Substance Related Disorders.Doc

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Nosology: We have two large categories :
1- substance dependence and substance abuse
2- substance induced mental disorders
we will deal with the descriptions of the clinical phenomena associated with the use of 11 designated classes of pharmacological agents: alcohol, amphetamines or similarly acting agents; caffeine; cannabis; cocaine; hallucinogens; inhalants; nicotine; opioids; phencyclidine (PCP) or similar agents; and sedatives, hypnotics, and anxiolytics. The ICD-10 includes caffeine in the category of other stimulants such as amphetamine and (PCP) phencyclidine is included with hallucinogens Substance Dependence:

“a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.” DSM-IV uses seven criteria requires three to describe dependence. ICD-10 requires three of six criteria . DSM-IV Diagnostic Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: (1) Tolerance, as defined by either of the following:

(a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect (b) Markedly diminished effect with continued use of the same amount of the substance (2) Withdrawal, as manifested by either of the following:

(a) The characteristic withdrawal syndrome for the substance (refer to criteria A and B of the criteria sets for withdrawal from the specific substances) (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms (3) The substance is often taken in larger amounts or over a longer period than was intended (4) There is a persistent desire or unsuccessful effort to cut down or control substance use (5) A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects (6) Important social, occupational, or recreational activities are given up or reduced because of substance use (7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption) Specify if:

With physiological dependence: evidence of tolerance or withdrawal (i.e., either item 1 or 2 is present) Without physiological dependence: no evidence of tolerance or withdrawal (i.e., neither item 1 nor 2 is present) Course specifiers:

Early full remission
Early partial emission
Sustained full remission
Sustained partial remission
On agonist therapy
In a controlled environment
- Intoxication: is a mental disorder caused by recent ingestion or presence in the body of an exogenous substance producing maladaptive behaviour by virtue of its effects on the central nervous system. The most common psychiatric changes involve disturbances of perception, wakefulness, attention, thinking, judgment, emotional control, and psychomotor behaviour; the specific clinical picture depends on the substance ingested. -Withdrawal: it is the appearance of signs and symptoms following cessation or reduction of dose. -Tolerance: it is the need to increase the dose to obtain the same effect -abuse: means any use of an illicit substance, as well as the harmful or excessive use, of legally available substances, such as...
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