PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

SUBSTANCE USE RELATED DISORDERS

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES)
ALCOHOL RELATED DISORDERS
• DECREASE LIFE SPAN BY 10 YEARS TO 15
• 22,OOO DEATHS/YEAR
• 2 MILLION NON FATAL INJURIES
• BEER –HALF OF ALCOHOL CONSUMPTION
• LIQUOR -1/3
• 50% HOMICIDES;25% SUICIDES
EPIDEMIOLOGY FOR ALCOHOL RELATED DISORDERS
• ALL SOCIOECONOMIC CLASS
• 70% OF ADULTS WITH COLLEGE DEGRESS ARE
CURRENT DRINKERS; 40% WITH LESS
EDUCATION
• BINGE ALCOHOL USE SIMILAR ACROSS
DIFFERENT LEVELS OF EDUCATION
• MEN > WOMEN
CO MORBID DISORDERS
• ANTISOCIAL PERSONALITY DISORDER
• DEPRESSION- 30 T0 40% (WOMEN)
• ANXIETY DISORDER
• SUICIDE
ETIOLOGY
• 60% GENETIC
• CHILDHOOD HISTORY OF ADHD, CONDUCT
DISORDER
• EEG,EVOKED POTENTIAL (P300)
• IDENTICAL TWIN/ADOPTIVE STUDIES
• 40% ENVIRONMENTAL
• PSYCHOLOGICAL THEORY
• REDUCE TENSION
• INC. FEELINGS OF POWER
• DEC.PSYCHOLOGICAL PAIN
• PSYCHODYNAMIC THEORY
• DECREASE UNCONSCIOUS STRESS LEVEL
• FIXATED TO ORAL STAGE
• BEHAVIORAL THEORY
• EXPECTATIONS ABT. REWARDING EFFECTS OF
DRINKING
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June 22, 2011
ALCOHOL
• SINGLE DRINK EQUAL TO 12 G ALCOHOL
• 12 OUNCES OF BEER
• METABOLISM IN ONE HOUR 15 TO 20 MG/DL
• Stomach absorption;SI
• Pyloric valve closure
• Peak blood conc.45 to 60 min. after ingestion
• Food delays absorption
• Rapid drinking decrease time to peak
concentration
• MELLANBY EFFECT
METABOLISM
• ALCOHOL-ACETALDEHYDE (ALCDH)ACETIC
ACID (ALDDH)
• 90% OXIDIZED IN THE LIVER;10% ECRETED
UNCHANGED INKIDNEYS AND LUNGS
• CHRONIC ALCOHOLISM –UPREGULATION OF
ENZYMES
• WOMEN,ASIANS,LOWER ENZYMES
EFFECTS ON THE BRAIN
• NO SINGLE MOLECULAR TARGET
• “INTERCALATION IN MEMBRANES OF
NEURONS”-FLUIDITY, STIFFNESS
• RECEPTORS ENHANCED BY ALCOHOL-
5HT3,GABA A,NIC. ACH
• INHITED RECEPTORS- GLUTAMATE,CALCIUM
CHANNEL
BEHAVIORAL EFFECTS
• 0.05%- THOUGHT,JUDGMENT&RESTRAINT
LOOSENED
• 0.1%-CLUMSY MOTOR ACTS
• 0.2%-DEPRESSED MOTOR AREA,CONTROL OF
EMOTIONAL BEHAVIOR
• 0.3%CONFUSION,
• STUPOROUS
• 0.4 TO 0.5%-COMA
• > RESPIRATORY DEPRESSION
PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

SLEEP • DEMENTIA
• DECREASE REM,DEC.DEEP SLEEP, SLEEP • PERSISTING AMNESTIC D/O
FRAGMENTATION • PSYCHOTIC D/OWITH DELUSIONS

PHYSIOLOGICAL EFFECTS SUBTYPES OF ALCOHOL DEPENDENCE

• FATTY LIVER • TYPE A- MILD DEPENDENCE, Late onset

• ALCOHOLIC HEPATITIS • TYPE B-SEVERE DEPENDENCE, early onset
• HEPATIC CIRRHOSIS • Antisocial alcoholism
• ESOPHAGITIS • Developmentally cumulative
• GASTRITIS • Negative effect alcoholism
• ACHLORHYDRIA • Developmentally limited alcoholism
• GASTRIC ULCER
• PANCREATIC CANCER
• FAILED NUTRIENT ABSORPTION
• HYPERTENSION
• INC. RISK MI,CVD
• INC. RESTING CO,HR,O2 CONSUMPTION
• INC.
HEAD,NECK,ESOPHAGEAL,STOMACH,HEPATIC,C
OLONIC,LUNG CANCER
• HYPOGLYCEMIA
• MYOPATHY

ALCOHOL RELATED DISORDERS

• ALCOHOL USE DISORDERS

1. ALCOHOL DEPENDENCE
2. ALCOHOL ABUSE

• ALCOHOL INDUCED DISORDERS

1. ALCOHOL INTOXICATION
2. ALCOHOL WITHDRAWAL

• ALCOHOL INDUCED
1. PSYCHOTIC DISORDER
2. MOOD DISORDER
3. ANXIETY DISORDER
4. SEXUAL DYSFUNCTION
5. PERCEPTUAL D/O
• INTOXICATION DELIRIUM
• WITHDRAWAL DELIRIUM

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

NEUROLOGICAL AND MEDICAL COMPLICATIONS OF

ALCOHOL USE

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

NEUROPHARMACOLOGY

• HALF LIFE 3 TO 10 HOURS

• TIME OF PEAK CONC. 30 TO 60 MG
• ANTAGONIST OF ADENOSINE RECEPTORS
• INHIBIT Gi protein inc. cAMP in neurons
• Dopamine and NE
• Global cerebral vasoconstriction
• ?rebound, coronary artery

CAFFEINE RELATED DISORDERS

• A CUP- 100 TO 150 MG

• TEA – 30 TO 100 MG
• CHOCOLATE BAR- 25 T0 35 MG
• SOFT DRINKS- 25 TO 50 MG
• DECAF- 2 TO 4 MG
• COMORBID USE OF SEDATIVE AND HYPNOTIC

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

AMPHETAMINE RELATED DISORDERS(STIMULANT)

 METAMPHETAMINE
 METHYLPHENIDATE
 EPHEDRINE
 PSEUDOEPHEDRINE
 PHENYLPROPANOLAMINE
 PHENTERMINE
 MODAFINIL

NEUROPHARMACOLOGY

• RELEASE DOPAMINE
• VENTRAL TEGMENTAL
AREACEREBRALCORTEX AND LIMBIC AREA
• DESIGNER AMPHETAMINE
• DA,NE,SEROTONIN

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

CANNABIS RELATED DISORDER

• NEUROBIOLOGY TETRAHYDROCANNABINOL

• G PROTEIN LINKED RECEPTOR (Gi)

• Monoamine and gaba
• Euphoria peak in 30 min then 2 to 4 hrs
• ? Reward center
• Amotivational syndrome,cognitive impairment

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

NICOTINE RELATED DISORDER

NEUROBIOLOGY

• LUNG CANCER, EMPHYSEMA,

CARDIOVASCULAR DISEASE
• SECONDHAND SMOKE
• SCHIZOPHRENIA-REDUCE SENSITIVITY TO
OUTSIDE STIMULI;INCREASE CONCENTRATION
• AGONIST OF NICOTINIC ACH RECEPTORS
• BRAIN 15 SEC. HALF LIFE 2HOURS
• ACTIVATE THE REWARD CENTER
• INCREASE NE,E, VASOPRESSIN,
ENDORPHIN,ACTH AND CORTISOL

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PSYCHIATRIC 3: SUBSTANCE ABUSE( DR ROSALES) June 22, 2011

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