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Deception and the Systemic Problem of Substance Abuse
Published in Harold V. Hall, Joseph G. Poirier, Detecting Malingering and Deception, 2020
Harold V. Hall, Joseph G. Poirier
The seriousness and extent of the problem of substance abuse are generally grasped by the American public. The DSM-V (American Psychiatric Association, 2013) diagnostic criteria for substance intoxication are available to the lay community. For the professional community, the rationale behind the evolution of the substance abuse diagnostic criteria into DSM-V have been extensively described by the DSM-V Substance Abuse Subcommittee (Hasin et al., 2013). Among a list of many unresolved issues, the subcommittee emphasized that the DSM was a “work in progress.” Particularly with the substance abuse disorders, the ongoing flow of changes has been prompted and guided by international research findings that continue to evolve.
Substance misuse and comorbid psychiatric disorders
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
The inter-relationships, and, therefore, their clinical presentations, can be very complicated. This is the reason that a vital first step is to understand the myriad of effects each substance may have on a person, as well as ways of distinguishing them from the features of psychiatric conditions. As regards substance use, occasionally just one dose may lead to psychological symptoms and psychiatric disorders, physical symptoms and disorders, as well as social problems. Substance use may exacerbate or alter the course of pre-existing psychological and physical symptomatology, psychiatric disorders, physical illness and social situations. Substance intoxication, harmful use and dependence may give rise to psychological symptoms or syndromes, physical symptoms or syndromes, and social instability. Substance withdrawal, usually following on from a person developing dependence, often causes psychological and physical symptoms, with each substance having its own constellation. Moreover, psychological and physical morbidity not amounting to a ‘disorder’ may precipitate substance use, e.g., dysphoria or distress, or pain. A ‘primary’ psychiatric illness may lead to substance misuse and substance use disorder. This may, in turn, result in further psychiatric disorder.
Alcoholism
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Charles A. Dackis, Mark S. Gold
In general, physicians are well aware that alcohol intoxication can mimic acute mania, and detoxification should be completed before a manic diagnosis is entertained. Less appreciated, however, is the frequency by which alcoholics abuse other substances which could generate psychiatric symptoms. For this reason, we recommend antibody-based urine or plasma screens for drugs of abuse. In particular, cocaine, amphetamines, phencyclidine, and hallucinogens can be associated with a manic presentation. Careful questioning of family or friend informants will often clarify significant substance abuse which might explain a seemingly manic syndrome. As with withdrawal-associated manic symptoms, those related to substance intoxication tend to clear spontaneously or with transient antipsychotic treatment.
Psychiatric and non-psychiatric drugs causing false-positive amphetamines urine test in psychiatric patients: a pharmacovigilance analysis using FAERS
Published in Expert Review of Clinical Pharmacology, 2023
Vera Battini, Giovanna Cirnigliaro, Luca Giacovelli, Maria Boscacci, Silvia Massara Manzo, Giulia Mosini, Greta Guarnieri, Michele Gringeri, Beatrice Benatti, Emilio Clementi, Bernardo Dell’Osso, Carla Carnovale
Substance use disorder (SUD) is a frequent and clinically relevant comorbidity in psychiatric patients [12–14]. Indeed, acute substance intoxication can result in the onset of a psychopathological picture in differential diagnosis with a primary psychotic disorder, which is characterized by delusions, hallucinations, and disorganized behavior. Second, substance abuse is a negative prognostic factor as it is associated with lower treatment compliance and higher risk of aggressive behavior in psychiatric patients [15–17]. Eventually, SUD should be treated with pharmacological and rehabilitative interventions in specific community services separate from psychiatric services. Screening for substance use through UDS is therefore usually performed for the correct management of psychiatric patients in diagnostic, prognostic, and therapeutic terms, especially in emergency departments. Unfortunately, a false-positive UDS for amphetamines can easily occur in this setting leading to diagnostic and therapeutic errors, poor physician–patient relationship, and legal problems [18]. It is therefore necessary for clinicians (psychiatrists in particular) who use UDS immunoassay as a routine laboratory analysis to know which drugs can cause false positivity to amphetamines in order to avoid serious impairment of patient well-being and care.
Catatonic Episodes Related to Substance Use: A Cross-Sectional Study Using Electronic Healthcare Records
Published in Journal of Dual Diagnosis, 2022
Su Ying Yeoh, Emmert Roberts, Fraser Scott, Timothy R. Nicholson, Anthony S. David, Jonathan P. Rogers
Catatonia is an important but under-recognized neuropsychiatric disorder characterized by qualitative and quantitative changes in psychomotor activity (Walther et al., 2019). First codified by Karl Kahlbaum, catatonia was considered to be a subtype of schizophrenia for much of the 20th Century (Edward & Fink, 2018). However, it has a diverse range of psychiatric, medical and neurological causes and its etiology is poorly understood (Carroll et al., 1994; Daniels, 2009). Whilst substance intoxication and withdrawal can commonly manifest with diverse neuropsychiatric symptoms including agitation, coma and delirium (Liakoni et al., 2016; Sibanda et al., 2019; Tait et al., 2016; Wojtowicz et al., 2008), they are also increasingly recognized as being temporally associated with catatonic episodes. For example, substance-related catatonia has previously been described in a patient with acute amphetamine intoxication (Chern & Tsai, 1993) and in an individual with cannabinoid withdrawal (Caudron et al., 2016). More recently, Palma-Álvarez et al. (2021) conducted a systematic review of catatonia associated with cannabis or synthetic cannabinoid use and identified 11 case series or reports with a total of only 14 patients (Palma-Álvarez et al., 2021). The small number of patients included in this review illustrates the paucity of research in this area.
Emotional difficulties among individuals with alcohol use disorder: the mediating role of psychological mechanisms linked to mindfulness
Published in Journal of Substance Use, 2020
Marco Cavicchioli, Pietro Ramella, Giulia Simone, Giulia Vassena, Mariagrazia Movalli, Cesare Maffei
On the one hand, there is a large consensus in hypothesizing a crucial role of mindfulness mechanisms in the treatment of SUDs (Brewer et al., 2010; Witkiewitz et al., 2013). On the other hand, few empirical studies showed the effects of mindfulness on emotion regulation among individuals with SUDs (Tang et al., 2016). However, no studies have so far empirically investigated how specific dimensions linked to mindfulness are involved in addressing emotional difficulties characterizing individuals with AUD. Therefore, the current study aims at testing the mediating role of psychological mechanisms linked to mindfulness construct on the relationship between DER and emotional distress among individuals with AUD. Accordingly, the study focused the attention on self-regulation of attention, non-reactive awareness, and nonjudgmental attitude. The study expected positive indirect effects of mindfulness dimensions, assuming a protective role of these psychological mechanisms on emotional difficulties. Ultimately, the sample included individuals with AUD who concluded an effective mindfulness-based intervention (i.e., Dialectical Behavior Therapy Skills Training; DBT-ST) (Cavicchioli et al., 2019b; Maffei et al., 2018) in order to control possible confounding effect of substance intoxication on emotional functioning (Heilig et al., 2010). Moreover, this approach was chosen in order to provisionally hypothesize how mindfulness processes could be involved in the therapeutic change of DER and emotional distress among individuals with AUD and other SUDs.