Common Substance-Related Disorders – Psychiatry | Lecturio


[Music] let’s talk now about some other substance related disorders starting with marijuana so the main active component in marijuana is THC an assessment for marijuana consists of urine drug screenings and it’ll actually stay positive for about four weeks after use some of the assessment signs are going to be seeing a patient who seems euphoric they may have impaired coordination during times of marijuana intoxication fast heartbeat or tachycardia conjunctival injection which is really a key marker for marijuana intoxication dry mouth and increased appetite during the withdrawal phase of marijuana patient may present with irritability insomnia nausea and decreased appetite so want to talk a little bit about motivational syndrome and what this is so motivational syndrome is really associated with cannabis abuse and it’s characterized by an unwillingness to participate in tasks that require prolonged attention so this can be seen in somebody who’s really a chronic user of marijuana and they really are unwilling to engage in things that are gonna require a lot of attention and focus moving on now to caffeine a very highly abused substance so intoxication with caffeine looks like the following anxiety insomnia twitching rambling speech flushed face diary C’s GI disturbance and also restlessness some results of caffeine consumption over one gram so a huge amount of caffeine can result in tinnitus severe agitation and it can actually cause a cardiac arrhythmia in extreme cases of caffeine consumption the symptoms can also include seizures and respiratory failure some of the symptoms of withdrawal from caffeine include headache nausea and vomiting zena’s anxiety and actually depression and usually caffeine withdrawal will begin in within 24 hours of its last use and it will peak within about two days the good news is for people hoping to get off of caffeine coffee soda whatever usually withdrawal will remit after about a week and then person basically resets and no longer has any of these undesirable symptoms now let’s talk about nicotine another very highly abused substance nicotine addiction is very prominent in other mental health disorders so it’s often seen in patients who have schizophrenia depression anxiety the lifetime prevalence of nicotine addiction is actually 20% so it’s very high and two of the most common causes of death associated with nicotine are actually cardiovascular disease which could be stroke or heart attack and lung disease in the form of COPD cancer or pneumonia so very serious consequences with this with this substance and a little bit more about nicotine so of course it’s derived from the tobacco plant it stimulates nicotinic receptors in the autonomic ganglia of the sympathetic and parasympathetic nervous systems it’s highly highly addictive because of its work through the dopaminergic system so when somebody say takes a hit of nicotine through smoking or whatnot they get a surge of dopamine release and then this is what drives them to keep smoking so they can keep releasing dopamine and it becomes very addictive during the intoxicated State with nicotine people can appear Restless they can have insomnia anxiety and Gi upset they can also have cravings dysphoria anxiety increased appetite irritability and insomnia again so health and cognitive problems that come along Oh what kind of things can you think about that put people especially children of smoking parents at risk so children in a home with a smoking parent are gonna be a particular risk for developing otitis media pneumonia asthma sudden infant death syndrome they’ll have a low birth weight low performance on standardized tests and also poorer athletic performance so there are a lot of drawbacks to that secondhand smoke especially when it’s a child who’s incurring the secondhand smoke treatment options for nicotine include behavioral counseling replacement through gum or a patch and also other medications like clonidine bupropion and varan cycling cocaine is a commonly abused substance and this works by blocking dopamine uptake from the synaptic cleft causing a stimulant effect in patients and dopamine plays a critical role in the brain’s reward system a very important point because this really is what drives addictions during cocaine intoxication a patient may appear euphoric have changes to their blood pressure and heart rate they may have some nausea you’ll see dilated pupils a very important point to remember weight loss and sometimes psychomotor changes they can also have chills respiratory problems sweating seizures arrhythmias and hallucinations so when you’re meeting somebody who’s testing positive for cocaine and they seem to be in the intoxicated state because they’re still euphoric you really do want to monitor them closely for an arrhythmia by checking an EKG you might monitor them closely for seizure disorder maybe even check an EEG and you want to screen them for psychiatric symptoms as well cocaine’s vasoconstrictive effects may result in a myocardial infarction or cerebrovascular accident so paying close attention to their cardiac system is very very important because cocaine use can actually lead to death through these things how long do you think the urine drug screen stays positive for cocaine after use the answer is three days so for a while and do you know any street names that are used for cocaine here are a few just to keep in mind the causes of death from cocaine use include a myocardial infarction cerebrovascular accident and also Mueller’s maneuver and what this is is a pneumothorax and it’s caused when a patient will exhale against a closed glottis thereby causing the pneumothorax here’s a question for you which of the following treatments here is for cocaine dependence so take a moment and look over these treatments and if you guess psychotherapy and group therapy you’re exactly right so the long-term treatment for a dependency problem is really going to be psychotherapy and support through peers however if you’re in the emergency room or an acute care setting and you encounter a patient who is intoxicated on cocaine they’re probably going to benefit from some of the following so because they’re overly excited and euphoric benzodiazepines might be helpful in the very short term to help calm them down they also we’re going to need some symptomatic support they’re gonna need to be hydrated you’re gonna have to check their vital signs always make sure their ABCs are under control and monitor them at on on an EKG for cardiac arrhythmia the patient is also going to respond positively to haloperidol which is an anti-psychotic and this can be used in the patient who’s having hallucinations during the period of intoxication especially if those hallucinations are at all dangerous such as command auditory hallucinations telling the patient to harm themselves or others and then eventually as the patient comes down from there intoxication they’re going to start to withdraw from the cocaine and they’re really going to experience what’s called a crash and this is going to look like hyper somnolence and the best thing you can do for your patient is really to let them sleep off that crash [Music]

2 thoughts on “Common Substance-Related Disorders – Psychiatry | Lecturio”

  1. Totally disagree with the first mentioned plant, with the correct portion its good for depression etc…What is really annoying that you doctors knows that too. You just said bad things about it…

Leave a Reply

Your email address will not be published. Required fields are marked *