Drug abuse schizophrenia-related

Stahl s Essential Psychopharmacology has established itself as the preeminent source of education and information in its field. This much expanded second edition enlists advances in neurobiology and recent clinical developments to explain with renewed clarity the concepts underlying drug treatment of psychiatric disorders. New neurotransmitter systems, new theories of schizophrenia, clinical advances in antipsychotic and antidepressant therapy, new coverage of attention deficit disorder, sleep disorders, and drug abuse, and a new chapter on sex-specific and sexual function-related psychopharmacology—these are all features of this edition. 

Chronic stimulant abuse alters the personality of the abuser. These and related changes are the result of neurotoxicity and are not characterized as either acute drug effects or withdrawal signs. Individuals have delusions of being pursued or persecuted and therefore become suspicious and paranoid. They become self-occupied and hostile toward others. Long-term abuse can produce toxic psychosis that closely resembles schizophrenia and must be treated with neuroleptic drugs (haloperidol, chlorpromazine). This psychosis can develop even within 1 to 2 weeks if the person is on a run of very high doses of stimulants. 

Payte TJ (2003). Methadone treatment. Safe induction techniques. Heroin Addiction Related Clinical Problems, 6, 35-42 Pearson G (1996). Drugs and deprivation. Journal of the Royal Society of Health, April, 113-6 Penk WE, Flannery RB Jr, Irvin E, Geller J, Fisher W Hanson MA (2000). Characteristics of substance-abusing persons with schizophrenia the paradox of the dually diagnosed. Journal of Addictive Diseases, 19, 23-30... 

Neurotrophins, such as nerve growth factor and brain-derived neurotrophic factor (BDNF), are implicated in neuronal development, growth, plasticity, and maintenance of function. Neurodevelopment is impaired in schizophrenia and vulnerable schizophrenic brains may be more sensitive to toxic influences. Thus, cannabis may be more neurotoxic to schizophrenic brains than to nonschizophrenic brains when used chronically. In 157 drug-naive first-episode schizophrenic patients there were significantly raised BDNF serum concentrations by up to 34% in patients with chronic cannabis abuse or multiple substance abuse before the onset of the disease (114). Thus, raised BDNF serum concentrations are not related to schizophrenia and /or substance abuse itself but may reflect cannabis-related idiosyncratic damage to the schizophrenic brain. Disease onset was 5.2 years earlier in the cannabis-consuming group. 

Cocaine toxicity has both somatic and psychiatric manifestations. Somatic effects include myocardial depression, malignant dysrhythmias, stroke, and sudden death, partially due to cocaine-related myocardial sodium channel blockade and coronary and cerebral vasoconstriction. Such life-threatening conditions occur mainly when cocaine is combined with other abused drugs. Psychiatric effects can mimic the positive and negative symptoms of schizophrenia. 

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