Alcohol Use Disorder
Ethyl alcohol stimulates GABA-A receptors.
Initially, it can lead to relaxation by suppressing anxiety. In the later period, it leads to deepening of anxiety and depression.
Folic acid deficiency anemia due to malnutrition
Causes Pellagra 4 D sign: Dementia, Diarrhea, Dermatitis, Death
Clinical manifestations related to alcohol use
Intoxication
Deprivation
Intoxication delirium
Withdrawal delirium
Dementia
Amnestic disorder
Psychotic disorder
Mood disorder
Anxiety disorder
Sexual dysfunction
Sleep disturbance
alcohol intoxication
at 50-100 mg
Impairment of speech in motor activity
Impairment of judgment and balance
intoxication above 200 mg
Ataxia, speech lisp
Reflexes are impaired
Severe hypoglycemia
Stupor above 300 mg
Potentially lethal above 400 mg
Alcohol Intoxication Treatment
✓ In terms of respiratory depression → ventilation
✓After 2 hours, charcoal and gastric lavage are ineffective
✓ Maintain fluid - electrolyte balance
✓ Give Thiamine
✓ Give polyvitamin- give folate
✓ In agitation → haloperidol
✓ Correct hypoglycemia and hypomagnesemia
✓ Dialysis may be required
Alcohol Withdrawal
Alcohol is the only substance that can lead to death with its abstinence.
Significant central nervous system hyperactivity occurs due to the sudden disappearance of the GABAergic effect of alcohol.
If left untreated, mortality in delirium tremens is 10%.
Autonomic hyperactivity
tremor in hands
insomnia
nausea vomiting
hallucinations
Anxiety
grand mal convulsions
NO rhinorrhea
Delirium Tremens Treatment
Keep away from environmental stimuli
Liquid-electrolyte balance
Thiamine is given
Benzodiazepines such as diazepam are given to prevent seizures.
Haloperidol in severe agitation
Drugs Used in Alcohol Addiction
Disulfiam: It is an aldehyde dehydrogenase inhibitor. Concomitant use with alcohol leads to toxic effects.
Acamprosate: NMDA antagonist and GABA - A activator. It reduces the desire to drink alcohol.
Naltrexone: It is an opiate receptor antagonist.
Nalmefene: It is an opiate receptor antagonist.
amphetamines
• Increases catecholamine (especially dopamine) release from presynaptic terminal.
• They are synthetic stimulant and sympathomimetic drugs.
Amphetamine intoxication
• Euphoria
• Concentration increase
• Tremor
• Confusion
• Blood pressure and heart rate increase
• Body temperature increases
• Muscle weakness
• Respiratory depression
• Mydriatic pupil
• Hallucinations
• Convulsions
• Table similar to paronoid schizophrenia
Amphetamine withdrawal
• Fatigue,
• Insomnia, excessive sleep
• Live unpleasant dreams
• Psychomotor retardation, agitation
cannabis
Cannabis Use
• Known as marijuana
• Inhibits the adenylate cyclase enzyme system by binding to cannabinoid type 1 (CB1) receptors in the brain.
• Substances known as Bonsai, Jamaica, synthetic cannabis derivatives.
• It impairs short-term memory.
• It causes an increase in appetite.
• It increases the risk of heart attack.
• It leads to feminization in males.
• It can cause delirium and psychosis.
Cannabis intoxication
• Tachycardia
• Reduction in secretion
• Increase in skin temperature
• Orthostatic hypotension
• Bronchodilation
• Panic symptoms
Cocaine
• It has a stimulant, sympathomimetic effect similar to amphetamines.
• Withdrawal and intoxication findings are similar to amphetamines.
• Intranasal and i.v. used
• Causes immediate intoxication with cigarettes
• May cause ischemic and hemorrhagic strokes
cocaine intoxication
• Intense anxiety
• Hallucinations
• Euphoria, stereotypical movements
• Bruxism
• Increase in blood pressure
• Tachycardia
• Mydriasis (not miosis)
• Hyperthermia
• Respiratory depression
• Convulsions
cocaine withdrawal
• Fatigue, lethargy
• Anxiety
• Feelings of worthlessness
• Depression
• Insomnia, excessive sleep
• Live unpleasant dreams
• Psychomotor retardation, agitation
Nicotine
Findings in nicotine withdrawal
dysphoria, depression
insomnia
irritability, anxiety
attention disorder
Unrest
bradycardia
increased appetite weight gain
no euphoria
smoking cessation treatment
Nicotine replacement therapy: Nicotine patches, nicotine gum can be used
Bupropion: It is an antidepressant drug that inhibits noradrenaline and dopamine reuptake.
Varenicline: It is a nicotinic partial receptor agonist.
hallucinogens
LSD, mescaline, psilocybin are examples of hallucinogens.
o Findings in hallucinogen intoxication:
Somatic symptoms: dizziness, weakness, tremor, nausea, drowsiness
Perception of shape and color changes
Time perception changes
Depersonalization
Delusions
Perception of reality is impaired,
Changes related to life and death
Opiates
Opiate intoxication
• Analgesia,
• Respiratory depression
• Constipation (no diarrhea)
• Nausea, vomiting
• Orthostatic hypotension
• Pin head1 pupil
• The skin is cold and damp
• Decreased muscle tone
• Mood changes
• Pruritus
Opiate deprivation
• It is due to rebound hyperactivity of locus coeruleus noradrenergic neurons.
• Influenza-like picture
• Lacrimation
• Rhinorrhea
• Anxiety
• insomnia
• Abdominal cramps
• Nausea 1 vomiting diarrhea
• Pupil dilated
Opiate Addiction Treatment
Buprenorphine: It is a partial opiate agonist. It is used sublingually as it is not orally bioavailable. An opiate antagonist, naloxone, is also included in the commercial preparation to prevent IV abuse.
Methadone: It is a weak opiate derivative.
Clonidine: It is used to suppress the autonomic symptoms of withdrawal.