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JOURNAL READING

Oleh :
Hanifiyah Nabela (201710401011050)
Pembimbing :
dr.Iwan Sys Indrawanto, Sp.KJ

SMF ILMU KEDOKTERAN JIWA


FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG

2018
Amphetamine-Related
Psychiatric
Disorders
Updated: Sep 12, 2017
Author: Amy Barnhorst, MD; Chief Editor: Glen L
Xiong, MD
Background
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes the
following 11 amphetaminerelated psychiatric disorders:

1 Amphetamine-induced anxiety disorder

2 Amphetamine-induced bipolar disorder

3 Amphetamine-induced depressive disorder

4 Amphetamine-induced psychotic disorder

5 Amphetamine-induced sexual dysfunction


Background
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes the
amphetaminerelated psychiatric disorders:

6. Amphetamine-induced sleep disorder

7 Amphetamine intoxication

8 Amphetamine intoxication delirium

9 Amphetamine withdrawal

1 Amphetamine-induced obsessive-compulsive and related disorder and


0 Unspecified stimulant-related disorder
Background
Either prescription or illegally
manufactured amphetamines can induce
01
these disorders.
A typical dose is 2.5-40 mg/d
02

Amphetamine-related psychiatric disorders are CONTENTS


conditions resulting from intoxication or long- TITLE
03 term use of amphetamines or amphetamine
derivatives.

04 The symptoms of amphetamine-induced


psychiatric disorders can be
differentiated from those of related
primary psychiatric disorders by time
Background Amphetamine-induced psychosis (delusions
and hallucinations) can be differentiated
from psychotic disorders when symptoms
resolve after amphetamines are
discontinued
Mood disorders similar to hypomania and
mania can be elicited during intoxication
with amphetamines.
Depression can occur during withdrawal, and
repeated use of amphetamines can
produce antidepressant-resistant
amphetamine-induced depression.
Pathophysiology

Your Content Here

In general, chronic amphetamine


abuse may cause psychiatric
symptoms due to inhibition of the
dopamine transporter in the
striatum and nucleus accumbens.
Epidemiology

Amphetamine-related Amphetamine-related
The Drug Abuse Warning
psychiatric disorders most psychiatric disorders
Network (DAWN) data
commonly occur in white most frequently occur
indicated that 26% of all
United States --> 2013 -->144.000 individuals. in people aged 20-39
drug-related deaths in
people years
Oklahoma City
.

Adolescents have developed a


method for abusing prescription
amphetamines in which
prescription tablets are crushed
into a powder and inhaled nasally.
History
Psychiatric history
● Two issues are emphasized:
● Determine whether a psychiatric disorder or symptoms ever
occurred when the patient was not exposed to amphetamines.
● Determine whether the patient ever had a psychiatric disorder or
symptoms similar to the present symptoms in relation to any
other drug or medication.
Recent history
★ The patient's history of amphetamine abuse is the most
important factor and is determined by asking the following
questions:
★ When did the patient's amphetamine use start?
★ How often does the patient use amphetamines?
★ How much does he or she use?
★ Is the patient currently intoxicated or in withdrawal from
amphetamines?
★ Does the patient frequently attend rave parties?
★ Has the patient recently increased his or her amphetamine use or
started to binge?
Substance abuse history
❖ Potentially abused substances include the following:
❖ Alcohol
❖ Marijuana
❖ Cocaine
❖ Lysergic acid diethylamide (LSD)
❖ OTC sympathomimetics
❖ Steroids
Family history
● A family history of a psychiatric disorder may suggest a primary
psychiatric disorder. A diagnosis of amphetamine-related
psychiatric disorder might still be possible if the patient has no
family history of psychiatric disorder
DSM criteria The DSM-5 criteria for C. Two (or more) of the following signs or
stimulant intoxication are symptoms, developing during, or shortly
for after, stimulant use:
intoxication as follows: ● Tachycardia or bradycardia
A. Recent ues of an ● Pupillary dilatation
and ● Elevated or lowered blood pressure
amphetamine-type
withdrawal substance, cocaine or ● Perspiration or chills
● Nausea or vomiting
other stimulant. ● Evidence of weight loss
B. Clinically significant ● Psychomotor agitation or retardation
● Muscular weakness, respiratory
problematic behavioral or depression, chest pain, or cardiac
psychological changes arrhythmias
that develop during, or ● Confusion, seizures, dyskinesias,
dystonias, or coma
shortly after, use of a The signs or symptoms are not attributable
stimulant. to another medical condition, and are
not better explained by another mental
disorder, including intoxication with
another substance.
The DSM-5 criteria for stimulant withdrawal are as follows:
A. Cessation of (or reduction in) prolonged amphetamine-type substance,
cocaine, or other stimulant use.
B. Dysphoric mood and two (or more) of the following physiologic changes
developing within a few hours to several days after Criterion A:
● Fatigue
● Vivid, unpleasant dreams
● Insomnia or hypersomnia
● Increased appetite
● Psychomotor retardation or agitation
● The signs or symptoms in Criterion B cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
● The signs or symptoms are not attributable to another general medical
condition, and are not better explained by another mental disorder,
including intoxication or withdrawal from another substance.
a mental status expected for a
physical patient with amphetamine


Mood: Anxious, hypomanic
Affect: Anxious and tense
intoxication is as follows: ● Insight and judgment: Poor
● Orientation: Alert to person,
● Appearance and behavior: place, and purpose; perspective
Unusually friendly, scattered of time is disorganized.
eye contact, buccal oral
gyrations, excoriations on
extremitie and face from
picking at skin, overly talkative
and verbally intrusive
● Speech: Increased rate
● Thought process: Tangential,
circumstantial over inclusive
and disinhibited
● Thought content: Paranoid; no
suicidal or homicidal thoughts
A mental status expected for a patient with amphetamine
psychosis is as follows:
● Appearance and behavior: Disheveled, suspicious, paranoid,
difficult to engage, and poor eye contact
● Speech: Decreased and rapid
● Thought process: Guarded and internally preoccupied
● Thought content: Paranoid; possible auditory hallucinations; no
suicidal or homicidal thoughts
● Mood: Anxious
● Affect: Paranoid and fearful
A mental status for a patient withdrawing form amphetamines is as
follows:
● Appearance and behavior: Disheveled, psychomotor slowing, poor eye
contact, pale appearance to skin
● Speech: Decreased tone and volume
● Thought processes: Decreased content, guarded
● Thought content: No auditory, visual hallucinations; suicidal thoughts
present, but no homicidal thoughts
● Mood: depressed
● Affect: Flat and withdrawn
● Insight and judgment: Poor
● Orientation: Oriented to person, place, and purpose
Causes
Causes may include the following:
● Amphetamine intoxication, binge pattern use, and long-term exposure
● Comorbid psychiatric disorders, such as depression, psychotic disorders, and
anxiety disorders
● Abuse of other substances such as alcohol, OTC sympathomimetics, and illicit
drugs
● Dehydration, which can result in electrolyte imbalances and renal failure
● Potential for serotonin syndrome in those prescribed serotonin reuptake
inhibitors or serotonin norepinephrine reuptake inhibitors
Differential Diagnoses
Cannabis-Related Disorders
Cocaine-Related Psychiatric Disorders
Delirium
Depression
Hallucinogen Use
Hyperthyroidism and Thyrotoxicosis
Hypothyroidism
Inhalant-Related Psychiatric Disorders
Insomnia
Laboratory Studies
Finger-stick blood glucose test
CBC determination
Determination of electrolyte levels, including magnesium, amylase,
albumin, total protein, uric acid, BUN, alkalin phosphatase, and
bilirubin levels
Urinalysis
Stat urine or serum toxicology
Imaging Studies
Other Tests :
ECG to evaluate for cardiac involvement.
Histologic Findings
Treatment
● Medical Care
● Consultations --> Consultations with a neurologist, internal
medicine specialist, psychiatrist, or social services may prove
helpful.
● Activity --> Patients intoxicated with amphetamines are
dangerous, and their activity should be limited (eg, no driving)
until their symptoms
Medication
● Antipsychotics --> Thiothixene (Navane), Benzodiazepines,
Lorazepam (Ativan), Chlordiazepoxide (Librium, Libritabs, Mitran)
● Opiate antagonists--> Naloxone (Narcan)
● Beta-blockers --> Propranolol
● Expectorants --> Ammonium chloride (Quelidrine)
● Adsorbents --> Activated charcoal suspension (Actidose-aqua,
Inst-Aqua, Liquid-Cha
Follow-up
● Further Outpatient Care --> Psychiatric follow-up care should
occur within, at most, 2 weeks of the initial evaluation to ensure
compliance.
● Further Inpatient Care
● Inpatient & Outpatient Medications --> If anxiety persists longer
than 2 weeks, consider the use of nonbenzodiazepine drugs
● Transfer --> If psychiatric conditions persist, causing social and
occupational impairment, inpatient treatment may be required.
Medical or neurologic complications require treatment in an
inpatient medical or neurologic unit.
Complications
Complications include an increased risk of the following:
1. Psychosis
2. Depression
3. Anxiety disorder
4. Sleep disturbance
5. Memory impairment
6. Medical complications
7. Neurologic complications
8. Abuse of another or several substances
9. Psychosocial impairment
Patient Education
● The family must be educated about the patient's addiction and its dangers.
● Refer the patient for psychosocial counseling.
● Hospitalize the patient if he or she is suicidal or homicidal.
● Refer the patient for substance abuse counseling.
● Helpful Web sites include the following
● Crystal Meth Anonymous
● National Institute on Drug Abuse, Methamphetamine Abuse and Addiction
● NIDA InfoFacts: Stimulant ADHD Medications - Methylphenidate and
Amphetamines
Thank you
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