Mental Disorder due to Heroin

ALDILASANI FIRDHAUSAHADI
2015 1040 1011 053

DEFINITION
Opioids are a class of drugs that include both natural and
synthetic substances.
-The natural opioids (referred to as opiates) include opium and
morphine.
- Heroin, the most abused opioid, is synthesized from opium.
Other synthetics (only made in laboratories) and commonly
prescribed for pain, such as cough suppressants, or as antidiarrhea agents, include codeine, oxycodone (OxyContin),
meperidine (Demerol), fentanyl (Sublimaze), hydromorphone
(Dilaudid), methadone and propoxyphene (Darvon).
Heroin is usually injected, either intravenously (into a vein) or
subcutaneously (under the skin), but can be smoked or used
intranasally (i.e., "snorted"). Other opioids are either injected
or taken orally.

Causes
There are no clear-cut causes of drug use

other than the initial choice to use the

drug. This decision to use may be highly
influenced by peer group.
For instance, many heroin users come from
families in which one or more family
members use alcohol or drugs excessively
or have mental disorders (such as
antisocial personality disorder ), behavioral
problems beginning in childhood, low selfconfidence and anti-authoritarian views.

a "heroin behavior syndrome" has

sometimes been described. This syndrome

consists of depression (often with anxiety
symptoms), impulsiveness, fear of failure,
low self-esteem, low frustration tolerance,
limited coping skills, and relationships
based primarily on mutual drug use.

Demographics
Males

are more commonly affected by

opioid disorders than femalesmales are
three to four times more likely to be
dependent on opioids. There is a tendency
for rates of dependence to decrease
beginning at 40 years of age and usually
first seen in the teens and 20s.

Symptoms

OPIOID DEPENDENCE.
TheDSM-IV-TRspecifies that three or more of the following symptoms
must occur at any time during a 12-month period (and cause significant
impairment or distress) in order to meet diagnostic criteria for opioid
dependence:
- Tolerance: The individual either has to use increasingly higher amounts of
the drug over time in order to achieve the same drug effect or finds that
the same amount of the drug has much less of an effect over time than
before.
-Withdrawal: The individual either experiences the characteristic abstinence
syndrome (i.e., opioid-specific withdrawal) or the individual uses opioids or
similar-acting drugs in order to avoid or relieve withdrawal symptoms.
- Loss of control: The individual either repeatedly uses more opioids than
planned or uses the opioids over longer periods of time than planned.
- Inability to stop using: The individual has either unsuccessfully attempted
to cut down or stop using the opioids or has a persistent desire to stop
using.
- Time: The individual spends a lot of time obtaining opioids, getting money
to buy opioids, using opioids, being under the influence of opioids, and
recovering from the effects of opioids.
- Interference with activities: The individual either gives up or reduces the

Symptoms
OPIOID ABUSE.
TheDSM-IV-TRspecifies that one or more of the following
symptoms must occur at any time during a 12-month period (and
cause significant impairment or distress) in order to meet
diagnostic criteria for opioid abuse:
- Interference with role fulfillment: The individual's use of opioids
repeatedly interferes with the ability to fulfill obligations at work,
home, or school.
- Danger to self: The individual repeatedly uses opioids in situations
in which it may be physically hazardous (while driving a car, for
example).
- Legal problems: The individual has recurrent opioidrelated legal
problems (such as arrests for possession of narcotics).
- Social problems: The individual continues to use opioids despite
repeated interpersonal or relationship problems caused by or made
worse by the use of opioids.

Symptoms
OPIOID INTOXICATION.
TheDSM-IV-TRspecifies that the following symptoms must be
present in order to meet diagnostic criteria for opioid intoxication:
-Use: The individual recently used an opioid.
-Changes: The individual experiences significant behavioral or
psychological changes during, or shortly after, use of an opioid.
These changes may include euphoria, followed by slowed
movements or agitation, impaired judgment,apathy("don't care
attitude"), dysphoric mood (depression, for example), or impaired
functioning socially or at work.
-Opioid-specific intoxication syndrome: The pupils in the eyes get
smaller. In addition, drowsiness or coma, slurred speech, and/or
impaired memory or attention during, or shortly after, opioid use
occur.

Symptoms
OPIOID WITHDRAWAL.
TheDSM-IV-TRspecifies that the following symptoms must be present
in order to meet diagnostic criteria for opioid withdrawal:
-Abstinence: Either the individual has stopped using (or has reduced the
amount of) opioids, or anopioid antagonist(i.e., a drug, such as
naloxone, that blocks the action of opioids) has been administered.
-Opioid-specific withdrawal syndrome: Three or more symptoms
develop after abstinence. These symptoms include dysphoric
(negative) mood, nausea or vomiting, muscle aches, runny nose or
watery eyes, dilated pupils, goosebumps, or sweating, diarrhea,
yawning, fever, and insomnia.
-Impairment or distress: The withdrawal symptoms must cause
significant distress to the individual or impairment in functioning
(socially, at work, or any other important area).
-Not due to other disorder: The withdrawal symptoms cannot be due to
a medical condition or other mental disorder.

Diagnosis
Diagnosis of opioid-related disorders are based on
patient interview and observations of symptoms,
including signs of withdrawal such as dilated pupils,
watery eyes, frequent yawning, and anxiety, among
others.
- Opioid dependence
Depression (usually either major depression or
substance-induced mood disorder) is the most
common disorder. Opioid-dependent individuals
frequently report suicidal ideation (thoughts) and
insomnia, other substance use disorders (such as
alcoholism), anxiety disorders, antisocial personality
disorder, post-traumatic stress disorder , and a
history of conduct disorder are also fairly common.

- Opioid intoxication
Intoxication on other substances, such as
alcohol, sedatives, hypnotics, and
anxiolytics, can resemble intoxication on
opioids. Furthermore, dilated pupils can be
seen.
- Opioid withdrawal
The restlessness and anxiety seen in opioid
withdrawal is also seen in withdrawal from
sedatives, hypnotics, and anxiolytics.

Treatment of Opioid dependence

1. Methadone maintenance treatment. Methadone is a long-

acting opioid that is generally administered in an

outpatient setting (a methadone maintenance clinic). The
methadone prevents the individual from experiencing
opioid withdrawal, reduces opioid craving, and enables the
individual to have access to other services (such as
individual counseling, medical services, and HIV-prevention
education).
2. Opioid antagonist treatment. An opioid antagonist is a
medication that blocks the effects of opioids. The effects of
taking any opioids are blocked by thenaltrexone (Trexan) it
will prevent the individual from getting "high.

3. Opioid agonist-antagonist treatment.

Buprenorphine (Buprenex) is an example of
an opioid agonist-antagonist, which means
it acts as both an agonist (having some
morphine-like action) and antagonist (it
blocks the effects of additional opioids).
4. Individualized drug counseling
5. Self-help groups
6. Psychotherapy

Treatment
- Opioid abuse
Most of the treatments for opioid dependence would be appropriate for
opioid abuse except methadone and opioid antagonist treatment.
- Opioid intoxication
An opioid antagonist, naloxone (Narcan), can be administered to
reverse the effects of acute intoxication or overdose on most opioids.
- Opioid withdrawal
Opioid withdrawal can be treated either on an inpatient basis
(detoxification) or on an outpatient basis (methadone detoxification):
Inpatient detoxification program. Typically, this would be from three to
seven days. The withdrawal can be medically
managed.Clonidinemay be administered to help reduce some
symptoms of withdrawal.
.

Prognosis
Opioid dependence

Recovering from opioid dependence is a

long, difficult process. Typically, multiple
treatment attempts are required.
Relapsing, or returning to opioids, is not
uncommon even after many years of
abstinence. Brief periods of abstinence are
common.

Prevention
The best single thing an individual can do

to prevent opioid-related disorders is never

to use opioids such as heroin. Opioids are
powerfully addicting, especially if used
intravenously.