JOURNAL READING

MENTAL DISORDER DUE TO HEROIN

Preceptor:
dr. Iwan Sys, SpKJ
By:
Dwi Prasetyana Rosadi (201510401011001)
Fajaruddin Maruf (201510401011051)

PSYCHIATRY
MEDICAL FACULTY
UNIVERSITY OF MUHAMMADIYAH MALANG
2017
 INTRODUCTION
Heroin, originally developed by the Bayer
Pharmaceutical Company as a cough
suppressant in 1895, is derived from the
opium poppy, placing it in the class of
chemicals known as opiates.
 DEFINITION
Heroin is one of the group of drugs known as
opiates. Other opiates include opium,
morphine, codeine, pethidine, and
methadone.
Heroin is a potent opioid derived from
morphine.
 Heroin is usually injected intravenously, although
increasing numbers of Australians smoke or snort
the drug. Oral heroin is largely metabolised by
the liver before exerting its main effects (high
first-pass metabolism), so that few users take
heroin orally.
Heroin is a short acting drug with rapid onset of
effects. Onset of effects occur within minutes of
smoking or injection, with significant effects
lasting up to 36 hours in regular users.
 What effects does heroin have
on the body?
Heroin binds to and activates specific receptors
in the brain (MORs) neurotransmitters that
bind to these receptors regulate pain,
hormone release, and feelings of well-being.
Opioids Act on Many Places in
the Brain and Nervous System
Opioids can depress
breathing (brain stem
breathing and heart rate are
controlled)
Opioids can increase feelings
of pleasure (limbic system
controls emotions)
Opioids can block pain
messages transmitted through
What are the immediate (shortterm)
effects of heroin use?

Feeling a surge of pleasurable sensation

A warm flushing of the skin, dry mouth, and
a heavy feeling in the extremities
Nausea, vomiting, and severe itching.
After the initial effects will be drowsy for
several hours, mental function is clouded,
heart function slows, and breathing is also
severely slowed, sometimes enough to be
life-threatening.
 Withdrawal symptoms of
heroin
Stomach and leg cramps
Vomitting
Goose bumps
Runny nose
Irritability
Insomnia
Loss of appetite
Increased heart rate
Muscle spasms
Depression
 Opioid Use Disorder
Diagnostic Criteria
A problematic pattern of opioid use leading to clinically significant impairment or
distress, as manifested by at least two of the following, occurring within a 12-month
period:
1. Opioids are often taken in larger amounts or over a longer period than was
intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid
use.
3. A great deal of time is spent in activities necessary to obtain the opioid, use the
opioid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulfill major role obligations at
work, school, or home.
6. Continued opioid use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of opioids.
 7. Important social, occupational, or recreational activities are given up or reduced
because of opioid use.
8. Recurrent opioid use in situations in which it is physically hazardous.
9. Continued opioid use despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of opioids to achieve intoxication or desired
effect.
b. A markedly diminished effect with continued use of the same amount of an opioid.
Note: This criterion is not considered to be met for those taking opioids solely under
appropriate medical supervision.
11. Withdrawal, as manifested by either of the following:
a. The characteristic opioid withdrawal syndrome (refer to Criteria A and B of the
criteria set for opioid withdrawal).
b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal
symptoms.
Note: This criterion is not considered to be met for those individuals taking opioids
solelyunder appropriate medical supervision.
 Specify current severity
305.50 (F11.10) Mild: Presence of 23 symptoms.
304.00 (F11.20) Moderate: Presence of 45 symptoms.
304.00 (F11.20) Severe: Presence of 6 or more symptoms.
OVERDOSE OF OPIOID
 Pharmacological Treatment
(Medications)
Methadone (Dolophine or Methadose)
Slow-acting opioid agonist preventing
withdrawal symptoms
Buprenorphine (Subutex)
Partial opioid agonist
Naltrexone (Depade or Revia)
Opioid antagonist blocks the action of
opioids, is not addictive or sedating, and does
not result in physical dependence