Inhalant-induced persisting dementia

Substance-induced persisting dementia (e.g., alcohol, inhalant, sedative, hypnotic, anxiolytic, or other substance)... 

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. 

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. 

DSM-IV-TR (American Psychiatric Association 2000) recognizes inhalant-, anesthetic-, and solvent-related disorders (Table 13-8). Anesthetics are associated with substance-induced anxiety disorder. Inhalant-related disorders include intoxication, delirium, persisting dementia, psychotic disorders with delusions or hallucinations, mood or anxiety disorders, and disorders not otherwise specified. Diagnosis depends on history or laboratory studies described earlier in this chapter. Physical signs such as deposits from inhalants around the mouth or nose or on hands and clothing may indicate recent use (Westermeyer 1987). Nasal membranes may be inflamed (Wester-meyer 1987). 

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. 

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