Psychoactive Drug Intoxication & Withdrawal PDF

588 SEC TION III PSYCHIATRY ` PSYCHIATRY!PATHOLOGY Psychoactive drug intoxication and withdrawal DRUG MECHANISM INTOXICATION WITHDRAWAL Depressants Nonspeci!c: mood elevation...

588 SEC TION III PSYCHIATRY ` PSYCHIATRY!PATHOLOGY Psychoactive drug intoxication and withdrawal DRUG MECHANISM INTOXICATION WITHDRAWAL Depressants Nonspeci!c: mood elevation, Nonspeci!c: anxiety, tremor, seizures, "anxiety, sedation, behavioral insomnia. disinhibition, respiratory depression. Alcohol GABA-A receptor Emotional lability, slurred speech, Adaptation causes "glutamate positive ataxia, coma, blackouts. AST receptors; symptoms result from allosteric value is 2! ALT value (“ToAST 2 unregulated excess excitation. modulator. ALcohol”). Treatment: longer-acting Inhibits Treatment: supportive (eg, #uids, benzodiazepines. glutamate- antiemetics). Alcoholic hallucinosis induced (usually visual) excitation of Withdrawal seizures Tremors, insomnia, diaphoresis, NMDA. agitation, GI upset Delirium tremens 0 3 6 12 24 36 48 96 Time from last drink (hours) Barbiturates GABA-A receptor Low safety margin, marked Delirium, life-threatening positive respiratory depression. Treatment: cardiovascular collapse. allosteric symptom management (eg, assist modulator. respiration, "BP). Benzodiazepines GABA-A receptor Greater safety margin. Ataxia, minor Seizures, sleep disturbance, positive respiratory depression. Treatment: depression. allosteric #umazenil (benzodiazepine modulator. receptor antagonist). Opioids Opioid receptor Activation of receptors causes the Mydriasis, diarrhea, #ulike symptoms, modulator. prototypic effect of miosis (pinpoint rhinorrhea, yawning, nausea, pupils), "GI motility, respiratory sweating, piloerection (“cold and CNS depression, euphoria, turkey”), lacrimation. "gag re#ex, seizures. Most common Treatment: symptom management, cause of drug overdose death. methadone, buprenorphine. Overdose treatment: naloxone. Inhalants Enhanced GABA Disinhibition, euphoria, slurred Irritability, dysphoria, sleep signaling. speech, ataxia, disorientation, disturbance, headache. drowsiness, periori!cal rash. Rapid onset and resolution. Stimulants Nonspeci!c. Mood elevation, "appetite, Post-use “crash,” including psychomotor agitation, insomnia, depression, lethargy, "appetite, cardiac arrhythmias,  HR, anxiety. sleep disturbance, vivid nightmares. Amphetamines Induces reversal Euphoria, grandiosity, mydriasis, Meth mites (tactile hallucinations) of monoamine prolonged wakefulness, transporters hyperalertness, hypertension, (VMAT, DAT, paranoia, fever. Skin excoriations SERT, NET), with methamphetamine use. Severe: "neurotrans- cardiac arrest, seizures. Treatment: mitter release. benzodiazepines for agitation and seizures.  PSYCHIATRY ` PSYCHIATRY!PATHOLOGY SEC TION III 589 Psychoactive drug intoxication and withdrawal (continued) DRUG MECHANISM INTOXICATION WITHDRAWAL Ca!eine Adenosine Palpitation, agitation, tremor, Headache, dif!culty concentrating, receptor insomnia. #ulike symptoms. antagonist. Cocaine Blocks reuptake Impaired judgment, mydriasis, Restlessness, hunger, severe by dopamine diaphoresis, hallucinations (including depression, sleep disturbance. (DAT), serotonin formication), paranoia, angina, (SERT), and sudden cardiac death. Chronic use norepinephrine may lead to perforated nasal septum (NET) due to vasoconstriction and resulting transporters. ischemic necrosis. Treatment: benzodiazepines. Nicotine Stimulates Restlessness. Irritability, anxiety, restlessness, central nicotinic "concentration, "appetite/weight. acetylcholine Treatment: nicotine replacement receptors. therapy (eg, patch, gum, lozenge); bupropion/varenicline. Hallucinogens Lysergic acid 5-HT2A receptor Perceptual distortion (visual, diethylamide agonist. auditory), depersonalization, anxiety, paranoia, psychosis, #ashbacks, mydriasis. Cannabis/ CB1 receptor Euphoria, anxiety, paranoid delusions, Irritability, anxiety, depression, cannabinoids agonist. perception of slowed time, impaired insomnia, restlessness, "appetite. judgment, social withdrawal, "appetite, dry mouth, conjunctival injection, hallucinations. MDMA (ecstasy) Induces reversal Euphoria, hallucinations, Depression, fatigue, change in of transporters disinhibition, hyperactivity, "thirst, appetite, dif!culty concentrating, for monoamines bruxism, distorted perceptions, anxiety. (SERT > DAT, mydriasis. Life-threatening effects NET), Ž  include hypertension, tachycardia, neurotransmitter hyperthermia, hyponatremia, release. serotonin syndrome. Phencyclidine NMDA receptor Violence, nystagmus, impulsivity, antagonist. psychomotor agitation, tachycardia, hypertension, analgesia, psychosis, delirium, seizures.