Psychotic disorders alcohol

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. 

Unlabeled Uses Treatment of alcohol withdrawal, diabetes insipidus, neurogenic pain, psychotic disorders... 

ADHD should not be diagnosed if the symptoms can be better accounted for by other mental disorders, such as mood disorder, Tourette s syndrome, anxiety disorder, dissociative disorder, personality disorder, personality change due to a general medical condition, or a substance-related disorder (e.g., due to bronchodilators, isoniazid, akathisia from neuroleptics). Moreover, ADHD is not diagnosed when symptoms occur exclusively during the course of a pervasive developmental disorder or psychotic disorder (American Psychiatric Association, 2000). Conditions other than ADHD, such as neurofibromatosis, fetal alcohol syndrome and lead poisoning, of which ADHD features are typical symptoms (Pearl et al., 2001), should also be ruled out. 

A randomised, crossover study in 8 men with psychotic disorders found that quetiapine 250 mg three times daily did not afTect the mean breath-alcohol concentration after they took 0.8 g/kg of alcohol in orange juice. Some statistically significant changes in the performance of psychomotor tests were seen, but these were considered to have little clinical relevance. However, the US manufacturers of quetiapine say that, in clinical studies, the motor and cognitive effects of alcohol were potentiated by quetiapine. Therefore the US manufacturers of quetiapine advise avoiding alcohol, and the UK manufacturers advise caution with the concurrent use of alcohol. Note that drowsiness is the most common adverse effect of quetiapine, occurring in over 10% of patients. Quetiapine may occasionally induce postural hypotension, which could be exacerbated by alcohol administration. 

There are data to confirm and reject the association of the Cys23Ser S-HT and the Gly22Ser 5-HTj receptor variants, characterized in vitro by reduced agonist potency, with phenotypes such as intractable suicidal ideation (98), ADHD (100), alcohol dependence, and schizophrenia (98,99,109-116). While the -1348 A/G polymorphism of the S-HT receptor has been associated with the negative symptoms of schizophrenia, other studies of eating disorders appear to be equivocal. A body of evidence is available, however, that S-HT variants may be associated with psychotic symptoms in Alzheimer s patients (94,100,117,118). 

For the treatment of psychoneurotic patients with depression or anxiety depression or anxiety associated with alcoholism or organic disease psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders. 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Depressive disorders can lead to death in other ways (Table 6-9). For example, depressed individuals are more prone to accidents that result from their impaired concentration and attention. They also often attempt to self-medicate, particularly with alcohol or other sedative agents, which may lead to death as a result of organ toxicity, as well as accidents. Psychotic depressive patients may act irrationally, putting themselves at greater physical risk. Although rare today, patients have died of severe malnutrition secondary to catatonic symptoms that precluded the ability to care for their basic needs. Depression can also contribute to a higher morbidity and mortality rate in patients with co-morbid medical disorders. For example, a large database indicates that depression may predispose to the development of ischemic heart disease and increase the risk of cardiac-related death ( 51). 

Although more stimulating antidepressants (e.g., bupropion, SSRIs, venlafaxine, or certain MAOIs) do not potentiate alcohol, they can produce insomnia. To minimize this problem, the dose may be given earlier in the day. TCAs may cause episodes of excitement (rare), confusion, or mania, usually in patients with an underlying psychotic illness, suggesting that a preexisting disorder must be present for these drugs to exert any psychotomimetic effects. 

Olanzapine has been compared with placebo in different mental disorders, including the non-approved indications of psychotic depression, Alzheimer s disease, obsessive-compulsive disorder, and alcohol dependence. 

SED-9, 8). The psychotic syndrome was indistinguishable from paranoid schizophrenia, with short periods of disorientation, and could occur after a single dose (many had taken the equivalent of some 500 mg of amfetamine or metamfetamine orally) with or without simultaneous alcohol, and was most pronounced in addicts (SED-9, 9). Amfetamine psychosis was also seen in 14 people in Australia (1) the predominant hallucinations were visual, which is unusual for schizophrenia (SED-8,11). Similarly, in contrast to schizophrenia, vision was the primary sensory mode in thinking disorders and body schema distortions in 25 amfetamine addicts (63). 

Of 52 patients with alcohol dependence/abuse who were given disulfiram 250 mg bd after food, six developed psychotic symptoms all had a mood disorder but no thought disorder (235). The psychotic symptoms remitted completely after withdrawal and a short course of antipsychotic therapy, except in one patient who had to be given lithium. 

Other uses that have been reported are Rehabilitation of criminals, treatment of sexual disorders, and treatment of mentally retarded or schizophrenic children. LSD has also proven itself successful treating psychotic adults, character disorders, sociopathic personality disorders and treatment of alcoholism. 

The dibenzapine derivatives are called tricyclic antidepressants and include imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), nortriptyline (Aventyl), protriptyline (Vivactil), and doxepin (Adapin). Amitriptyline is indicated in depression major depression with melancholia or psychotic symptoms depressive phase of bipolar disorder depression associated with organic disease, alcoholism, schizophrenia, or mental retardation anorexia or bulimia associated with depression (see Figure 20). 

Desipramine is a tricyclic antidepressant, inhibits reuptake of norepinephrine and serotonin in CNS, and is indicated in relief of symptoms of depression. Desipramine (75 to 150 mg p.o./day in divided doses) is indicated in endogenous depression major depression with melancholia or psychotic symptoms depression associated with organic brain disease, alcoholism, schizophrenia, or mental retardation and the depressive phase of manic-depressive disorder. Desipramine is absorbed rapidly from the GI tract, distributed widely in the body, and appears also in breast miUc. It is bound to plasma proteins to the extent of 90%, undergoes extensive first-pass metabolism, and its metabolites are excreted in urine. Desipramine strongly blocks the norepinephrine uptake mechanism and has no effect on the uptake of serotonin. Desipramine has weak alpha -adrenergic and... 

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