What are Mental and Behavioral Disorders Due to Opioid Use?
Opioids are the most common drugs after cannabioids. Patients in this group are characterized by antisocial behavior and antisocial traits in premorbid.
Causes of Mental and Behavioral Disorders Due to Opioid Use
The opioid group includes drug dependence of the opium group, which include morphine, codeine, as natural poppy products, and opiate-like compounds: methadone, heroin, fentanyl. There are three types of opiate receptors: mu, kappa and delta. Morphine binding is associated with mu receptors in the rostroventral nucleus, thalamus, and hind horn of the spinal cord. The mu receptor is involved in the development of euphoria, miosis and respiratory depression. Other opiate receptors are bound by enkephalins and other opiate synthetic compounds. Possibly drug addiction is associated with a genetically determined level of receptors. A marker of receptor level is affective instability, and probably the desire for antisociality.
Symptoms of Mental and Behavioral Disorders from Opioid Use
Acute intoxication
It is characterized by analgesia and euphoria, the pupils are narrowed (pinpoint, with a pinhead), suppression of the cough reflex, respiratory depression and peristalsis, decreased libido, bradycardia and hypotension.
Harmful use and dependence syndrome
Dependency syndrome, peripheral neuropathy, myelopathy are formed, tactile sensitivity, unstable mood swings are reduced. An increase in the frequency of respiratory diseases, nausea and vomiting, nephropathy and menstruation are very persistent symptoms of withdrawal. Personality change with a tendency to asociality, an egocentric desire for drugs.
Withdrawal syndrome
Anxiety and fear of withdrawal, longing for a drug. Sweating, nasal congestion and runny nose, constant yawning, lacrimation, dilated pupils, stomach cramps, tremors and muscle pains, diarrhea, fever, chills and headache, increased blood pressure and tachycardia. With prolonged (several months) withdrawal symptoms – hypotension and insomnia, bradycardia and passivity, decreased appetite, craving for a drug.
Psychotic disorder
In the period of abstinence, the development of paranoid disorders with the ideas of persecution and schizophrenic psychoses, as well as deep depressive states, is possible.
Amnestic syndrome
Amnestic disorders occur in the form of episodes of retro-anterograde amnesia.
Residual state and psychotic disorder with delayed debut.
With prolonged withdrawal for more than 6 months. hypotension and insomnia, bradycardia and passivity, decreased appetite, craving for a drug are noted. During this period, a recurrence of episodes of paranoid disorder is possible.
Diagnosing Mental and Behavioral Disorders Due to Opioid Use
It is based on the detection of opioids in plasma and urine, anamnesis, a typical picture of opioid intoxication, as well as the reaction to the administration of a test dose of naloxone, which, when administered in a dose of 0.2-0.4 mg, changes (often stops) the withdrawal syndrome .
Differential diagnosis
Differentiates with other forms of mental and behavioral disorders due to the use of psychoactive substances.
Treatment for Mental and Behavioral Disorders Due to Opioid Use
Therapy for acute opiate overdose includes the use of naloxone (0.01 mg per kg of body weight) or antaxone. Detoxification methods using hemosorption, hemodialysis, iv iv novocaine and benzodiazepines are used. Specific therapies include methadone as the primary therapy for detoxification, and during rehabilitation as supportive therapy, treatment with clonidine during detoxification, as well as therapy with naloxone and naltrexone or buprenorphine as a partial agnost of opiates. There is also experience in eliminating oxytocin from intoxication at a dose of up to 2.0 IM per day. Long and persistent group and individual psychotherapy and rehabilitation in specialized centers are also required.