Inhalant-induced psychotic disorder

Haverkos HW, Pinsky PF, Drotman DP, etal Disease manifestation among homosexual men with acquired immunodeficiency syndrome a possible role of nitrites in Kaposi s sarcoma. Sex Transm Dis 12 203-208, 1985 Haverkos HW, Kopstein AN, Wilson H, et al Nitrite inhalants history, epidemiology, and possible links to AIDS. Environ Health Perspect 102 858-861, 1994 Hernandez-Avila CA, Ortega-Soto HA, Jasso A, et al Treatment of inhalant-induced psychotic disorder with carbamazepine versus haloperidol. Psychiatr Serv49 812— 815, 1998... 

Prevalence of adolescent experimentation with solvents in the United Kingdom averages 3.5%-10%, with approximately 100 deaths per year from solvent intoxication (Ramsey et al. 1989). Despite the lower Hispanic American rate in the United States, solvent abuse remains the most common adolescent addiction in Mexico City, Mexico. Mexican public psychiatric hospitals report frequent cases of inhalant-induced psychotic disorder (Doon 1990 Hernandez-Avila et al. 1998). 

Inhalant intoxication Inhalant intoxication delirium8 Inhalant-induced persisting dementia8 Inhalant-induced psychotic disorder,8 with delusions Inhalant-induced psychotic disorder, with hallucinations Inhalant-induced mood disorder Inhalant-induced anxiety disorder ... 

Treatment consists primarily of abstinence and symptomatic management of withdrawal or related disorders. Carbamazepine and haloperidol have equal efficacy for treating inhalant-induced psychotic disorder (Hernandez-Avila et al. 1998). Risperidone may effectively treat the psychotic symptoms and craving for inhalants (Misra et al. 1999). 

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. 

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. 

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). 

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