Inhalant intoxication delirium

DSM-IV-TR (American Psychiatric Association 2000) tecognizes six inhalant-induced disotdets inhalant intoxication, inhalant intoxication delirium. 

The main disturbance in inhalant intoxication delirium is a reversible decrease in the level of consciousness and awareness of the environment, which includes an inability to focus, sustain, or shift attention. The intoxicated person is confused and easily distracted by irrelevant stimuli and difficult to engage in a meaningful conversation. He or she may also exhibit prominent disorientation, short- and long-term memory deficits, language disturbances, and perceptual disturbances that may include illusions and hallucinations. Other prominent features associated with inhalant intoxication delirium are... 

Inhalant intoxication dehrium can occur as a consequence of disturbances in dopaminergic, glutamatergic, and GABAergic neu to transmission secondary to acute, high-level exposure to psychoactive ingredients in solvents such as toluene, trichloroethane, and trichloroethylene. Systemic effects of solvent inhalation such as cerebral hypoxia and/or metabolic acidosis may also be involved (Rosenberg 1982). Under these circumstances, inhalant intoxication dehrium develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. Usually, the delirium resolves as the intoxication ends or within a few hours after cessation of use. 

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). 

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. 

That a low dose was administered only once or a very few times in the Army research does not completely rule out the possibility that a vulnerable subject might have developed a delayed psychotic reatlon. The dose given by mouth In Edgewood experiments was up to 5 mg—a modest amount, but one that should produce some symptoms of Intoxication in most nontolerant subjects.1- Other subjects Inhaled unknown amounts In aerosol form. Table 3-4 lists the clinical effects of various doses of SNA. Doses of 250 mg and more have been Ingested by chronic users after the development of tolerance. In comparison, 5-10 mg intravenously can result in delirium, 20 mg In coma, and 50 mg In convulsions. 

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