Date post: | 10-Feb-2017 |
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MANAGEMENT OF SUBSTANCE RELATED
PSYCHIATRIC DISORDERSEDATIVE, HYPNOTIC AND ANXIOLYTIC DRUGS AND
INHALANTS
SEDATIVE, HYPNOTIC AND ANXIOLYTIC
3 groups of drugs associated with this class of substance-related disordersBenzodiazepines (diazepam, flurazepam, oxazepam)Barbiturates (secobarbital, pentobarbital, secobarbital-
amobarbital combination)Barbiturate-like substances (methqualone, meprobamate)
Can be used as antiepileptic, muscle relaxants, and anaesthetics
Associated with physical and psychological dependence also withdrawal symptoms
EPIDEMIOLOGY
• About 6% of individuals have used either sedatives or tranquilizers illicitly
• Highest prevalence was 26- to 34- years of age• Slight male predominance• About one quarter to one third of all substance-related
emergency room visits involve substances of this class
ROUTES OF ADMINISTRATION
• Oral Occasionally to achieve a time-limited specific effect
(young people) Regularly to obtain a constant usually, mild intoxication
(middle age people)• Intravenous
Young people intimately involved with illegal substances Highly associated with rapid and profound tolerance,
dependence and a severe withdrawal syndrome
MANAGEMENT OVERDOSE
• Gastric lavage• Activated charcoal• Careful monitoring of vital signs, CNS activity• Benzodiazepine antagonist: Flumazenil
INHALANT DRUGS
Are volatile hydrocarbon that are inhaled for psychotropic effects. Eg : Toluene, n-hexane, methyl butyl ketone, tricholoroethylene,
trichloroethane, dichloromethane, gasoline, butane. Sold in 4 commercial classes:
o Solvents for glue & adhesiveso Propellants for aerosol paint sprays, hair sprays, frying pan sprays,
shaving creamo Thinners (paint products, typing correction fluids)o Fuels
• Symptoms of mild intoxication similar to intoxication with alcohol or sedative-hypnotics
• Possible toxic effects: - Brain damage - Liver damage- BM depression - Peripheral neuropathies- Immunosuppression
Psychological effects Physical effectsEuphoria Ataxia
Belligerence ConfusionAssaultiveness Disorientation
Impaired judgment Slurred speechImpulsiveness Dizziness
Depressed reflexesNystagmus
• Withdrawal rarely developed • Characterized by:
IrritabilitySleep disturbancesJittersSweatsNausea, vomitingTachycardiaHallucination & delusion (sometimes)
MANAGEMENT
• According to bio psycho-social & spiritual modelInvestigations
Biology Psychosocial
Get information from family members
REFERENCES
• Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry, 5th Edition
• Kaplan & Sadock’s Synopsis of Clinical Psychiatry, 10th Edition