PATHOPHYSIOLOGY Mental Illness and Cognitive Disorders ProjectMrs. Bowman

Student Name: Nemmer R. MiariApril 7th, 2015

Etiology Although addiction usually (but not always)

begins with a conscious decision to use a drug, changes that occur in the brain at some point can turn drug use and then abuse into a chronic, relapsing illness.

Some genetically predisposed individuals, however, become "addicted" almost immediately, with very little progression from use to abuse to dependency.

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Common Signs and Symptoms of Drug Abuse You’re neglecting your responsibilities at school,

work, or home (e.g. flunking classes, skipping work, neglecting your children) because of your drug use.

You’re using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex.

Your drug use is getting you into legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit. 

Your drug use is causing problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of old friends.

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Common Signs and Symptoms of Drug Addiction You’ve built up a drug tolerance. You need to use more of the drug

to experience the same effects you used to attain with smaller amounts.

You take drugs to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.

You’ve lost control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using, but you feel powerless.

Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.

You’ve abandoned activities you used to enjoy, such as hobbies, sports, and socializing.

You continue to use drugs, despite knowing it’s hurting you. It’s causing major problems in your life—blackouts, infections, mood swings, depression, paranoia—but you use them anyway.

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Diagnosis Methods

Some speculate that two events must occur for the addictive process to be initiated. First, there is an activation of the brain's "pleasure pathway." This occurs in the medial forebrain bundle, which runs from the brain stem and midbrain through the hypothalamus to a variety of sites in the forebrain that are concerned with emotion, motivation, reward, and decision-making.

Dopamine is the transmitter that ascends to the subcortical and cortical structures of the limbic system (in the forebrain). Dopamine's role seems to be to provide steady (tonic) regulation of the activity of the nerve cells in the limbic system.

When levels of dopamine rise significantly beyond physiologic levels (as with cocaine or amphetamine exposure), the entire medial forebrain bundle system linking dopamine-containing cell bodies with many regions of the forebrain may begin to function aberrantly.

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Diagnosis Methods – Cont. Second, for the addictive response to be initiated, the neural

response to the drug exposure must have a rapid onset and must also rebound below the initial baseline of neural activity before returning to it. For example, in the case of inhaled cocaine, the drug blocks the transport of dopamine back into the nerve terminal, thereby elevating dopamine levels greatly. Dopamine levels rise rapidly to a peak that is typically several-fold greater than that achievable through physiologic stimulation (emotion, exercise) alone.

Next, dopamine levels fall rapidly and drop below the normal baseline before returning to stable values. When exposure to cocaine is repeated, the brain adapts to these drug-induced effects.

Two adaptations are of particular relevance to addiction: sensitization, an increased nerve cell response to repeated drug exposure; and learning, a reflection of enduring changes in the emotional brain as a direct result of aspects of the drug exposure that resemble other types of conditioned behavior. 6

Abuse vs. Dependency

There are important differences between abuse of and dependency on a drug.

Drug abuse refers to the intentional misuse or overuse of drugs. Drug abusers maintain control over their behavior. They do not have a medical disease; they have a self-imposed problem.

Drug dependency involves "impaired control" over use of the drug (this applies to all substances except certain mood-altering drugs that do not have a major effect on the medial forebrain bundle), which refers to an obsessive preoccupation with the use of the drug.

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Expected Lifespan

The majority of long-term, hard-core drug addicts are dying in their 40s and 50s.

The life expectancy of a drug addict is 15 to 20 years after they start being a drug addict.

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Effective Treatment Approaches Medication and behavioral therapy, especially when

combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention.

Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components.

A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community–or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug–free lifestyle.

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DRUGSDRUGS

BRAIN MECHANISMS

BRAIN MECHANISMS

ADDICTIONADDICTION

ENVIRONMENTENVIRONMENT

HISTORYHISTORY- previous history- expectation- learning

- previous history- expectation- learning

- social interactions- stress- conditioned stimuli

- social interactions- stress- conditioned stimuli

- genetics- circadian rhythms- disease states- gender

- genetics- circadian rhythms- disease states- gender

BIOLOGYBIOLOGY

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And One of the Most PowerfulTriggers for Relapse

In Recovering Addicts

And One of the Most PowerfulTriggers for Relapse

In Recovering Addicts

Research Tells Us That STRESS Can Be A Major Factor In the

Initiation of Drug Use…

Research Tells Us That STRESS Can Be A Major Factor In the

Initiation of Drug Use…

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Stress and Drug Addiction

Research Has Also Shown That There IsOverlap Between Neuro-circuits That

Respond To Drugs and Those ThatRespond To Stress

Research Has Also Shown That There IsOverlap Between Neuro-circuits That

Respond To Drugs and Those ThatRespond To Stress

Piazza PV and Le Moal, M, Trends in Pharmacological Science, 19, February 1998;Piazza PV and Le Moal, M, Trends in Pharmacological Science, 19, February 1998;

Kreek, MJ and Koob, G, Drug Alcohol Depend, 51, 1998.Kreek, MJ and Koob, G, Drug Alcohol Depend, 51, 1998.

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Stress and Drug Addiction – Cont.

The Stress Hormone CycleThe Stress Hormone Cycle

HypothalamusHypothalamus

PituitaryGland

PituitaryGland

AdrenalGlands

AdrenalGlands

KidneysKidneys

CRFCRF

ACTHACTHCORTISOLCORTISOL

Stress ResponsesStress Responses

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DRUG USEDRUG USE(Self-Medication)(Self-Medication)DRUG USEDRUG USE

(Self-Medication)(Self-Medication)

STRESSSTRESSSTRESSSTRESS

CRFCRFCRFCRF

AnxietyAnxietyAnxietyAnxiety

CRFCRFCRFCRF

AnxietyAnxietyAnxietyAnxiety

What Role Does Stress Play In

Initiating Drug Use?

What Role Does Stress Play In

Initiating Drug Use?

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ProlongedProlongedDRUGDRUGUSEUSE

ProlongedProlongedDRUGDRUGUSEUSE

AbstinenceAbstinenceAbstinenceAbstinence

RELAPSERELAPSERELAPSERELAPSE

CRFCRFCRFCRF

AnxietyAnxietyAnxietyAnxiety

What Happens WhenA Person StopsTaking A Drug?

What Happens WhenA Person StopsTaking A Drug?

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What Do Mental and AddictiveDisorders Have in Common?

What Do Mental and AddictiveDisorders Have in Common?

Both are Behavioral DysfunctionsWith Similar Neurobiological Basis

Because of this overlap, drugs of abuse can cause symptoms that mimic

most forms of mental illness

Both are Behavioral DysfunctionsWith Similar Neurobiological Basis

Because of this overlap, drugs of abuse can cause symptoms that mimic

most forms of mental illness 16

Addictive DisorderAddictive Disorder

Mental DisorderMental Disorder

Addictive DisordersAddictive DisordersOften Often Co-ExistCo-Exist With With

Mental DisordersMental Disorders

Addictive DisordersAddictive DisordersOften Often Co-ExistCo-Exist With With

Mental DisordersMental Disorders

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Examples of Dual Disorders

MENTAL DISORDERS Schizophrenia

Bi-polar

Schizoaffective

Major Depression

Borderline Personality

Post Traumatic Stress

Social Phobia

Others

ADDICTION DISORDERS Alcohol Abuse/Dependency

Cocaine/ Amphetamine

Opiates

Marijuana

Poly-substance combinations

Prescription drugs

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Drug DisorderCocaine and MethamphetamineCocaine and Methamphetamine Schizophrenia, paranoia,

anhedonia, compulsivebehavior

Schizophrenia, paranoia,anhedonia, compulsivebehavior

StimulantsStimulants Anxiety, panic attacks, mania and sleep disordersAnxiety, panic attacks, mania and sleep disorders

LSD, Ecstasy & psychedelicsLSD, Ecstasy & psychedelics Delusions and hallucinationsDelusions and hallucinations

Alcohol, sedatives, sleep-aids and narcoticsAlcohol, sedatives, sleep-aids and narcotics

Depression and mood disturbancesDepression and mood disturbances

PCP & KetaminePCP & Ketamine Antisocial behaviorAntisocial behavior19

• Nearly half of individuals Nearly half of individuals with a past year substance with a past year substance use disorder also had a use disorder also had a mental disordermental disorder

• Mental disorders found to Mental disorders found to be most prevalent included be most prevalent included affective disorders, anxiety affective disorders, anxiety disorders, personality disorders, personality disorders, and psychotic disorders, and psychotic disordersdisorders

• Nearly half of individuals Nearly half of individuals with a past year substance with a past year substance use disorder also had a use disorder also had a mental disordermental disorder

• Mental disorders found to Mental disorders found to be most prevalent included be most prevalent included affective disorders, anxiety affective disorders, anxiety disorders, personality disorders, personality disorders, and psychotic disorders, and psychotic disordersdisorders

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Long-Term Effects

Lifetime Prevalence of Drug Disorders AmongPersons With Various Mental Disorders

(vs. any Drug Disorder Alone)

Lifetime Prevalence of Drug Disorders AmongPersons With Various Mental Disorders

(vs. any Drug Disorder Alone)

Source: Regier,D.A. et al., JAMA 264(19), pp. 2511-2518, November 21, 1990.Source: Regier,D.A. et al., JAMA 264(19), pp. 2511-2518, November 21, 1990.

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5

10

15

20

25

30

35

40

45

Schizo-phreniaSchizo-phrenia APDAPD

AnxietyAnxietyPanic

DisorderPanic

Disorder

OCDOCDBipolar

DisorderBipolar

Disorder

DepressionDepressionAny DrugDisorder(alone)

Any DrugDisorder(alone) 21

Some drugs of abuse have a mechanism of action similar to

that of drugs used as psychotherapeutic agents.

Significance: rationale forself-administration

Chronic use of some of these drugs may alter the way the brain

functions,making persons particularlysusceptible to mental illness

Some drugs of abuse have a mechanism of action similar to

that of drugs used as psychotherapeutic agents.

Significance: rationale forself-administration

Chronic use of some of these drugs may alter the way the brain

functions,making persons particularlysusceptible to mental illness

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Drug Abuse

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Works Cited1. http://www.helpguide.org/articles/addiction/drug-abuse-a

nd-addiction.htm

2. http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/definition/con-20020970

3. http://www.webmd.com/mental-health/addiction/drug-abuse-addiction

4. https://ncadd.org/learn-about-drugs/signs-and-symptoms

5. http://www.medicinenet.com/drug_abuse/page2.htm

6. http://www.thefix.com/content/10-hardest-addictive-drugs-to-kick7055

7. http://en.wikipedia.org/wiki/Substance_dependence

8. http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

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