MENTAL BEHAVIOURAL DISORDERS

AND COMORBIDITY DUE TO

STIMULANTS USES
F R I D A N E I L A R A H M AT I K A

2014.2040.1011.082

D E PA RT M E N T O F P S YC H I AT R I CS
M E N U R A S Y L U M - S U R A B AYA
M U H A M M A D I YA H M A L A N G M E D I C A L S C H O O L
2016

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OVERVIEW
Substance misuse or abuse is frequently classified
:
Experimental
Recreational
Dependant
that may result in adverse
psychological effects

physical

and/or

TERMS DSM V CRITERIA

Abuse

Dependen
ce

maladaptive pattern of substance use leading to significant

adverse consequences
must recur during a 12-month period.

maladaptive pattern of substance use leading to clinically

significant impairment or distress, as manifested of the
following within a 12 month period:
tolerance,
withdrawl symptom,
Persistent desire or unsuccessful efforts to cut down or
control use
Social impairment

Withdrawl
Intoxicati
on

a syndrome due to cessation of, or

reduction in, heavy and prolonged
substance use
clinically significant impairment or
distress
lasts several days to 2 weeks.
reversible substance-specific
syndrome with maladaptive behavioral
or psychological changes developing
during or shortly after using the
substance

STIMULANTS ?
are drugs that are purported to enhance
sociability, confidence and alertness while
reducing inhibition.

The sensation : euphoria and wellbeing these

effects are usually only short lasting.

INCLUDES
Cocaine,
dexamphetamine,
methamphetamine (including crystal and ice),
ecstasy (3,4 Methylenedioxymethamphetamine,
MDMA),
methylphenidate,
ephedrine,
Pseudoephedrine
Caffeine

Originally found in plants : Cocca and

Ephedra
Legally uses :
amphetamine [Dexedrine, Adderall], methylphenidate
[Ritalin]) : Both are uses as psycotrophic agents
Epehdrine Pseudoephedrine : use widely

Ilegal uses :
Cocaine

PHYSIOLOGICAL EFFECTS
Increased heart rates

Increased blood pressure

Increased temperature

Amphetamine : reduce coordination

increase risk taking

EFFECT SOUGHT BY USER

Euphoria
Empathy
Enhanced sociability
Increased energy level and stamina
Appetite suppression.

ASSOCIATED HARMS

Tachycardia,

hypertension,
seizures,
PHYSIOLOGICAL

arrhythmias,
tremor,

Psychological :

mydriasis,

dehydration,
diaphoresis,
nausea,
muscle cramping,
jaw clenching,
jitteriness

Paranoia
Psychosis
Depresion
INCREASED RISK
TA K I N G
fear reduction : dangerous
driving, risk of suicide

Injecting drugs associated

risk
Long term brain structure changes

ICD-10 CLASSIFICATION
F14. Mental and behavioural disorders due to use of
cocaine
F15. Mental and behavioural disorders due to use of
other stimulants, including caffeine

STIMULANT OVERDOSE
Low to medium risk of overdose for oral use.
high risk of overdose associated with smoking or
injecting use
Sign include :

Very fast breathing and heartbeat

Unconsciousness
Chest pains
Midriasis
Seizures or Jittering
Muscle Cramping
Dizziness
Urinating Problem .

STIMULANT WITHDRAWAL
Acute , lasting up to two weeks :
Depression, dysphoria, fatigue,
exhaustion and somnolence and loss of
appetite
Following prolonged use, last several
weeks or months.
insomnia, persistent craving, intense
dreaming and irritability

TREATMENTS FOR ABUSE AND DEPENDENCY

Detoxification
Symptomatic
rehabilitation centers or supportive
housing

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DEPRESSION AND STIMULANTS USES

Depression is common amongst stimulant
users, both in the days following heavy use and
during withdrawal.
Rebound
depletion

phenomen

due

to

monamine

Stimulant effects on sleep may worsen sleepwake cycle disturbances associated with
depression

Reductions in stimulant use improve symptoms of

depression.

If depression persists despite adequate withdrawal

from stimulants, then treat as for primary depression

There is little consistent evidence that antidepressants

are beneficial in management of stimulant withdrawal

CBT may address stimulant use and is effective

ANXIETY AND STIMULANTS USES

Usualy present with withdrawl symptom
Higher stimulant use predicting greater
severity of anxiety
Management : reduce stimulant uses
can be treated with benzodiazepines,
even CBT is also effective in reducing
general symptoms of anxiety.

PSYCHOSIS AND STIMULANTS USE

characterised by a loss of connectedness
with reality
Stimulants are amongst the most commonly
used substances in individuals with psychosis
Stimulant-induced psychosis involves both
positive and negative symptoms including
paranoid hallucinatory states, bizarre ideas
as well as volitional disturbances and can
often be indistinguishable from acute or
chronic schizophrenia

ACUTE PSYCHOTIC

treatment should involve efforts to encourage

abstinence from stimulants which should result
in the resolution of psychotic symptoms

Antipsychotics may be added

LONGER TERM PSYCHOTIC

In those who have experienced
more
than
one
episode
of
psychosis, regular low dose use of
antipsychotics may be necessary
Clozapine
is
effective
in
individuals with psychosis and
comorbid stimulant use.

PERSONALITY DISORDER
Use of stimulants may exacerbate
impulsivity, mood disturbance and
anger in people with Cluster B type
personality disorders

K
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SOURCE
Drug and Alcohol Services South Australia 2008 : Comorbidity of
mental disorders and substance use: A brief guide for the primary care
clinician
Curran, C. , NEETHA B and ANDREW McBRIDE
psychosis: systematic review

2004 : Stimulant