Clinical signs of intoxication and dependence
Each psychoactive substance causes specific changes in the body. For example, cocaine intoxication is typically characterized by insomnia and marked hypersexuality, while cannabinoid intoxication presents with facial skin flushing and increased appetite. Systematic tobacco smoking leads to nicotine dependence, the classic sign of which is morning cough.
Long-term consequences occupy a special place: regular use of volatile solvents leads to the development of the most pronounced encephalopathy compared to other psychoactive substances. In addition, patients with alcoholism eventually develop cross-tolerance to barbiturates.
Emergency conditions and psychomotor agitation
Acute conditions in psychiatric practice require emergency intervention to prevent fatal outcomes.
- Causes: acute psychoses, behavioral disorganization, severe organic lesions, and overdoses.
- Behavior during agitation: chaotic actions, attempts to hide from imaginary pursuers, aggression.
- Tactics: the physician must maintain absolute self-control, conduct a calm conversation, and strive for rapid hospitalization of the patient.
To manage pronounced agitation, antipsychotics are administered orally or by injection (in case of refusal of treatment). Blood pressure is always measured beforehand to rule out severe hypotension. If there are contraindications to antipsychotics, benzodiazepine tranquilizers are used.
Dependence dynamics and tolerance
The development of drug addiction and substance abuse is accompanied by a regular change in substance tolerance:
- Increased tolerance: at the initial stage, huge doses are required to achieve euphoria, and the protective vomiting reflex disappears.
- Decreased tolerance: at the end stage of the disease, the body loses its protective properties, but the patient continues to strive for previous doses, which sharply increases the risk of fatal poisoning.
During the withdrawal syndrome, the pathological craving for psychoactive substances becomes irresistible (compulsive), equal in strength to basic instincts like thirst or asphyxia.
Personality changes and encephalopathy
Chronic intoxication inevitably leads to profound social maladjustment and restructuring of values. Patients use various psychological defense mechanisms (rationalization, projection, dissociation) and suffer from anosognosia — a complete inability to critically assess the severity of their condition.
The final stage of the disease is an organic brain lesion or toxic encephalopathy. This psychoorganic syndrome manifests as gross memory impairments, including Korsakoff's amnestic syndrome, intellectual decline, dementia, and emotional lability.
Anosognosia (denial of illness), Factor of severe consequences (continued use despite everything), Tolerance exacerbation (dose increase), Irresistible craving during withdrawal.
Class and exam questions
What drugs are used to manage psychomotor agitation if antipsychotics are contraindicated?
In such cases, benzodiazepine tranquilizers are used, for example, diazepam, phenazepam, lorazepam, or nitrazepam.
What is the difference between the two phases of changes in psychoactive substance tolerance?
In the first phase, tolerance increases—increasingly larger doses are required for euphoria, and the protective vomiting reflex disappears. In the second phase, tolerance drops due to organic brain damage, but the patient still strives to take a high dose, which threatens fatal poisoning.
What is the main diagnostic sign of a substance use disorder highlighted in the material?
The main diagnostic sign is considered to be the patient's continued use of psychoactive substances despite obvious severe consequences for their health and social status.
What else to study on this topic
- Specifics of intensive care units in psychiatric hospitals
- Mechanisms of psychological defense in alcoholism and drug addiction
- Cross-tolerance and GABAergic drugs
- Features of treating alcoholic liver disease against the background of withdrawal syndrome
- Clinical manifestations of Wernicke-Korsakoff encephalopathy
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Other topics in «Chapter 21. Disorders due to use of alcohol and other psychoactive substances»
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