Amnestic disorder

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Amnesia. Like dementia, the main feature of amnesia is memory loss. Amnesia, however, does not affect other intellectual abilities in the same manner as dementia. Distingnishing dementia from amnesia is most often a consideration when you evaluate memory problems in a chronic alcoholic. Alcoholics may become demented, but they may also develop an amnestic disorder known as Wernicke-Korsakoff syndrome. 

Before focusing on dementia, let us consider what dementia is not. Dementia is not amnestic disorder, in which there is impairment of memory but other functions are quite intact. Amnestic disorders may be due to general medical conditions (e.g., head trauma and cerebrovascular... 

Substance-induced delirium Substance-induced psychotic disorder Substance-induced mood disorder Substance-induced persisting amnestic disorder Substance-induced anxiety disorder... 

Substance-induced persisting amnestic disorder Symptoms of dementia... 

Most inhalants or volatile substances are solvents, but the DSM-IV-TR text attributes only five of the eight disorders associated with inhalants to solvents substance-induced psychotic disorder, anxiety disorder, delirium, persisting amnestic disorder, and symptoms of dementia. The association of solvents with dementia is more controversial than their association with mood disorders, but DSM-IV-TR does not recognize mood disorder resulting from solvent exposure. These inconsistencies probably reflect incomplete fidelity between the literature and the psychiatric nosology rather than current opinion. 

Anxiolytics are drugs used for the treatment of anxiety disorders. Apart from benzodiazpines, a frequently used anxiolytic is the 5HT1A (serotonin) receptor agonist buspiron, which has no sedative, amnestic or muscle-relaxant side effects, but whose action takes about a week to develop. Furthermore, it is less efficaceous than the benzodiazepines. Buspiron s mechanism of action is not fully understood. 

Benzodiazepines are highly effective anxiolytics and sedatives. They also have muscle relaxant, amnestic, and anticonvulsant properties. Benzodiazepines effectively treat both acute and chronic generalized anxiety and panic disorder. The high-potency benzodiazepines alprazolam and clonazepam have received more attention as antipanic agents, but double-blind studies also have confirmed the efficacy of diazepam and lorazepam in the treatment of panic disorder. Although only a few benzodiazepines are specifically approved by the... 

C. Delirium, Dementia, Amnestic, and Other Cognitive Disorders... 

Disadvantages of the benzodiazepines include the risk of dependence, depression of central nervous system functions, and amnestic effects. In addition, the benzodiazepines exert additive central nervous system depression when administered with other drugs, including ethanol. The patient should be warned of this possibility to avoid impairment of performance of any task requiring mental alertness and motor coordination. In the treatment of generalized anxiety disorders and certain phobias, newer antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are now considered by many authorities to be drugs of first choice (see Chapter 30). 

Eszopiclone Bind selectively to a subgroup of GABAa receptors, acting like benzodiazepines to enhance membrane hyperpolarization Rapid onset of hypnosis with few amnestic effects or day-after psychomotor depression or somnolence Sleep disorders, especially those characterized by difficulty in falling asleep Oral activity short half-lives CYP substrates Toxicity Extensions of CNS depressant effects dependence liability Interactions Additive CNS depression with ethanol and many other drugs... 

Confirmation of BZ-induced dementia is also reconfirmed in the DSM-IV-TR in its Table I Diagnosis Associated With Class of Substances. Among 12 classes of substances, only 3 are indicated as causing persisting dementia alcohol, inhalants, and sedatives, hypnotics, or anxiolytics. Only two are associated with amnestic (memory) disorders alcohol and sedatives, hypnotics, or anxiolytics. The table indicates that BZs are in fact associated with the whole range of disorders that are also associated with alcohol, including dementia. 

Caine, E., Grossman, H., Lyness, J. (1995). Delirium, dementia, and amnestic and other cognitive disorders and mental disorders due to a general medical condition. In H. Kaplan B. Sadock (Eds.), Comprehensive textbook of psychiatry. New York Williams and Wilkins. 

The most frequent adverse effect which occurs in at least one-third of patients is drowsiness, often accompanied by incoordination or ataxia. Problems with driving, operating machinery, or falls can result, particularly in the elderly, and can be an important source of morbidity, loss of physical function, and mortality (47,48). Memory impairment, loss of insight, and transient euphoria are common paradoxical reactions of irritability or aggressive behavior have been well documented (11) and appear to occur more often in individuals with a history of impulsiveness or a personality disorder (40), and in the context of interpersonal stress and frustration (49). Tolerance to the sedative and hypnotic effects generally occurs more rapidly than to the anxiolytic or amnestic effects (1). 

Disorders of cognition—delirium, dementia, and amnestic and other cognitive disorders... 

Substance-related disorders are divided in DSM-IV into dependence, abuse, intoxication, and withdrawal. In addition, each substance may have related disorders phenomenologically similar to other disorders delirium, dementia, amnestic, psychotic, mood, anxiety, sex, and sleep disorders. 

Bowler, R.M., C. Hartney and L.H. Ngo. 1998. Amnestic disturbance and posttraumatic stress disorder in the aftermath of a chemical release. Arch Clin Neuropsychol 13(5) 455-71. 

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