Mental & Behavioral Disorders I Unit 4 PDF

Mental & Behavioral Disorders I UNIT 4 Note: This document only provides minimal information. Please refer to the textbooks for detailed answers and additional information. Introduction: Almost all people use one or more substances that affect...

Mental & Behavioral Disorders I UNIT 4 Note: This document only provides minimal information. Please refer to the textbooks for detailed answers and additional information. Introduction: Almost all people use one or more substances that affect the central nervous system, relieving physical and mental anguish or producing euphoria, their initial effects are usually pleasing, a factor that is perhaps at the root of substance use disorders. Drug Culture drugs to wake up (coffee or tea), to stay alert throughout the day (cigarettes, soft drinks), to relax (alcohol), and to reduce pain (aspirin). Substance use disorders and addiction are serious, complex, chronic illnesses that impact individuals, families, and communities. When substance use disorders and addiction are unrecognised or untreated, the consequences can be long-term and life-shattering: unemployment, arrest and incarceration, homelessness, family separation, social isolation, development of comorbid chronic illnesses, disability, and death. Symptoms: - Substance abuse alleviate physical pain/ anxiety altered states of consciousness substances interact with the nervous system - Substance withdrawal muscle pains and twitching sweats vomiting diarrhoea insomnia According to APA, Substance use disorder is a cluster of physiological, behavioural, and cognitive symptoms associated with the continued use of substances despite substance-related problems, distress, and/or impairment, such as impaired control and risky use. Mental & Behavioral Disorders I UNIT 4 ALCOHOL Anxious, depressed, weak, restless, and unable to sleep. Muscle tremors, especially of the fingers, face, eyelids, lips, and tongue, and pulse, blood pressure, and temperature may be elevated. Rare cases, delirium tremens (DTs) when the level of alcohol in the blood drops suddenly. The person becomes delirious as well as tremulous and has hallucinations that are primarily visual but may be tactile as well. Examples: Unpleasant and very active creatures—snakes, cockroaches, spiders, and the like—may appear to be crawling up the wall or over the person’s body or to be filling the room. Feverish, disoriented, and terrified, the person may claw frantically at his or her skin to get rid of the creatures. The low dose (.04 blood alcohol content) could lead to a small impairment in motor functioning, but the high dose (.08 blood alcohol content) led to more significant motor impairment that interfered with driving ability. Almost every tissue and organ of the body is adversely affected by prolonged consumption of alcohol. Alcohol contributes directly to malnutrition by impairing the digestion of food and absorption of vitamins. In older people who have chronically abused alcohol, a deficiency of B-complex vitamins can cause amnestic syndrome, a severe loss of memory for both recent and long-past events. These memory gaps are often filled in by reporting imaginary events (confabulation). Mental & Behavioral Disorders I UNIT 4 Prolonged alcohol use plus reduction in the intake of proteins – cirrhosis of the liver, a disease in which some liver cells become engorged with fat and protein. Other common changes to the body due to drinking include damage to the endocrine glands and pancreas, heart failure, erectile dysfunction, hypertension, stroke, and capillary haemorrhages, which are responsible for the swelling and redness in the face, brain issues especially memory loss. Heavy alcohol consumption by a woman during pregnancy is the leading known cause of intellectual developmental disorder among children. The growth of the foetus is slowed, and cranial, facial, and limb anomalies can be produced, a condition known as foetal alcohol syndrome (FAS). NICOTINE Nicotine is the addicting agent of tobacco. The smoke coming from the burning end of a cigarette, so-called secondhand smoke, or environmental tobacco smoke (ETS), contains higher concentrations of ammonia, carbon monoxide, nicotine, and tar than does the smoke actually inhaled by the smoker. Nonsmokers can suffer lung damage, possibly permanent, from extended exposure to cigarette smoke. Those living with smokers are at greatest risk. Precancerous lung abnormalities have been observed in those living with smokers, and nonsmokers are at greater risk for developing cardiovascular disease and lung cancer. In addition, some nonsmokers have allergic reactions to the smoke from burning tobacco. Babies of women exposed to secondhand smoke during pregnancy are more likely to be born prematurely, to have lower birth weights, and to have birth defects. Children of smokers are more likely to have upper respiratory infections, asthma, bronchitis, and inner-ear infections than are their peers whose parents do not smoke. Secondhand smoke can cause sudden infant death syndrome (SIDS). MARIJUANA Marijuana consists of the dried and crushed leaves and flowering tops of the hemp plant, Cannabis sativa. It is most often smoked, but it may be chewed, prepared as a tea, or eaten in baked goods. Hashish, much stronger than marijuana, is produced by removing and drying the resin exudate of the tops of cannabis plants. Smokers of marijuana find it makes them feel relaxed and sociable. Large doses have been reported to bring rapid shifts in emotion, to dull attention, to fragment thoughts, to impair memory, and to give the sense that time is moving more slowly. Extremely heavy doses have sometimes been found to induce hallucinations and other effects similar to those of LSD, including extreme panic, sometimes arising from the belief that a frightening experience will never end. Mental & Behavioral Disorders I UNIT 4 Dosage can be difficult to regulate because it may take up to half an hour after smoking marijuana for its effects to appear; many users thus get much higher than intended. The major active chemical in marijuana is delta-9-tetrahydrocannabinol (THC). The amount of THC in marijuana is variable, but marijuana is more potent now than it was two decades ago. An abundance of scientific evidence indicates that marijuana can interfere with a wide range of cognitive functions. Of special significance are findings that show an impact on short-term memory. The short-term effects of marijuana include bloodshot and itchy eyes, dry mouth and throat, increased appetite, reduced pressure within the eye, and somewhat raised blood pressure. The major active chemical in marijuana is delta-9-tetrahydrocannabinol (THC). The amount of THC in marijuana is variable, but marijuana is more potent now than it was two decades ago. An abundance of scientific evidence indicates that marijuana can interfere with a wide range of cognitive functions. Of special significance are findings that show an impact on short-term memory. The short-term effects of marijuana include bloodshot and itchy eyes, dry mouth and throat, increased appetite, reduced pressure within the eye, and somewhat raised blood pressure. Therapeutic Effects: Ironically, therapeutic uses of marijuana came to light just as the negative effects of regular and heavy usage of the drug were being uncovered. In the 1970s several double-blind studies showed that THC and related drugs could reduce the nausea and loss of appetite that accompany chemotherapy for some people with cancer (e.g., Salan, Zinberg, & Frei, 1975). Later findings confirmed this result (Grinspoon & Bakalar, 1995). Marijuana often appears to reduce nausea when other anti nausea agents fail. Marijuana is also an effective treatment for the discomfort of AIDS (Sussman et al., 1996), glaucoma, chronic pain, muscle spasms, and seizures. OPIATES The opiates include opium and its derivatives morphine, heroin, and codeine. They are considered sedatives, but in the DSM-5, opiate use disorder will likely be in a category distinct from sedative/hypnotic/anxiolytic use disorder. The opiates are a group of addictive drugs that in moderate doses relieve pain and induce sleep. Foremost among them is opium, originally the principal drug of illegal international traffic. The alkaloid morphine was separated from raw opium. This bitter-tasting powder proved to be a powerful sedative and pain reliever. Before its addictive properties were noted, it was commonly used in medicines. In the middle of the nineteenth century, when the hypodermic needle was introduced in the United States, morphine began to be injected directly into the veins to relieve pain. In 1874 they found that morphine could be converted into another powerful pain-relieving drug, which they named heroin. Used initially as a cure for morphine addiction, heroin was substituted for morphine in cough syrups and other patent medicines. Today, heroin is most often injected, though it can also be smoked, snorted, or taken orally. Mental & Behavioral Disorders I UNIT 4 More recently, opiates legally prescribed as pain medications, including hydrocodone and oxycodone, have become drugs of abuse. Hydrocodone is most often combined with other drugs, to create prescription pain medicines like Vicodin Oxycodone is found in medicines like OxyContin. Vicodin is one of the most commonly abused drugs containing hydrocodone, and OxyContin is one of the most commonly abused drugs containing oxycodone. Produce a “rush,” a feeling of warm, suffusing ecstasy immediately after an intravenous injection. The user sheds worries and fears and has great self-confidence for 4 to 6 hours. However, the user then experiences a severe letdown, bordering on stupor. Opiates produce their effects by stimulating neural receptors of the body’s own opioid system (the body naturally produces opioids, called endorphins and enkephalins). Withdrawal from heroin may begin within 8 hours of the last injection, at least after high tolerance has built up. During the next few hours after withdrawal begins, the person typically experiences muscle pain, sneezing, and sweating; becomes tearful; and yawns a great deal. There may be uncontrollable muscle twitching, cramps, chills alternating with excessive flushing and sweating, and a rise in heart rate and blood pressure. The person is unable to sleep, vomits, and has diarrhoea. These symptoms typically persist for about 72 hours and then diminish gradually over a 5- to 10-day period. An additional problem associated with intravenous drug use is exposure, through sharing needles, to infectious agents such as the human immunodeficiency virus (HIV), which causes AIDS STIMULANTS Stimulants act on the brain and the sympathetic nervous system to increase alertness and motor activity. Caffeine is the most commonly used stimulant and it’s consumption is legal. Amphetamines are synthetic stimulants Methamphetamine is a type of amphetamine. Cocaine is a natural stimulant AMPHITAMINE The first amphetamine, benzedrine, was synthesised in 1927, and other amphetamines were synthesised soon afterwards. Inhalant to relieve stuffy noses, the public discovered its stimulating effects, and physicians soon began to prescribe it and the other amphetamines to control mild depression and appetite. During World War II, soldiers on both sides were supplied with amphetamines to ward off fatigue. Amphetamines such as benzedrine, dexedrine, and methedrine produce their effects by causing the release of norepinephrine and dopamine and blocking the reuptake of these neurotransmitters. Amphetamines are taken orally or intravenously and can be addicting. Mental & Behavioral Disorders I UNIT 4 Wakefulness is heightened, intestinal functions are inhibited, and appetite is reduced—hence their use in dieting. The heart rate quickens, and blood vessels in the skin and mucous membranes constrict. The person becomes alert, euphoric, and outgoing and is possessed of seemingly boundless energy and self-confidence. Larger doses can make a person nervous, agitated, and confused; other symptoms include palpitations, headaches, dizziness, and sleeplessness. Sometimes heavy users become extremely suspicious and hostile, to the extent that they can be dangerous to others. Large doses taken over a period of time can induce a state quite similar to the paranoia sometimes seen with schizophrenia. METHAMPHETAMINE Abuse of an amphetamine derivative called methamphetamine skyrocketed in the 1990s Like other amphetamines, methamphetamine can be taken orally or intravenously. It can also be taken intranasally (i.e., by snorting). In a clear crystal form, the drug is often referred to as “crystal meth” or “ice.” Craving for methamphetamine is particularly strong, often lasting several years after use of the drug is discontinued. Like other amphetamines, users get an immediate high, or rush, that can last for hours. This includes feelings of euphoria as well as changes to the body, such as increases in blood flow to the heart and other organs and an increase in body temperature. The high eventually levels off (the “shoulder”) and then it comes crashing down (“tweaking”). Not only do the good feelings crash, but the person also becomes very agitated. COCAINE The alkaloid cocaine was first extracted from the leaves of the coca shrub in the mid-1800s and has been used since then as a local anaesthetic. In the mid-1980s a new form of cocaine, called crack, appeared on the streets. Crack comes in a rock-crystal form that is then heated, melted, and smoked. Cocaine has other effects in addition to reducing pain. It acts rapidly on the brain, blocking the reuptake of dopamine in mesolimbic areas. Cocaine can increase sexual desire and produce feelings of self-confidence, well-being, and indefatigability. An overdose may bring on chills, nausea, and insomnia, as well as strong paranoid feelings and terrifying hallucinations of insects crawling beneath the skin. Chronic use can lead to heightened irritability, impaired social relationships, paranoid thinking, and disturbances in eating and sleeping. Cocaine is a vasoconstrictor, causing the blood vessels to narrow As users take larger and larger doses of the purer forms of cocaine now available, they are more often rushed to emergency rooms and may die of an overdose, often from a heart attack, increases a person’s risk for stroke and causes cognitive impairments, such as difficulty paying attention and remembering and affects pregnancy HALLUCINOGENS - LSD Mental & Behavioral Disorders I UNIT 4 In 1938 the Swiss chemist Albert Hofmann manufactured a few milligrams of d-lysergic acid diethylamide into a drug known today as LSD. Unlike the hallucinations in schizophrenia, however, these are usually recognized by the person as being caused by the drug. In addition to hallucinations, LSD can alter a person’s sense of time (it seems to go slowly). A person using LSD may have sharp mood swings but can also experience an expanded consciousness such that he or she seems to appreciate sights and sounds like never before Many users experience intense anxiety after taking LSD, in part because the perceptual experiences and hallucinations can provoke fears that they are “going crazy.” For some, these anxieties unfold into full-blown panic attacks. A minority of people, however, go into a psychotic state that can require hospitalisation and extended treatment. Flashbacks (also referred to as hallucinogen persisting perception disorder, or HPPD) are visual recurrences of psychedelic experiences after the physiological effects of the drug have worn off. They occur in some people who have used LSD, most frequently in times of stress, illness, or fatigue. Flashbacks seem to have a force of their own; they may come to haunt people weeks and months after they have taken the drug and are very upsetting for those who experience them. - MESCALINE & PSILOCYBIN Other hallucinogens include mescaline and psilocybin, whose effects are thought to be due to stimulating serotonin receptors. Mescaline, an alkaloid and the active ingredient of peyote, was isolated in 1896 from small, disklike growths of the top of the peyote cactus. The drug has been used for centuries in the religious rites of Native American people living in the U.S. Southwest and northern Mexico. Psilocybin is a crystalline powder that Hofmann isolated from the mushroom Psilocybe mexicana in 1958 ECSTASY Ecstasy became illegal in 1985. Ecstasy is made from MDMA (methylenedioxymethamphetamine). MDMA was first synthesised in the early 1900s, and it was used as an appetite suppressant for World War I soldiers. Ecstasy contains compounds from both the hallucinogen and amphetamine families, but its effects are sufficiently different from either that some have suggested putting it in its own category, called the “entactogens” (Morgan, 2000). Ecstasy acts primarily by contributing to both the release and the subsequent reuptake of serotonin Users report that Ecstasy enhances intimacy and insight, improves interpersonal relationships, elevates mood and self-confidence, and promotes aesthetic awareness. It can also cause muscle tension, rapid eye movements, jaw clenching, nausea, faintness, chills or sweating, anxiety, depression, depersonalization, and confusion. Some evidence suggests that the subjective and physiological effects of Ecstasy, both pleasurable and adverse, may be stronger for women. PCP Mental & Behavioral Disorders I UNIT 4 PCP, phencyclidine, often called angel dust, is another drug that is not easy to classify. Developed as a tranquilliser for horses and other large animals, it generally causes serious negative reactions, including severe paranoia and violence. Coma and death are also possible. PCP affects multiple neurotransmitters in the brain, and chronic use is associated with a variety of neuropsychological deficits. ETIOLOGY Developmental Process - Positive attitude - Experimentation - Regular Use - Heavy Use - Dependence or abuse Genetics - ADH, DRD2, SLC6A3, CYP2A6 Neurological mechanism: Dopamine system Vulnerability model vs.Toxic effect model Incentive-sensitization theory – Dopamine system becomes sensitive to drugs & the related cues (Liking à Craving) Psychological factors Mood alteration (enhancement à reinforcement, reduction in negative affect) Personality factors – High negative affect + low constraint Negative affect (persistent desire for arousal along with increased positive affect) Constraint (cautious behaviour, harm avoidance, and conservative moral standards). Sociocultural factors influenced by peers, parents, the media, availability and cultural norms about acceptable behaviour TREATMENT Inpatient Hospital Treatment – detoxification. Self-Help Groups – AA, DAA Contingency management therapy (reinforce behaviour inconsistent with substance) Medications / Replacements (Antabuse / Nicotine patches / drug replacements) PREVENTIONS OF SUBSTANCE USE DISORDERS - SELF STUDY