Psychiatry - Drugs

USE: analgesia, euphoria

SIDE EFFECTS: nausea, vomiting, constipation, drowsiness, anorexia, lowered libido, apathy, slurred speech

DEPENDENCE: small pinpoint pupils, malaise, venepuncture marks,erectile dysfunction, tremor

WITHDRAWAL: intense craving, nausea, vomiting, muscle and joint aches and pains, lacrimation, rhinorrhoea, dilated pupils, sweating, pyrexia, restlessness, insomnia, tachycardia

TREATMENT: chlormethiazole/benzodiazepine during detox, methadone for heroin

USE: relaxation, euphoria, marked psychological dependence

SIDE EFFECTS: conjunctival injection, dry mouth, cough, tachycardia, increased appetite, suspiciousness, feeling of slowed time

SERIOUS SIDE EFFECTS: impaired judgement, persecutory hallucinations, depersonalisation, derealisation

USE: local anaesthetic, strong psychological dependence, euphoria

SIDE EFFECTS: tachycardia, dilated pupils, raised BP, sweating, nausea, vomiting, behavioural changes (grandiosity, agitation, impairment of judgement, social and occupational functioning)

HIGH DOSES: increased sexual interest, delusional disorder

WITHDRAWAL: dysphoric mood, craving for more cocaine, anxiety, irritability, fatigue, insomnia, paranoid and suicidal thoughts

TREATMENT: CBT, support groups, counselling

USE: dexamfetamine use in treatment of narcolepsy and in hyperkinesis in children, physical and psychological dependene

SIDE EFFECTS: euphoria, excitement, increased confidence, increased energy and drive, reduced need for sleep, tachycardia, dilated pupils, hypertension

HIGH DOSES: sweating, nausea, vomiting, grandiosity, hypervigilance, agitation, impaired judgement, social and occupational functioning, illusions, hallucinations, delusional disorder, cardiac arrhythmias, paranoid psychosis

WITHDRAWAL: cravings, dysphoric mood, fatigue, insomnia, hypersomnia, agitation, excessive hunger, shaking, seizures, arrhythmias, suicidal ideation, psychosis

TREATMENT: symptom control, CBT, counselling, support groups

USE: diazepam (valium), hypnotics, physical dependence occurs quickly, chronic use can cause amnesic syndrome

SIDE EFFECTS: slurred speech, incoordination, unsteady gait, impaired attention and memory, paradoxical increased aggression, disinhibition, mood lability, impaired judgement, social and occupational functioning

WITHDRAWAL: nausea, vomiting, malaise, weakness, tachycardia, sweating, anxiety, irritability, orthostatic hypotension, tremor, insomnia, grand mal fits, tinnitis, anorexia, hallucinations, delusions, agitation, delirium

TREATMENT: medically supervised detoxification, CBT, group therapy

DRUGS: LSD, DMT, magic mushrooms, PCP (phencyclidine), ketamine, MDMA

SIDE EFFECTS: dilated pupils, tachycardia, palpitations, sweating blurred vision, incoordination, tremor, perceptual abnormalities, hallucinations, depersonalisation, derealisation, illusions, synaesthesia

HIGH DOSES: anxiety, depression, suicidal ideation, ideas of reference, fear of going mad, paranoid thoughts, impaired judgement, social and occupational functioning

FLASHBACKS: re-experiencing perceptual changes that occurred whilst intoxicated, may occur for years, leads to distress, panic disorder, depression, suicide

LSD - lasts 6 hours, sense of detachment, visual distortions, misperceptions, harm comes from 'bad trips' causing behavioural toxicity and flashbacks
PCP - confusion, visual sensory distortions, aggression, sudden violence (opioid & aspartate receptors)
Mushrooms - not associated with dependence or withdrawal, harm comes from 'bad trips'
Ketamine - synaesthesia, ataxia, slurred speech, psychosis, amnesic syndrome

USE: euphoria, stimulant

SIDE EFFECTS: increased sweating, nausea, vomiting, diminished potency, dehydration, hyperthermia, neurotoxic, hepatotoxic, chronic cognitive impairment,

OVERDOSE: extreme nausea, panic, anxiety, inability to sweat or urinate, loss of consciousness, arrhythmias, confusion, muscle cramps, death due to hyperthermia

WITHDRAWAL: fatigue/anorexia/depressed mood last for 24-48 hours, panic attacks, depersonalisation, derealisation, insomina

TREATMENT: symptom management

USE: adhesives, petrol, butane gas, paint, paint thinner, cleaning agents

SIDE EFFECTS: euphoria, disinhibition, slurred speech, blurred vision, visual misperceptions

HIGH DOSES: local irritation, headache, cardiac arrhythmias, unconsciousness, aspiration, sudden death (direct toxicity or inhalation of gastric contents)

CHRONIC USE: liver and kidney damage, impaired memory and concentration, cognitive impairment, withdrawal similar to alcohol withdrawal

TREATMENT: CBT, group support, counselling

SIDE EFFECTS: boastfullness, embarrassing speech, offensiveness, reduced inhibition, labile mood, slurred speech, unsteady gait, nystagmus, erectile dysfunction, blackouts, increased risk of suicide, nausea, vomiting, gastritis, peptic ulcer, Mallory-Weiss tear

CHRONIC USE: loss of libido, loss of body hair, gynaecomastia, delusional jealousy, hepatic damage, pancreatitis, hypertension, arrhythmias, iron deficiency anaemia, vitamin K deficiency

KORSAKOV'S SYNDROME: chronic, thiamine deficiency, amnesic syndrome, impairment of recent and remote memory with preservation of immediate recall, confabulation

WERNICKE'S ENCEPHALOPATHY: acute, severe thiamine deficiency, acute confusion, gait ataxia, nystagmus, clouding of consciousness GIVE PABRINEX (thiamine)

DEPENDENCE TREATMENT: disulfiram (antabuse - ingestion of alcohol causes N&V)

WITHDRAWAL TREATMENT: thiamine, chlordiazepoxide (benzodiazepine), diazepam for withdrawal fits, phenothiazines for hallucinosis, zopiclone for insomnia, midazolem for seizures