Amphatamine Use Disorders
Dr. Mohammad Maqbool
ASST. PROFESSOR PSYCHIATRY
Government Medical College, Srinagar
A psychoactive drug is one that is capable of altering the
mental functioning
Four important patterns of use are;-
1. Acute Intoxitation: is a transient condition
following the administration of a psychoactive
substance resulting in disturbance in
- Levels of consciousness
- Cognition
- Perception
- Affect or behaviour
- and other psyco-physiological functions
2. Withdrawal Syndrome
• Characterized by a cluster of symptoms
• Often specific to the drug used
• Develop on total or partial withdrawl of drug
• Usually after repeated high dose and long term use.
3. Dependence
• At least three of the following present
• A strong desire to take the drug
• Difficulties in controlling substance taking behaviour
• A physiological state of withdrawal when the substance is
withdrawn characteristic withdrawal syndrome.
• Evidence of Tolerance: Increased dose is needed to
achieve effects originally produced by lower doses.
• Progressive neglect of alternate pleasures or interests.
• Persisting with substance use despite clear evidence
of harmful consequences e.g.
- Medical complications
- Depressed mood
- Social complications
4. Harmful Use
Characterized by
• Continued use despite awareness of medical/
social effect of the drug being used.
• A pattern of physically hazardous use of drug e.g.
driving during intoxication.
Etiological Factor (Causes)
1. Biological Factors
• Genetic vulnerability
• Co-morbid psychiatric disorders
• Co-morbid medical disorders
• Reinforcing effect of the drug continuation of drug
use.
• Withdrawal effects continuation of drug use.
• Biochemical factors Role of dopamine in the
reward pathway from ventral tegmental area to nucleus
accumbens.
2. Psychosocial Factors
• Curiosity: need for novelty seeking.
• Early initiation of smoking (gateway)
• Poor impulse control
• Sensation seeking
• Low self esteem
• Childhood trauma or loss
• Peer pressure
• Modeling
• Easy availability
• Poor social/family support
• Rapid urbanization
• Intra-familiar conflicts
Amphatamine 1st synthesized in 1887 by
Edlano and Garden Alles first described
to psycho-stimulant, autonomic and other
pharmacological effects.
Common preparations
• Methyl phenidate
• Dextro-amphytamine
• After oral administration effect usually occurs
within 30 minutes
• Mostly metabolized in liver
• Significant unchanged amphetamine urine
• Excretion increased by acification of urine.
Mechanism of Action
• Primarily increases release of norepinephrine,
dopamine and scrotum.
• Powerful CNS stimulant.
• Stimulation of reward pathway.
Effect on various organ systems:
B.P.
H.R.
• Cardiac arrhythmias.
• Relaxation of bronchial muscles.
• Constipation
• Painful micturation
• Increase in rate of body metabolism
and oxygen consumption.
• Increase in plasma free fatty acid.
• CNS stimulation.
• Increased wakefullness alertness
• Elevated mood
• Increased psychomotor activity
• Decreased sleep
• Suppression of appetite
• Weight loss
Patterns of Use
• Prescription for narcolapsy, ADHD etc addiction
• Intermittent use seen in
- Drivers
- Students dependence
- Athletes
• Induce euphoria by IV use dependence
• Street name Ecstasy
INTOXICATION
• ANS + • Tetany
• Tachycardia • Coma
• Hypertension • Anxiety
• Cardiac failure • Panic
• Cardiovascular shock • Insomnia
• Seizures • Restlessness
• Hyperpyrexia • Irritability
• Tremors • Hostility
• Ataxia • Bruxism
• Euphoria • Paranoid Illness
• Pupillary dilatation
• Disorientation and other similar symptoms
(amphetamine delirium).
• Tactile hallucinations (fornication) in clear
consciousness.
Withdrawal Syndrome
• Depression (suicidal)
• Asthenia
• Epathy
• Fatigue
• Hypersomnia alternating with insomnia
• Agitation
• Hyperphagia
• Lasts for 9 hours – 4 days
Common Pattern of Chronic Use
Runs Crashes
Cycle of runs (heavy use for several days)
followed by crashes (stopping the drug)
Treatment
1. Treatment of Intoxication
- Symptomatic measures
- Hyperpyrexia treated by cold spongying,
parenteral antipyretics.
- Seizures: Parenteral diazepam 5-10mg I/V
- Sympathetic over-activity: Prophenol I/V
- Psychosis: Haloperidol 5mg orally tid.
- Acidification of urine is done with NH4Cl for
rapid elimination of emphetamines if renal and
hepatic functions are normal 500mg/4 hrs.
2. Treatment of withdrawal
- Suicidal depression may need hospitalization,
antidepressants.
- Symptomatic management.
- Supportive Psychotherapy.
Prevention of drug addiction in general.
A) Individual Level
- be contended
- trust in God
- be helpful
B) Family Level:
- Help each other
- Give time to your children
- Be moderate towards children
- Do not ignore your children
- Do not give excess money
C) Community Level
• Seminars in schools, colleges
• Media, newspaper, radio, TV
• Friday preachers and religious leaders
• Burn uncultivated charas
• Do not get drugs without doctors prescription.
• Help people in distress
• Recreation like play, music etc.
D) Govt. Level
• Ban cultivation of opoids except for medicinal purposes.
• Strict – drug control
• Stop quacks from practising.
• Decrease syllabus of kids.
• Include hazards of drug abuse in syllabus.
• Help people in distress
• Stop atrocities
• Good psychiatric services at district levels and central
hospitals.
• De-addiction centres at all tertiary hospitals.
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