problems in daily life, such as affecting work or relationships.  D. Not caused by something else: These symptoms can’t be explained by another medical condition or mental disorder.  Diagnostic Features Timing: Symptoms begin within 12-24 hours of reducing or stopping caffeine, peaking at 1-2 days and typically improving within 2-9 days. Symptoms: The main symptoms are headaches, tiredness, mood changes, and trouble concentrating. These are caused by the body adjusting to the lack of caffeine. Temporary nature: Symptoms usually disappear as the body adapts to being without caffeine.  Etiology Regular and Frequent Use of Caffeine: 1.The primary cause is habitual use of caffeine, often from sources like coffee, tea, energy drinks. 2.Over time, the body becomes dependent on caffeine to function normally. Body's Physical Dependence: 1.When someone regularly consumes caffeine, their body adjusts to the stimulant effects. Sudden Reduction or Stopping Caffeine: 1.When caffeine use is suddenly reduced or stopped, the body reacts to the lack of caffeine. 2.This leads to withdrawal symptoms, which can include headaches, fatigue, irritability, difficulty concentrating, and mood changes.  Prevalence Common in regular caffeine users: About 50-75% of people who regularly consume caffeine experience withdrawal symptoms when they cut back or stop. More common in those with heavy caffeine use: People who consume 200-300 mg of caffeine (about 2-3 cups of coffee) daily are more likely to experience withdrawal symptoms. Risk and Prognostic Factors Heavy or Regular Caffeine Use: People who drink a lot of caffeine every day are more likely to experience withdrawal symptoms. Individual Sensitivity: Some people are more sensitive to caffeine, so they may experience stronger withdrawal symptoms. Psychological Conditions: People with anxiety or depression might be more vulnerable to feeling irritable or anxious during withdrawal.  Sex and Gender-Related Diagnostic Issues Sex Differences: Men may be more likely to consume higher amounts of caffeine, while women might experience stronger symptoms when they reduce intake.  Differential Diagnosis  Fatigue or Low Energy: Conditions like depression, or sleep disorders may cause fatigue or tiredness, but caffeine withdrawal is specifically linked to reducing caffeine use. Headaches: Migraines or tension headaches can also cause pain, but caffeine withdrawal headaches are usually associated with changes in caffeine consumption. Comorbidity  Anxiety and Depression: People who already experience anxiety or depression may feel more irritable or tired when going through caffeine withdrawal.  Sleep Disorders: People with insomnia or other sleep problems might feel more affected by the fatigue from caffeine withdrawal.  Caffeine-Induced Mental Disorder  Caffeine-Induced Mental Disorder refers to mental health symptoms like anxiety or mood changes that are caused directly by consuming too much caffeine. These symptoms can occur during caffeine intoxication (when someone drinks a lot of caffeine in a short period) or during caffeine withdrawal (when someone reduces or stops caffeine use suddenly). The symptoms are usually temporary and go away once the caffeine is processed by the body or the person adjusts to not having caffeine. These disorders can affect a person's mood, concentration, or anxiety levels, but they are linked directly to caffeine consumption. Unspecified Caffeine-Related Disorder  Unspecified Caffeine-Related Disorder is a diagnosis used when a person experiences problems related to caffeine use, but the symptoms don’t fit exactly into any of the specific caffeine-related disorders, such as intoxication or withdrawal. This diagnosis is used when there isn’t enough information to make a more specific diagnosis, or when the symptoms don’t clearly match a particular condition. It helps doctors acknowledge the issues related to caffeine use and provide appropriate care even if the exact disorder is unclear.  Treatment Gradual Reduction of Caffeine Intake Pain Relief for Headaches: Over-the-counter pain relievers, like ibuprofen or acetaminophen Hydration and Rest Healthy Diet Behavioral Strategies and Support like: Cognitive-Behavioral Therapy (CBT): If caffeine use is linked to stress or other emotional issues, therapy like CBT can help by teaching coping skills to manage triggers. Support Groups: Talking with others who are going through similar experiences (e.g., caffeine reduction) can provide motivation and encouragement. Avoiding Caffeine Triggers Changing Habits: Identifying situations where you typically consume caffeine (like during social gatherings or at work) and replacing it with a non-caffeinated alternative (e.g., herbal tea or water) can help reduce cravings.  CANNABIS RELATED DISORDERS & HALLUCINOGENS RELATED DISORDERS Syeda Sabahat Batool CANNABIS RELATED DISORDERS  Introduction Cannabis refers to substances derived from the Cannabis sativa plant Cannabis is the most widely used illegal drug globally, with its use extending to various regions, including India. Contains Compounds  non-psychoactive compound  Psychoactive compound  cannabidiol (CBD).  tetrahydrocannabinol (THC) Cannabis Related Disorders  Cannabis Use Disorder  Cannabis Intoxication  Cannabis Withdrawal  Cannabis-Induced Mental Disorders  Unspecified Cannabis-Related Disorder  Cannabis Use Disorder Diagnostic Criteria A. A harmful pattern of cannabis use causing distress, shown by at least two of the following in 12 months:  Using more cannabis or for longer than planned.  Wanting to quit but being unable to.  Spending excessive time obtaining, using, or recovering.  Strong urges or cravings to use cannabis.  Failing to meet responsibilities (work, school, home).  Continuing use despite relationship problems.  Giving up activities due to cannabis use. Diagnostic Criteria  Using cannabis in dangerous situations.  Continuing use despite worsening health issues..  Tolerance  Needing more cannabis to feel the same effects.  Feeling less effect with the same amount.  Withdrawal:  Experiencing irritability, sleep problems, or appetite loss when not using.  Using cannabis to avoid withdrawal symptoms.  No criteria met for 3-12 months. Exception: Craving (A4) may occur. Early Remission Specify If No criteria met for 12+ months. Sustained Exception: Craving (A4) may occur. Remission Cannabis access is restricted (e.g., Controlled rehab, prison) Environment Etiology Genetic Factors  Genetic predisposition may increase vulnerability to cannabis use disorder.  Genes related to dopamine receptors in the brain's reward system are involved.  THC activates the dopamine system, creating pleasurable feelings and increasing addiction risk. Environmental Factors  Family environment  Peer Influence  Stressful Life Events Cultural and Societal Factors  Increased acceptance of cannabis  Greater accessibility can increase the risk of problematic use. Differential Diagnosis  Nonproblematic Cannabis Use  Cannabis Intoxication  Cannabis Withdrawal:  Cannabis-Induced Mental Disorders Comorbidity  Substance Use Disorders: Alcohol, cocaine, opioid, heroin, and tobacco use disorders.  Mental Health Conditions: Depression, bipolar disorders, anxiety, PTSD, personality disorders, ADHD, conduct disorder.  Psychotic Disorders: Schizophrenia and other psychotic disorders, where cannabis use may worsen symptoms.  Medical Conditions: Cannabinoid hyperemesis syndrome (CHS), respiratory issues (e.g., asthma, COPD), cardiovascular problems (e.g., arrhythmias, tachycardia). Treatment  Therapies: Primarily behavioral therapies such as Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET), and Contingency Management.  Medications: No FDA-approved medication for CUD, but treatments like bupropion, gabapentin, or N-acetylcysteine (NAC) may help reduce cravings and manage withdrawal symptoms. Cannabis Intoxication Diagnostic Criteria A. Recent use of cannabis. B. Significant changes in behavior or mood (e.g., poor coordination, feeling euphoric, anxious, a sense of time slowing down, bad judgment, or social withdrawal) that happen during or shortly after using cannabis. C. Two or more of the following symptoms that appear within 2 hours of cannabis use:  Conjunctival injection (Red eyes).  Increased hunger.  Dry mouth.  Tachycardia (Increased heart rate). D. These symptoms are not caused by another medical condition or another mental disorder, including the use of other substances.  Hallucinations or false perceptions With occur, but the person remains aware Specify If of reality. perceptual disturbances Typical intoxication symptoms, no Without hallucinations perceptual disturbances Etiology Genetic Factors  THC metabolism variations and CB1 receptor sensitivity  Higher THC doses have stronger effects, especially with low tolerance Environmental Factors  Relaxing environments enhance euphoria  Stressful or unfamiliar settings can trigger anxiety and paranoia Psychological Factors  Pre-existing mental health conditions increase risk of intense effects  Cannabis use during adolescence may increase risk of psychosis, especially in those with genetic predisposition Differential Diagnosis  Alcohol and Sedative Intoxication  Hallucinogen Intoxication  Phencyclidine (PCP) Intoxication  Cannabis-Induced Mental Disorders Comorbidity  Given the typical overlap of cannabis intoxication with cannabis use disorder, see “Comorbidity” under Cannabis Use Disorder for more details about co-occurring conditions that are likely to be encountered. Treatment Therapies  Supportive care and reassurance are usually sufficient.  Psychiatric support may be necessary for severe anxiety or paranoia. Medications  Benzodiazepines (e.g., Lorazepam) for anxiety or agitation.  Antipsychotics for severe symptoms like psychosis. Cannabis Withdrawal Diagnostic Criteria A. Cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months). B. Three (or more) of the following signs and symptoms develop within approximately 1 week after Criterion A: 1. Irritability, anger, or aggression. 2. Nervousness or anxiety. 3. Sleep difficulty (e.g., insomnia, disturbing dreams). 4. Decreased appetite or weight loss. 5. Restlessness.  Diagnostic Criteria 6. Depressed mood. 7. At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache. C. Symptoms cause significant distress or impairment in daily life. D: Symptoms are not due to another medical or mental condition. Etiology  Biological Factors: THC alters the brain's endocannabinoid system, causing withdrawal symptoms like irritability and anxiety when use stops. Genetic Factors: Genetics may predispose individuals to develop cannabis dependence and influence the severity of withdrawal symptoms.  Environmental Factors: Stressful environments, life changes, and exposure to cannabis use can worsen withdrawal symptoms. Differential Diagnosis  Withdrawal symptoms (irritability, anxiety, sleep issues) may overlap with other substances like alcohol or tobacco.  Symptoms can mimic mental health conditions (anxiety, depression); evaluation is needed.  Users may confuse withdrawal symptoms with the need to keep using cannabis. Comorbidity  Depression  Anxiety  Antisocial Personality Disorder  For further details on overlapping conditions, refer to the "Comorbidity" section under Cannabis Use Disorder. Treatment  Therapies: CBT, motivational interviewing, and contingency management help address cravings, anxiety, and withdrawal symptoms.  Medications: Gabapentin, benzodiazepines (e.g., Diazepam), and baclofen may be used to manage anxiety, irritability, insomnia, and cravings. HALLUCINOGEN-RELATED DISORDERS HALLUCINOGENS  Psychoactive substances that alter perception, mood, and cognition.  Cause intense sensory distortions, including vivid visual hallucinations.  Alter body sensations (e.g., feeling unusually large or small).  Change the perception of time. PHENCYCLIDINE  Phencyclidine (PCP) is a dissociative hallucinogen.  Initially developed as an anesthetic, it is no longer used medically due to dangerous side effects.  Known as "angel dust" or "wet" on the street.  It causes hallucinations, detachment from reality, and intense psychological effects, including paranoia and aggression.  PCP affects the brain’s receptors, leading to distorted sensory experiences and altered perceptions of body movement.  It is often ingested by smoking, snorting, or swallowing. Hallucinogen-Related Disorders  Phencyclidine Use Disorder  Other Hallucinogen Use Disorder  Phencyclidine Intoxication  Other Hallucinogen Intoxication  Hallucinogen Persisting Perception Disorder  Phencyclidine-Induced Mental Disorders  Hallucinogen-Induced Mental Disorders  Unspecified Phencyclidine-Related Disorder  Unspecified Hallucinogen-Related Disorder Phencyclidine Use Disorder Diagnostic Criteria A. A pattern of using phencyclidine (or similar substances) that leads to significant problems or distress, shown by at least two of the following symptoms within 12 months:  Taking phencyclidine in larger amounts or for a longer time than intended.  Wanting to reduce or control use but being unable to do so.  Spending a lot of time getting, using, or recovering from phencyclidine.  Strong cravings or urges to use phencyclidine.  Ongoing use that leads to failure in major responsibilities at work, school, or home (e.g., poor work performance, school suspensions, neglecting household duties). Diagnostic Criteria  Continued use despite having ongoing social or interpersonal problems caused or worsened by use (e.g., arguments or physical fights).  Reducing or giving up important social, work, or recreational activities due to phencyclidine use.  Repeated use in physically dangerous situations (e.g., driving while impaired).  Continued use despite knowing it causes or worsens physical or mental health problems.  Developing tolerance, shown by either:  a. Needing much higher amounts to get the same effect.  b. Experiencing less effect when using the same amount. Etiology  Genetic Factors Family history of substance use disorders may increase the risk of developing phencyclidine (PCP) use disorder, suggesting a genetic predisposition.  Neurochemistry PCP affects the brain’s neurotransmitter systems, particularly the glutamate and dopamine systems. Alterations in these systems can contribute to addiction by reinforcing drug use Differential Diagnosis  Other substance use disorders  PCP use disorder vs. intoxication/induced mental disorders  Independent mental disorders Comorbidity  Behavioral disorders Conduct disorder in adolescents and antisocial personality disorder in adults are often linked to PCP use.  Substance use disorders PCP use disorder frequently occurs alongside other substance use disorders, particularly alcohol, cocaine, and amphetamine use disorders. Treatment  Therapies Cognitive Behavioral Therapy (CBT), Motivational Interviewing, Contingency Management.  Medications Gabapentin, Benzodiazepines (e.g., Diazepam), Baclofen. Phencyclidine Intoxication Diagnostic Criteria A. Recent use of phencyclidine (or a pharmacologically similar substance). B. Clinically significant problematic behavioral changes (e.g., belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment) that developed during, or shortly after, phencyclidine use. C. Within 1 hour, two (or more) of the following signs or symptoms:  Vertical or horizontal nystagmus. Diagnostic Criteria  Hypertension or tachycardia.  Numbness or diminished responsiveness to pain.  Ataxia.  Dysarthria.  Muscle rigidity.  Seizures or coma.  Hyperacusis.  The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance Differential Diagnosis  Other Substance Intoxication  Phencyclidine-Induced Mental Disorders  Other Medical Conditions Comorbidity  For details on co-occurring conditions, refer to the "Comorbidity" section under Phencyclidine Use Disorder. Treatment  Therapies Cognitive Behavioral Therapy (CBT), Motivational Interviewing, Contingency Management.  Medications Benzodiazepines (e.g., Diazepam), Antipsychotics (e.g., Haloperidol), Gabapentin (for anxiety and irritability). Hallucinogen Persisting Perception Disorder Diagnostic Criteria A. After stopping hallucinogen use, the person re-experiences one or more perceptual symptoms that occurred during intoxication, such as:  Geometric hallucinations  False perceptions of movement in the peripheral vision  Flashes of color  Intensified colors  Trails of images from moving objects  Positive afterimages  Halos around objects Diagnostic Criteria  Macropsia (objects appear larger) and micropsia (objects appear smaller) B. These symptoms cause significant distress or impairment in social, occupational, or other important areas of life. C. The symptoms are not due to another medical condition (e.g., brain lesions, infections, or visual epilepsy) and are not better explained by another mental disorder (e.g., delirium, major neurocognitive disorder, schizophrenia) or hypnopompic hallucinations. Differential Diagnosis  Rule out schizophrenia, other drug effects, neurodegenerative disorders, stroke, brain tumors, infections, and head trauma.  Neuroimaging typically negative in HPPD.  In HPPD, reality testing remains intact; if not, consider psychotic disorders or medical conditions. Comorbidity  Panic disorder  Alcohol use disorder  Major depressive disorder  Bipolar I disorder  Schizophrenia spectrum disorders Treatment  Therapies Cognitive Behavioral Therapy (CBT), Supportive Therapy.  Medications Benzodiazepines (e.g., Diazepam), Antipsychotics (e.g., Risperidone), SSRIs (e.g., Sertraline). SEDATIVE, HYPNOTIC OR ANXIOLYTIC, STIMULANT, TOBACCO AND OTHER RELATED DISORDERS Name: MEERAB EHSAN Sap id:  Topics of discussion sedative, hypnotic Stimulant related Tobacco induced/ Other substance and anxiolytic disorder related disorders related disorders related disorders SEDATIVE HYPNOTIC AND ANXIOLYTIC AND OTHER SUBSTANCE RELATED DISORDERS introduction Sedatives, hypnotics, and anxiolytics are prescription medications used for treating anxiety disorders, sleep disorders, seizures, or as anesthesia during surgery. They are commonly known as “depressants” due to their slowing effects on physiological functioning. Sedative, hypnotic, and anxiolytic drugs include: Benzodiazepines: Ativan, Halcion, Librium, Valium, Xanax, Rohypnol Barbiturates: Amytal, Nembutal, Seconal, Phenobarbital Ambien, Lunesta, Sonata Symptoms of sedative, hypnotic, or anxiolytic use disorder  Sedative, hypnotic, or anxiolytic use disorder symptoms include behavioral and psychological changes that impede daily functioning and cause significant distress.  Acute intoxication symptoms may include:  Mood changes  Slowed breathing  Tiredness  Slurred speech  Unsteady walk, trouble with coordination  Irregular, uncontrolled eye movements  Inability to focus, lack of attention  Stupor  Coma  Sedative, hypnotic, or anxiolytic dependence symptoms may include:  Tolerance to the drug (i.e., needing larger dosages than previously)  Using more than intended  Unsuccessful attempts to stop taking the drug  Drug-seeking behaviors such as spending a great deal of time trying to obtain the drug (doctor shopping or illegal means), feigning illnesses, or procuring the medication illegally  Experiencing intense cravings to use the drugs  Repeatedly failing to fulfill obligations at home, school, and work  Continued use and prioritization of use despite the consequences  Use of the drug in dangerous situations, such as driving a car  Dishonesty on the extent of use or hiding use of the medications from loved ones and medical professionals Withdrawal symptoms of sedative, hypnotic, or anxiolytic use disorder  Repeated use of sedatives, hypnotics, or anxiolytics causes physical dependece, or tolerance, within the body. Tolerance means the body adapts to the medication, requiring larger amounts of the drug to achieve effects.  When someone stops taking sedative, hypnotic, or anxiolytic medications, the body will go into withdrawal. Symptoms may include:  Anxiety  Tremors, shaky hands  Sleep disturbances: nightmares or insomnia  Changes in appetite, nausea, or vomiting  Rapid pulse and respiratory rates  Changes in blood pressure  Fever, sweating  Delirium  Seizures Epidemiology  In the United States, the 12-month prevalences of sedative, hypnotic, or anxiolytic use disorder (DSM-IV criteria) are estimated to be 0.3% in teenagers (age 12 to 17) and 0.2% in adults.  The development of this disorder typically follows one of two trajectories:  (1) Early age of onset during from teenage years to mid-20s, when the use of the substance is associated with other substances, and with social use (e.g. - at parties).  (2) A second, less common, but equally important clinical course, is when an individual is given a prescription from a physician, usually for anxiety, insomnia, or somatic complaints. The individual may develop a tolerance or a need for higher doses of the medication, resulting in a gradual increase in the dose and frequency of self-administration. In these cases, the individual may find multiple physicians to prescribe supplies of the medication.  Registry studies suggest on a population level about 15% of all individuals prescribed a benzodiazepine will go on to continue taking one at the 1-year mark, and about 7% had dose escalation beyond recommended dosages.  Individuals at greatest risk for dose escalation were those who had psychiatric comorbidity and substance use disorders Risk factors  Temperamental. Impulsivity and novelty seeking are individual temperaments that relate to the propensity to develop a substance use disorder but may themselves be genetically determined.  Environmental. Since sedatives, hypnotics, or anxiolytics are all pharmaceuticals, a key risk factor relates to availability of the substances. In the United States, the historical patterns of sedative, hypnotic, or anxiolytic misuse relate to the broad prescribing patterns. For instance, a marked decrease in prescription of barbiturates was associated with an increase in benzodiazepine prescribing. Peer factors may relate to genetic predisposition in terms of how individuals select their environment. Other individuals at heightened risk might include those with alcohol use disorder who may receive repeated prescriptions in response to their complaints of alcohol-related anxiety or insomnia.  Genetic and physiological. As for other substance use disorders, the risk for sedative, hypnotic, or anxiolytic use disorder can be related to individual, family, peer, social, and environmental factors. Within these domains, genetic factors play a particularly important role both directly and indirectly. Overall, across development, genetic factors seem to play a larger role in the onset of sedative, hypnotic, or anxiolytic use disorder as individuals age through puberty into adult life.  Course modifiers. Early onset of use is associated with greater likelihood for developing a sedative, hypnotic, or anxiolytic use disorder.  Females are at higher risk than males for prescription misuse of sedative, hypnotic, or anxiolytic substances  Diagnostic criteria  Criterion A A problematic pattern of sedative, hypnotic, or anxiolytic use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: 1. Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use. 3. A great deal of time is spent in activities necessary to obtain the sedative, hypnotic, or anxiolytic; use the sedative, hypnotic, or anxiolytic; or recover from its effects. 4. Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic. 5. Recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to sedative, hypnotic, or anxiolytic use; sedative-, hypnotic, or anxiolytic-related absences, suspensions, or expulsions from school, neglect of children or household). 6. Continued sedative, hypnotic, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of sedatives, hypnotics, or anxiolytics (e.g., arguments with a spouse about consequences of intoxication; physical fights). 7. Important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotic, or anxiolytic use. 8. Recurrent sedative, hypnotic, or anxiolytic use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by sedative, hypnotic, or anxiolytic use). 9. Sedative, hypnotic, or anxiolytic 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 sedative, hypnotic, or anxiolytic. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect. b. b. A markedly diminished effect with continued use of the same amount of the sed-ative, hypnotic, or anxiolytic.Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision. 11. Withdrawal, as manifested by either of the following: c. The characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics (refer to Criteria A and B of the criteria set for sedative, hypnotic, or anxiolytic withdrawal, pp. 557-558). d. Sedatives, hypnotics, or anxiolytics (or a closely related substance, such as al-cohol) are taken to relieve or avoid withdrawal symptoms. Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision  Specify if: In early remission: After full criteria for sedative, hypnotic, or anxiolytic use disorder were previously met, none of the criteria for sedative, hypnotic, or anxiolytic use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic," may be met). In sustained remission: After full criteria for sedative, hypnotic, or anxiolytic use disorder were previously met, none of the criteria for sedative, hypnotic, or anxiolytic use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic," may be met).Specify if: In a controlled environment: This additional specifier is used if the individual is in an environment where access to sedatives, hypnotics, or anxiolytics is restricted. Differential diagnosis  Other mental disorders or medical conditions. Individuals with sedative-, hypnotic-, or anxiolytic-induced disorders may present with symptoms (e.g., anxiety) that resemble primary mental disorders (e.g, generalized anxiety disorder vs. sedative-, hypnotic-, or anxiolytic-induced anxiety disorder, with onset during withdrawal). The slurred speech, incoordination, and other associated features characteristic of sedative, hypnotic, or anxiolytic intoxication could be the result of another medical condition (e.g., multiple sclero-sis) or of a prior head trauma (e.g., a subdural hematoma).  Alcohol use disorder. Sedative, hypnotic, or anxiolytic use disorder must be differentiated from alcohol use disorder.  Clinically appropriate use of sedative, hypnotic, or anxiolytic medications. Individuals may continue to take benzodiazepine medication according to a physician's direction for a legitimate medical indication over extended periods of time. Even if physiological signs of tolerance or withdrawal are manifested, many of these individuals do not develop symptoms that meet the criteria for sedative, hypnotic, or anxiolytic use disorder because they are not preoccupied with obtaining the substance and its use does not interfere with their performance of usual social or occupational roles. Cormorbidity  Nonmedical use of sedative, hypnotic, or anxiolytic agents is associated with alcohol use disorder, tobacco use disorder, and, generally, illicit drug use. There may also be an over-lap between sedative, hypnotic, or anxiolytic use disorder and antisocial personality dis-order; depressive, bipolar, and anxiety disorders; and other substance use disorders, such as alcohol use disorder and illicit drug use disorders. Antisocial behavior and antisocial personality disorder are especially associated with sedative, hypnotic, or anxiolytic use disorder when the substances are obtained illegally. Sedative hypnotic anxiolytic intoxication A. Recent use of a sedative, hypnotic, or anxiolytic. B. Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, sedative, hypnotic, or anxiolytic use. C. One (or more) of the following signs or symptoms developing during, or shortly after, sedative, hypnotic, or anxiolytic use: 1. Slurred speech. 2. Incoordination. 3. Unsteady gait. 4. Nystagmus. 5. Impairment in cognition (e.g., attention, memory). 6. Stupor or coma. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another sub-stance.  Sedative hypnotic anxiolytic withdrawl A. Cessation of (or reduction in) sedative, hypnotic, or anxiolytic use that has been pro-longed. B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) sedative, hypnotic, or anxiolytic use described in Criterion A: 1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 2. 2. Hand tremor 3. 3. Insomnia. 4. 4. Nausea or vomiting. 5. 5. Transient visual, tactile, or auditory hallucinations or illusions. 6. 6. Psychomotor agitation. 7. 7. Anxiety. 8. 8. Grand mal seizures. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Specify if:With perceptual disturbances: This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Other sedative hypnotic anxiolytic induced disorders  The following sedative-, hypnotic-, or anxiolytic-induced disorders are described in other chapters of the manual with disorders with which they share phenomenology 1. sedative-, hypnotic-, or anxiolytic-induced psychotic disorder ("Schizophrenia Spectrum and Other Psychotic Disorders"). 2. sedative-, hypnotic-, or anxiolytic-induced bipolar disorder ("Bipolar and Related Disorders"). 3. sedative-, hypnotic-, or anxiolytic-induced depressive disorder ("De-pressive Disorders"). 4. sedative-, hypnotic-, or anxiolytic-induced anxiety disorder ("Anxiety Disorders"). 5. sedative-, hypnotic-, or anxiolytic-induced sleep disorder ("Sleep-Wake Disorders"). 6. sedative-, hypnotic-, or anxiolytic-induced sexual dysfunction ("Sexual Dysfunctions"). 7. sedative-, hypnotic-, or anxiolytic-induced major or mild neuro-cognitive disorder ("Neurocognitive Disorders"). 8. sedative, hypnotic, or anxiolytic intoxication delirium and sedative, hypnotic, or anxiolytic withdrawal delirium Unspecified sedative hypnotic anxiolytic related disorder  This category applies to presentations in which symptoms characteristic of a sedative-, hypnotic, or anxiolytic-related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific sedative-, hypnotic, or anxiolytic-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class Treatment  Sedative hypnotic or anxiolytic use disorder treatment should be individualized according to the patient’s needs. Substance use disorders are complex with multiple factors to consider, including detoxification needs and relapse prevention.  Detoxification  Detoxification should be closely monitored by a physician due to the possibility of seizures and other potentially life-threatening withdrawal symptoms. Sedatives, hypnotics, or anxiolytics should be gradually tapered off to prevent more severe withdrawal symptoms. The physician may decide to use an alternative medication for some time to manage withdrawal symptoms  Psychotherapy  Sedative, hypnotic, or anxiolytic use disorder is complex and continued support after detoxification is needed. Psychotherapy has been shown effective at managing these symptoms and sustaining abstinence.  Psychotherapy for sedative, hypnotic, or anxiolytic use disorder treatment is often based on cognitive behavioral therapy. This approach will focus on identifying triggers, and patterns of thoughts and behaviors, creating action plans for triggers, and building coping skills. STIMULANT RELATED DISORDER  Introduction  Stimulant use disorder is the continued use of stimulants despite harm to the person using them. Stimulants include cocaine, amphetamine, methamphetamine, MDMA (also known as ecstasy or molly), and prescription drugs such as Adderall and Ritalin. These drugs are classified as stimulants because they increase the level of activity that occurs in the body’s central nervous system.  In recent years, the rate of fatal overdose when using stimulants has increased. For people who use cocaine and psychostimulants such as methamphetamine, more than half the deaths also involved fentanyl or other opioids  Legal Prescription Stimulants:  Ritalin  Strattera  Adderall  Concerta  Illegal Stimulants:  Cocaine (“coke”, “crack”)  Amphetamine (“speed”)  Methamphetamine (“meth”)  MDMA (“Molly”) Signs and symptoms  Signs and symptoms of stimulant use disorder:  People who misuse stimulants can experience many side effects, including:  Elevated heart rate.  Dilated pupils.  Increased blood pressure.  Sweating or chills.  Nausea or vomiting.  Chest pain. Withdrawal symptoms  When a person stops using stimulants, they may experience withdrawal symptoms like:  Depression  Anxiety  Irritability  Drug cravings  Increased appetite  Sleep problems  Paranoia  Fatigue  Problems concentrating  Suicidal thoughts Effects of stimulant use disorder  Unhealthy use of stimulants—such as using them without medical supervision or taking them for longer, in higher doses, or more frequently than prescribed— can lead to serious, dangerous and potentially fatal health consequences, including:  Heart attack.  Stroke.  Severe weight loss or dental problems.  Violent behavior and psychosis.  Paranoia, anxiety and confusion.  Loss of productivity at work.  Overdose.  Premature death. Diagnostic Criteria: A. A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the follow-ing, occurring within a 12-month period: 1. The stimulant is often taken in larger amounts or over a longer period than was in-tended. 2. There is a persistent desire or unsuccessful efforts to cut down or control stimulant use. 3. A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects. 4. Craving, or a strong desire or urge to use the stimulant. 5. Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant. 7. Important social, occupational, or recreational activities are given up or reduced because of stimulant use. 8. Recurrent stimulant use in situations in which it is physically hazardous. 9. Stimulant 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 stimulant.  10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of the stimulant.Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for atten-tion-deficit/hyperactivity disorder or narcolepsy. 11. Withdrawal, as manifested by either of the following: c. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for stimulant withdrawal, p. 569). d. The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for atten-tion-deficit/hyperactivity disorder or narcolepsy. Specify if:In early remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the stimulant," may be met). In sustained remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the stimulant," may be met). Specify it:In a controlled environment: This additional specifier is used if the individual is in an environment where access to stimulants is restricted.  Specify current severity:  Mild: Presence of 2-3 symptoms.  305.70 (F15.10) Amphetamine-type substance  305.60 (F14.10) Cocaine  305.70 (F15.10) Other or unspecified stimulant  Moderate: Presence of 4-5 symptoms.  304.40 (F15.20) Amphetamine-type substance  304.20 (F14.20) Cocaine  304.40 (F15.20) Other or unspecified stimulant  Severe: Presence of 6 or more symptoms.  304.40 (F15.20) Amphetamine-type substance  304.20 (F14.20) Cocaine  304.40 (F15.20) Other or unspecified stimulant  Stimulant intoxication A. Recent use of an amphetamine-type substance, cocaine, or other stimulant. B. Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, use of a stimulant. C. Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use: 1. Tachycardia or bradycardia. 2. 2. Pupillary dilation. 3. 3. Elevated or lowered blood pressure. 4. 4. Perspiration or chills 5..5. Nausea or vomiting. 6. 6. Evidence of weight loss. 7. 7. Psychomotor agitation or retardation. 8. 8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias. 9. 9. Confusion, seizures, dyskinesias, dystonias, or coma. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another sub-stance. Specify the specific intoxicant (i.e., amphetamine-type substance, cocaine, or other stimulant).Specify if:With perceptual disturbances: This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a de-lirium.  Stimulant withdrawal A. Recent use of an amphetamine-type substance, cocaine, or other stimulant. B. B. Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, use of a stimulant. C. C. Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use 1. Tachycardia or bradycardia. 2. Pupillary dilation. 3. Elevated or lowered blood pressure. 4. Perspiration or chills. 5. Nausea or vomiting. 6. Evidence of weight loss. 7. Psychomotor agitation or retardation. 8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias. 9. Confusion, seizures, dyskinesias, dystonias, or coma. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another sub-stance.Specify the specific intoxicant (i.e., amphetamine-type substance, cocaine, or other stimulant). Specify if:With perceptual disturbances: This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a de-lirium. Other stimulant induced disorder  The following stimulant-induced disorders (which include amphetamine-, cocaine, and other stimulant-induced disorders) are described in other chapters of the manual with disorders with which they share phenomenology (see the substance/ medication-induced mental disorders in these chapters):  stimulant-induced psychotic disorder ("Schizophrenia Spectrum and Other Psychotic Disorders").  stimulant-induced bipolar disorder ("Bipolar and Related Disorders").  stimulant-induced depressive disorder ("Depressive Disorders").  stimulant-induced anxiety disorder ("Anxiety Disorders").  stimulant-induced obsessive-compulsive disorder ("Obsessive-Compulsive and Related Disorders").  stimulant-induced sleep disorder (Sleep-Wake Disorders"); and stimulant-induced sexual dysfunction ("Sex-ual Dysfunctions").  stimulant intoxication delirium. Unspecified stimulant related disorders  This category applies to presentations in which symptoms characteristic of a stimulant-related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific stimulant- related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class. treatment  Stimulant use disorder is treated with therapy in either an inpatient or outpatient setting. People with severe cases may require inpatient treatment, where they stay at a facility and attend daily therapy sessions. People with mild cases may benefit from outpatient treatment, where they receive therapy once or more per week. There are several different types of therapy that are effective for stimulant use disorder:  Contingency management provides rewards for positive behaviors like abstinence.  Cognitive behavioral therapy (CBT) helps people change unhealthy thought patterns that lead to substance use.  Motivational interviewing focuses on building motivation to change by exploring the costs of a person’s substance use.  Community reinforcement approach helps people make changes in their lives so that recovery is more rewarding than substance use.  Support groups can also be beneficial in addition to treatment. These groups are free and run by either a peer in recovery or a trained facilitator. Depending on the group, they may focus on offering social support or tools to aid in recovery. Groups for people recovering from stimulant use disorder include:  Narcotics Anonymous  Cocaine Anonymous  Crystal Meth Anonymous  SMART Recovery Prevalence  Among U.S. adults, 6.6% (annual average) used prescription stimulants overall; 4.5% used without misuse, 1.9% misused without use disorders, and 0.2% had use disorders. Adults with past-year prescription stimulant use disorders did not differ from those with misuse without use disorders in any of the examined sociodemographic characteristics and in many of the examined substance use problems. The most commonly reported motivations for misuse were to help be alert or concentrate (56.3%). The most likely source of misused prescription stimulants was by obtaining them free from friends or relatives (56.9%). More frequent prescription stimulant misuse and use disorder were associated with an increased likelihood of obtaining medications from physicians or from drug dealers or strangers and less likelihood of obtaining them from friends or relatives.  Approximately 16.0 million U.S. adults used prescription stimulants in the preceding year (annual average), 5.0 million misused prescription stimulants, and 0.4 million had use disorders. Cognitive enhancement was the most commonly reported reason for misusing prescription stimulants. Patients who are using their medication for cognitive enhancement or diverting their medication to others present a high risk. TOBACCO INDUCED SUBSTANCE RELATED DISORDERS OTHER SUBSTANCE RELATED DISORDERS  Other (or Unknown) Substance Use Disorder  Other (or Unknown) Substance Intoxication  Other (or Unknown) Substance Withdrawal  Other (or Unknown) Substance-Induced Disorders  Unspecified Other (or Unknown) Substance-Related Disorder