Chapter 21. Disorders Due to Alcohol and Other Psychoactive Substance Use
15 concise topics with breakdowns: definitions, key facts, and class questions.
This chapter covers the fundamentals of addictology and the mechanisms underlying psychoactive substance (PAS) dependence. We will examine the entire spectrum of disorders—from pathological craving and withdrawal to severe alcohol-induced psychoses.
The material covers the clinical presentation, diagnosis, and treatment of alcoholism, as well as specific types of substance use disorders: opioid, cannabinoid, cocaine, psychostimulant, hallucinogen, sedative and hypnotic dependence, and volatile solvent abuse. The basic principles of addiction therapy are also discussed separately.
In tests and real clinical practice, the most frequently tested topics include algorithms for managing alcohol delirium («delirium tremens») and severe withdrawal syndrome, as well as the differential diagnosis of acute intoxication by various groups of psychoactive substances. Knowledge of these conditions is critical for physicians of any specialty, as such patients are regularly admitted to somatic hospitals.
This is a historical theory (B. Morel) according to which mental illnesses and behavioral disorders are caused by the accumulation of «bad qualities» in offspring.
What is cross-tolerance in alcoholism?
This is an increase in resistance to other substances with a similar mechanism of action. In patients with alcoholism, tolerance to all GABAergic agents increases: benzodiazepines, barbiturates, and general anesthetics.
How to distinguish withdrawal syndrome from intoxication in a healthy person?
In a healthy person, alcohol poisoning causes an aversion to alcohol. In withdrawal syndrome, alcohol is perceived as the only source of salvation, and an irresistible compulsive craving for it develops.
Can alcohol delirium occur in the first stage of alcoholism?
No, in stage I the conditions for the development of psychoses are absent. Delirium occurs only in the presence of severe withdrawal syndrome, which is characteristic of stage II.
Does delirium tremens occur during severe intoxication?
No. Delirium is an alcohol-induced psychosis. It starts during the recovery from severe intoxication, when ethanol intake stops and withdrawal syndrome develops.
How to distinguish alcohol hallucinosis from delirium?
The main difference is the state of consciousness. In hallucinosis, consciousness remains clear, the patient is fully oriented to the environment, but hears true voices. In delirium, consciousness is clouded, with massive disorientation and suggestibility.
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