Leslie Iversen
- Published in print:
- 2008
- Published Online:
- March 2012
- ISBN:
- 9780198530909
- eISBN:
- 9780191689802
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198530909.003.0009
- Subject:
- Neuroscience, Behavioral Neuroscience
The previous chapters have reviewed the various uses and abuses of amphetamines in different societies. These man-made chemicals had a great impact on ...
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The previous chapters have reviewed the various uses and abuses of amphetamines in different societies. These man-made chemicals had a great impact on life in the 20th century and seem set to continue as major players — for good as well as evil. This concluding chapter attempts to put some perspective on the use and abuse of these drugs and attempts some predictions of future trends. It also explores the medical uses of amphetamines, particularly in cases of ADHD; the continuing spread of illicit amphetamine abuse; and the possible treatments for amphetamine addiction.Less
The previous chapters have reviewed the various uses and abuses of amphetamines in different societies. These man-made chemicals had a great impact on life in the 20th century and seem set to continue as major players — for good as well as evil. This concluding chapter attempts to put some perspective on the use and abuse of these drugs and attempts some predictions of future trends. It also explores the medical uses of amphetamines, particularly in cases of ADHD; the continuing spread of illicit amphetamine abuse; and the possible treatments for amphetamine addiction.
F. Bermúdez-Rattoni
- Published in print:
- 1998
- Published Online:
- January 2008
- ISBN:
- 9780198523475
- eISBN:
- 9780191712678
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198523475.003.0005
- Subject:
- Psychology, Neuropsychology
While the CTA eliciting stimuli are restricted to the gustatory modality, the same substance can also be used as the US when it is ingested, and it influences the gastrointestinal system. Many drugs ...
More
While the CTA eliciting stimuli are restricted to the gustatory modality, the same substance can also be used as the US when it is ingested, and it influences the gastrointestinal system. Many drugs or treatments (chemotherapy or radiotherapy) triggering emesis may serve as the CTA eliciting US. The above development depends on species specific digestive processes, which explains why the same drug is well tolerated by some animals but entirely rejected by other animals. Similar mechanisms may explain CTA elicited by self-administered drugs (morphine, phencyclidine, cocaine, amphetamine), which may serve as aversive stimuli for CTA production. Another substance influencing food intake is cholecystokinine (CCK), a neuropeptide synthesized in the gut as a response to a meal, which may serve as a satiety factor. Injection of higher dosages of CCK (2μg/kg) may elicit CTA. CTA acquisition may be connected with poisoning induced stress or elicited by injection of cyclophosphamide.Less
While the CTA eliciting stimuli are restricted to the gustatory modality, the same substance can also be used as the US when it is ingested, and it influences the gastrointestinal system. Many drugs or treatments (chemotherapy or radiotherapy) triggering emesis may serve as the CTA eliciting US. The above development depends on species specific digestive processes, which explains why the same drug is well tolerated by some animals but entirely rejected by other animals. Similar mechanisms may explain CTA elicited by self-administered drugs (morphine, phencyclidine, cocaine, amphetamine), which may serve as aversive stimuli for CTA production. Another substance influencing food intake is cholecystokinine (CCK), a neuropeptide synthesized in the gut as a response to a meal, which may serve as a satiety factor. Injection of higher dosages of CCK (2μg/kg) may elicit CTA. CTA acquisition may be connected with poisoning induced stress or elicited by injection of cyclophosphamide.
Nathan Michael Corzine
- Published in print:
- 2016
- Published Online:
- April 2017
- ISBN:
- 9780252039799
- eISBN:
- 9780252097898
- Item type:
- book
- Publisher:
- University of Illinois Press
- DOI:
- 10.5406/illinois/9780252039799.001.0001
- Subject:
- Sociology, Sport and Leisure
In 2007, the Mitchell Report shocked traditionalists who were appalled that drugs had corrupted the “pure” game of baseball. This book rescues the story of baseball's relationship with drugs from the ...
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In 2007, the Mitchell Report shocked traditionalists who were appalled that drugs had corrupted the “pure” game of baseball. This book rescues the story of baseball's relationship with drugs from the tyranny of such myths. It reveals a game splashed with spilled whiskey and tobacco stains from the day the first pitch was thrown. Indeed, throughout the game's history, stars and scrubs alike partook of a pharmacopeia that helped them stay on the field and cope off of it: In 1889, Pud Galvin tried a testosterone-derived “elixir” to help him pile up some of his 646 complete games. Sandy Koufax needed codeine and an anti-inflammatory used on horses to pitch through his late-career elbow woes. Players returning from World War II mainstreamed the use of the amphetamines they had used as servicemen. Vida Blue invited teammates to cocaine parties, Tim Raines used the drug to stay awake on the bench, and Will McEnaney snorted it between innings. The book also ventures outside the lines to show how authorities handled—or failed to handle—drug and alcohol problems, and how those problems both shaped and scarred the game. The result is an eye-opening look at what baseball's relationship with substances legal and otherwise tells us about culture, society, and masculinity in America.Less
In 2007, the Mitchell Report shocked traditionalists who were appalled that drugs had corrupted the “pure” game of baseball. This book rescues the story of baseball's relationship with drugs from the tyranny of such myths. It reveals a game splashed with spilled whiskey and tobacco stains from the day the first pitch was thrown. Indeed, throughout the game's history, stars and scrubs alike partook of a pharmacopeia that helped them stay on the field and cope off of it: In 1889, Pud Galvin tried a testosterone-derived “elixir” to help him pile up some of his 646 complete games. Sandy Koufax needed codeine and an anti-inflammatory used on horses to pitch through his late-career elbow woes. Players returning from World War II mainstreamed the use of the amphetamines they had used as servicemen. Vida Blue invited teammates to cocaine parties, Tim Raines used the drug to stay awake on the bench, and Will McEnaney snorted it between innings. The book also ventures outside the lines to show how authorities handled—or failed to handle—drug and alcohol problems, and how those problems both shaped and scarred the game. The result is an eye-opening look at what baseball's relationship with substances legal and otherwise tells us about culture, society, and masculinity in America.
Leslie Iversen
- Published in print:
- 2008
- Published Online:
- March 2012
- ISBN:
- 9780198530909
- eISBN:
- 9780191689802
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198530909.003.0006
- Subject:
- Neuroscience, Behavioral Neuroscience
The resemblance between amphetamine-induced psychosis and some forms of schizophrenia generated much interest in the research community. New lines of ...
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The resemblance between amphetamine-induced psychosis and some forms of schizophrenia generated much interest in the research community. New lines of research sought to examine how close the parallels were and to probe their underlying neurochemical and neuropharmacological bases. This work was of great importance in supporting the ‘dopamine hypothesis’ of schizophrenia and providing insight into the mechanism of action of the anti-psychotic drugs used to treat schizophrenia as dopamine antagonists. Although no short-term drug-induced effects can ever accurately mimic the symptoms of complex and chronic psychosis, amphetamine comes closer than any other. Research on amphetamine in animals and in human subjects has contributed importantly to these ideas.Less
The resemblance between amphetamine-induced psychosis and some forms of schizophrenia generated much interest in the research community. New lines of research sought to examine how close the parallels were and to probe their underlying neurochemical and neuropharmacological bases. This work was of great importance in supporting the ‘dopamine hypothesis’ of schizophrenia and providing insight into the mechanism of action of the anti-psychotic drugs used to treat schizophrenia as dopamine antagonists. Although no short-term drug-induced effects can ever accurately mimic the symptoms of complex and chronic psychosis, amphetamine comes closer than any other. Research on amphetamine in animals and in human subjects has contributed importantly to these ideas.
Nigel Lane, Louise Powter, and Sam Patel (eds)
- Published in print:
- 2016
- Published Online:
- November 2020
- ISBN:
- 9780199680269
- eISBN:
- 9780191918360
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780199680269.003.0017
- Subject:
- Clinical Medicine and Allied Health, Professional Development in Medicine
Chiadi U. Onyike
- Published in print:
- 2008
- Published Online:
- November 2020
- ISBN:
- 9780195309430
- eISBN:
- 9780197562451
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780195309430.003.0024
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
Stimulants are typically prescribed for their positive effects on mood, motivation, alertness, arousal, and energy. They are believed to exert their ...
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Stimulants are typically prescribed for their positive effects on mood, motivation, alertness, arousal, and energy. They are believed to exert their pharmacologic effects by increasing synaptic release of endogenous catecholamines (norepinephrine and dopamine) while simultaneously blocking catecholamine reuptake at the nerve terminals. Themost commonly used ‘‘traditional’’ agents are methylphenidate and dextroamphetamine. Methylphenidate reaches peak blood levels in 1 to 3 hours and has an elimination half-life of 2 to 3 hours. Dextroamphetamine reaches peak levels in 2 to 4 hours and has an elimination half-life of 3 to 6 hours. Controlled-release formulations are available, allowing for dosing once daily. Dextroamphetamine is excreted primarily in the urine in unchanged form, whereas methylphenidate is excreted mainly as ritalinic acid. The newer generation stimulant modafinil has been marketed in the United States since 1998. Initially used in the treatment of narcolepsy, it is now prescribed for a wider range of conditions because of its positive effects on wakefulness, vigilance, cognitive performance, and mood. Its pharmacologic effects are thought to result primarily from the stimulation of wakefulness-promoting orexinergic neurons in the anterior hypothalamus. Inhibition of norepinephrine reuptake in the ventrolateral preoptic nucleus and of dopamine reuptake (by binding to the transporter) may contribute to its action. Modafinil is administered orally, achieves peak plasma concentrations in 2 to 4 hours, and has an elimination half-life of 12 to 15 hours. It is 90% metabolized in the liver, and its metabolites are excreted in the urine. The ergot alkaloids bromocriptine and pergolide are familiar to most neurologists in their use in the treatment of Parkinson’s disease (PD) and migraine headache. These dopamine receptor agonists are also used in neuropsychiatry in the treatment of apathetic states in patients recovering from brain trauma, cerebral anoxia, and strokes. Amantadine is another familiar agent used in the treatment of PD and drug-induced parkinsonism. In addition to other effects in the central nervous system (CNS), amantadine facilitates dopamine release and inhibits its reuptake. It thus has modest ‘‘stimulant-like’’ effects useful in the treatment of executive dysfunction syndromes, particularly in patients with dementia. Bupropion is a dopamine and norepinephrine reuptake inhibitor. It usually is prescribed as a ‘‘nonsedating’’ antidepressant, but its potentiation of catecholamine neurotransmission results in modest stimulant-like clinical effects.
Less
Stimulants are typically prescribed for their positive effects on mood, motivation, alertness, arousal, and energy. They are believed to exert their pharmacologic effects by increasing synaptic release of endogenous catecholamines (norepinephrine and dopamine) while simultaneously blocking catecholamine reuptake at the nerve terminals. Themost commonly used ‘‘traditional’’ agents are methylphenidate and dextroamphetamine. Methylphenidate reaches peak blood levels in 1 to 3 hours and has an elimination half-life of 2 to 3 hours. Dextroamphetamine reaches peak levels in 2 to 4 hours and has an elimination half-life of 3 to 6 hours. Controlled-release formulations are available, allowing for dosing once daily. Dextroamphetamine is excreted primarily in the urine in unchanged form, whereas methylphenidate is excreted mainly as ritalinic acid. The newer generation stimulant modafinil has been marketed in the United States since 1998. Initially used in the treatment of narcolepsy, it is now prescribed for a wider range of conditions because of its positive effects on wakefulness, vigilance, cognitive performance, and mood. Its pharmacologic effects are thought to result primarily from the stimulation of wakefulness-promoting orexinergic neurons in the anterior hypothalamus. Inhibition of norepinephrine reuptake in the ventrolateral preoptic nucleus and of dopamine reuptake (by binding to the transporter) may contribute to its action. Modafinil is administered orally, achieves peak plasma concentrations in 2 to 4 hours, and has an elimination half-life of 12 to 15 hours. It is 90% metabolized in the liver, and its metabolites are excreted in the urine. The ergot alkaloids bromocriptine and pergolide are familiar to most neurologists in their use in the treatment of Parkinson’s disease (PD) and migraine headache. These dopamine receptor agonists are also used in neuropsychiatry in the treatment of apathetic states in patients recovering from brain trauma, cerebral anoxia, and strokes. Amantadine is another familiar agent used in the treatment of PD and drug-induced parkinsonism. In addition to other effects in the central nervous system (CNS), amantadine facilitates dopamine release and inhibits its reuptake. It thus has modest ‘‘stimulant-like’’ effects useful in the treatment of executive dysfunction syndromes, particularly in patients with dementia. Bupropion is a dopamine and norepinephrine reuptake inhibitor. It usually is prescribed as a ‘‘nonsedating’’ antidepressant, but its potentiation of catecholamine neurotransmission results in modest stimulant-like clinical effects.
LESLIE IVERSEN
- Published in print:
- 2008
- Published Online:
- March 2012
- ISBN:
- 9780198530909
- eISBN:
- 9780191689802
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198530909.001.0001
- Subject:
- Neuroscience, Behavioral Neuroscience
Amphetamines have had a relatively short, though chequered history. From their use in wartime, their abuse by the beat generation, up to the popularity of Ecstasy in the ...
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Amphetamines have had a relatively short, though chequered history. From their use in wartime, their abuse by the beat generation, up to the popularity of Ecstasy in the late 20th century, many have found amphetamines an enjoyable, though unpredictable, stimulant. More than that though, amphetamine-based treatments have been found to have beneficial effects for those suffering from attention-deficit disorders, and are now widely prescribed in the US and elsewhere as a treatment for children and adults. What is the truth behind these medical claims? What are the real effects of stimulants like Ecstasy? Just how harmful are amphetamines? This book explores the uses and abuses of amphetamines. Starting with a look at the origins of amphetamines, their use in wartime and by poets, musicians — and even a President of the US — it presents an account of amphetamine use. It examines the evidence for the claims that drugs like Ecstasy kill, and considers the widespread use of amphetamines for ADHD, presenting an account based on science and fact, rather than dogma.Less
Amphetamines have had a relatively short, though chequered history. From their use in wartime, their abuse by the beat generation, up to the popularity of Ecstasy in the late 20th century, many have found amphetamines an enjoyable, though unpredictable, stimulant. More than that though, amphetamine-based treatments have been found to have beneficial effects for those suffering from attention-deficit disorders, and are now widely prescribed in the US and elsewhere as a treatment for children and adults. What is the truth behind these medical claims? What are the real effects of stimulants like Ecstasy? Just how harmful are amphetamines? This book explores the uses and abuses of amphetamines. Starting with a look at the origins of amphetamines, their use in wartime and by poets, musicians — and even a President of the US — it presents an account of amphetamine use. It examines the evidence for the claims that drugs like Ecstasy kill, and considers the widespread use of amphetamines for ADHD, presenting an account based on science and fact, rather than dogma.
Leslie Iversen
- Published in print:
- 2008
- Published Online:
- March 2012
- ISBN:
- 9780198530909
- eISBN:
- 9780191689802
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198530909.003.0001
- Subject:
- Neuroscience, Behavioral Neuroscience
Amphetamines come in many different forms and have powerful effects for good and evil. An epidemic of methamphetamine abuse is sweeping through the USA ...
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Amphetamines come in many different forms and have powerful effects for good and evil. An epidemic of methamphetamine abuse is sweeping through the USA and Southeast Asia — from Hawaii, where the epidemic started in the 1980s, and from Thailand. Meanwhile another amphetamine-like chemical, methylphenidate (Ritalin) has proved popular for the treatment of children, and more recently adults, with attention deficit hyperactivity disorder (ADHD) on both sides of the Atlantic. This book seeks to review the positive and negative aspects of amphetamines — man-made chemicals which had a great impact on the 20th century and continue to do so in the new millennium.Less
Amphetamines come in many different forms and have powerful effects for good and evil. An epidemic of methamphetamine abuse is sweeping through the USA and Southeast Asia — from Hawaii, where the epidemic started in the 1980s, and from Thailand. Meanwhile another amphetamine-like chemical, methylphenidate (Ritalin) has proved popular for the treatment of children, and more recently adults, with attention deficit hyperactivity disorder (ADHD) on both sides of the Atlantic. This book seeks to review the positive and negative aspects of amphetamines — man-made chemicals which had a great impact on the 20th century and continue to do so in the new millennium.
Leslie Iversen
- Published in print:
- 2008
- Published Online:
- March 2012
- ISBN:
- 9780198530909
- eISBN:
- 9780191689802
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198530909.003.0002
- Subject:
- Neuroscience, Behavioral Neuroscience
This chapter discusses the chemistry of amphetamines and their effects on the brain. Amphetamines are easily administered by a variety of routes and they ...
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This chapter discusses the chemistry of amphetamines and their effects on the brain. Amphetamines are easily administered by a variety of routes and they penetrate readily and rapidly into the central nervous system (CNS). They act by stimulating the release of natural neurotransmitters. In peripheral tissues, amphetamine stimulates the release of norepinephrine from the nerve endings of the ‘sympathetic nervous system’ which controls a variety of peripheral functions. Because of its ability to stimulate functions normally controlled by the sympathetic nervous system, amphetamine has long been recognised as a ‘sympathomimetic amine’. This chapter also discusses the effects of amphetamines on human mood, cognitive performance, sexual function, and the stereotyped behaviour in human amphetamine users.Less
This chapter discusses the chemistry of amphetamines and their effects on the brain. Amphetamines are easily administered by a variety of routes and they penetrate readily and rapidly into the central nervous system (CNS). They act by stimulating the release of natural neurotransmitters. In peripheral tissues, amphetamine stimulates the release of norepinephrine from the nerve endings of the ‘sympathetic nervous system’ which controls a variety of peripheral functions. Because of its ability to stimulate functions normally controlled by the sympathetic nervous system, amphetamine has long been recognised as a ‘sympathomimetic amine’. This chapter also discusses the effects of amphetamines on human mood, cognitive performance, sexual function, and the stereotyped behaviour in human amphetamine users.
Leslie Iversen
- Published in print:
- 2008
- Published Online:
- March 2012
- ISBN:
- 9780198530909
- eISBN:
- 9780191689802
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198530909.003.0005
- Subject:
- Neuroscience, Behavioral Neuroscience
A United Nations report (United Nations 2003) estimated a worldwide total of 34 million people who regularly abuse amphetamine-like stimulants and 8 ...
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A United Nations report (United Nations 2003) estimated a worldwide total of 34 million people who regularly abuse amphetamine-like stimulants and 8 million who use ecstasy. This exceeds the number of heroin and cocaine abusers combined. D-Amphetamine and D-methamphetamine are among the most widely used of all illicit drugs, ranking second in popularity only to cannabis in many countries. It is now generally recognized that amphetamines are drugs of addiction. This chapter reviews the evidence for this and explores the underlying brain mechanisms. It also reviews the social history of amphetamine abuse in various parts of the world.Less
A United Nations report (United Nations 2003) estimated a worldwide total of 34 million people who regularly abuse amphetamine-like stimulants and 8 million who use ecstasy. This exceeds the number of heroin and cocaine abusers combined. D-Amphetamine and D-methamphetamine are among the most widely used of all illicit drugs, ranking second in popularity only to cannabis in many countries. It is now generally recognized that amphetamines are drugs of addiction. This chapter reviews the evidence for this and explores the underlying brain mechanisms. It also reviews the social history of amphetamine abuse in various parts of the world.
Leslie Iversen
- Published in print:
- 2008
- Published Online:
- March 2012
- ISBN:
- 9780198530909
- eISBN:
- 9780191689802
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198530909.003.0007
- Subject:
- Neuroscience, Behavioral Neuroscience
All drugs, even such apparently innocuous ones as aspirin, carry some health risks. But how dangerous are the amphetamines? Can an overdose kill someone? ...
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All drugs, even such apparently innocuous ones as aspirin, carry some health risks. But how dangerous are the amphetamines? Can an overdose kill someone? Does amphetamine abuse cause damage to the health and social lives of the users and those around them? Are there any long-term irreversible adverse effects of chronic use? This chapter attempts to answer some of these questions and reviews the extensive literature on the neurotoxicity of amphetamines studied in animal experiments. Overall, the use of high-dose amphetamine is associated with an alarming series of adverse risks for both the user and those around him.Less
All drugs, even such apparently innocuous ones as aspirin, carry some health risks. But how dangerous are the amphetamines? Can an overdose kill someone? Does amphetamine abuse cause damage to the health and social lives of the users and those around them? Are there any long-term irreversible adverse effects of chronic use? This chapter attempts to answer some of these questions and reviews the extensive literature on the neurotoxicity of amphetamines studied in animal experiments. Overall, the use of high-dose amphetamine is associated with an alarming series of adverse risks for both the user and those around him.
Joy G. Dryfoos
- Published in print:
- 1992
- Published Online:
- November 2020
- ISBN:
- 9780195072686
- eISBN:
- 9780197560259
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780195072686.003.0007
- Subject:
- Education, Care and Counseling of Students
Quantifying the number of young people who are high risk because of substance abuse is complicated by the ambiguity of existing definitions and the absence ...
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Quantifying the number of young people who are high risk because of substance abuse is complicated by the ambiguity of existing definitions and the absence of ideal data. Among other definitional problems, the term substance abuse covers a multitude of “sins”—smoking, drinking, use of marijuana, and use of a whole range of drugs from over-the-counter diet pills to illicit heroin and cocaine. In recent years, chewing smokeless tobacco and wine coolers have been added to the menu. To add to the confusion, the substance abuse field has not produced an adequate response to the question: Who is at risk of long-term consequences? In the teen pregnancy field, the problem is generally defined using the outcome to be prevented, early childbearing (see Chapter 5). Teen fertility is quantifiable, measured from official statistics (Vital Statistics), and the characteristics of those at risk can be determined by studying the outcome date. In the delinquency field, there are official arrest figures. In the education field, school records and selfreports can be used to define low achievers and dropouts. In the substance abuse field, research suggests that there are important differences between occasional users and those who ever tried these substances (but are not abstainers), and the subset who become heavy users. It is the subset of heavy users who should be the prime targets of interventions, and yet it appears that most prevention is aimed at the larger group. The task of defining risk groups for substance-abuse prevention programs would be facilitated if one could turn to a data set that had all the requisite parts: a large random sample of 10- to 17-year-olds, followed longitudinally, and rich in detail about precursors and the social environment. From such a resource, we could better understand the antecedents of drug and alcohol use, current use patterns by different subgroups of the population, and the consequences that followed from that use. A number of researchers have produced important work on what they describe as the etiology or the causes of substance abuse, others have focused on the consequences, and many surveys have been conducted to track prevalence patterns.
Less
Quantifying the number of young people who are high risk because of substance abuse is complicated by the ambiguity of existing definitions and the absence of ideal data. Among other definitional problems, the term substance abuse covers a multitude of “sins”—smoking, drinking, use of marijuana, and use of a whole range of drugs from over-the-counter diet pills to illicit heroin and cocaine. In recent years, chewing smokeless tobacco and wine coolers have been added to the menu. To add to the confusion, the substance abuse field has not produced an adequate response to the question: Who is at risk of long-term consequences? In the teen pregnancy field, the problem is generally defined using the outcome to be prevented, early childbearing (see Chapter 5). Teen fertility is quantifiable, measured from official statistics (Vital Statistics), and the characteristics of those at risk can be determined by studying the outcome date. In the delinquency field, there are official arrest figures. In the education field, school records and selfreports can be used to define low achievers and dropouts. In the substance abuse field, research suggests that there are important differences between occasional users and those who ever tried these substances (but are not abstainers), and the subset who become heavy users. It is the subset of heavy users who should be the prime targets of interventions, and yet it appears that most prevention is aimed at the larger group. The task of defining risk groups for substance-abuse prevention programs would be facilitated if one could turn to a data set that had all the requisite parts: a large random sample of 10- to 17-year-olds, followed longitudinally, and rich in detail about precursors and the social environment. From such a resource, we could better understand the antecedents of drug and alcohol use, current use patterns by different subgroups of the population, and the consequences that followed from that use. A number of researchers have produced important work on what they describe as the etiology or the causes of substance abuse, others have focused on the consequences, and many surveys have been conducted to track prevalence patterns.
Stephen J. Glatt, Stephen V. Faraone, and Ming T. Tsuang
- Published in print:
- 2019
- Published Online:
- November 2020
- ISBN:
- 9780198813774
- eISBN:
- 9780191917233
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780198813774.003.0008
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
The diagnosis of schizophrenia cannot be made based on the results of an objective diagnostic test or laboratory measure, though we and others are working towards ...
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The diagnosis of schizophrenia cannot be made based on the results of an objective diagnostic test or laboratory measure, though we and others are working towards this. Instead, clinicians diagnose schizophrenia based on behaviour and psychopathology (including the symptoms described in the previous chapter). These require the subjective interpretation of clinicians, but they can be assessed reliably. The definitions of major mental illnesses used by clinicians are presented in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (in the United States) and the World Health Organization’s International Classification of Diseases (ICD) in other countries. These definitions are updated from time to time to reflect gains in knowledge, or to reflect modern thinking on the similarities and differences between certain disorders. From one edition to the next, some diagnoses are revised, some are added, and some vanish altogether, only to be replaced or absorbed under other diagnoses. The diagnostic criteria for schizophrenia as defined by the most recent version of the DSM (DSM- 5) include the presence of two or more of the following symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behaviour, and negative symptoms. At least one of the two must be delusions, hallucinations, or disorganized speech, while the second symptom type required for diagnosis could be any of the remaining four criteria. The requirement of delusions, hallucinations, or disorganized speech maintains the resemblance of the modern- day diagnosis to that first described by the clinician Emil Kraepelin over a century ago. Kraepelin’s discovery that schizophrenia is marked by a chronic and gradually worsening course is seen in modern- day criteria as well. A DSM-5 diagnosis of schizophrenia requires continuous signs of illness for at least 6 months, during which the individual must show at least 1 month of active symptoms (less if well treated). The diagnosis also requires social or work deterioration over a significant amount of time. Lastly, the diagnosis requires that the observed symptoms are not due to some other medical condition, including other psychiatric disorders such as bipolar disorder or major depressive disorder.
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The diagnosis of schizophrenia cannot be made based on the results of an objective diagnostic test or laboratory measure, though we and others are working towards this. Instead, clinicians diagnose schizophrenia based on behaviour and psychopathology (including the symptoms described in the previous chapter). These require the subjective interpretation of clinicians, but they can be assessed reliably. The definitions of major mental illnesses used by clinicians are presented in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (in the United States) and the World Health Organization’s International Classification of Diseases (ICD) in other countries. These definitions are updated from time to time to reflect gains in knowledge, or to reflect modern thinking on the similarities and differences between certain disorders. From one edition to the next, some diagnoses are revised, some are added, and some vanish altogether, only to be replaced or absorbed under other diagnoses. The diagnostic criteria for schizophrenia as defined by the most recent version of the DSM (DSM- 5) include the presence of two or more of the following symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behaviour, and negative symptoms. At least one of the two must be delusions, hallucinations, or disorganized speech, while the second symptom type required for diagnosis could be any of the remaining four criteria. The requirement of delusions, hallucinations, or disorganized speech maintains the resemblance of the modern- day diagnosis to that first described by the clinician Emil Kraepelin over a century ago. Kraepelin’s discovery that schizophrenia is marked by a chronic and gradually worsening course is seen in modern- day criteria as well. A DSM-5 diagnosis of schizophrenia requires continuous signs of illness for at least 6 months, during which the individual must show at least 1 month of active symptoms (less if well treated). The diagnosis also requires social or work deterioration over a significant amount of time. Lastly, the diagnosis requires that the observed symptoms are not due to some other medical condition, including other psychiatric disorders such as bipolar disorder or major depressive disorder.
Rebecca McKnight, Jonathan Price, and John Geddes
- Published in print:
- 2019
- Published Online:
- November 2020
- ISBN:
- 9780198754008
- eISBN:
- 9780191917011
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780198754008.003.0025
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
The provision of mental health services for older adults faces two main challenges: … 1 The world population is ageing, leading to increased numbers of ...
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The provision of mental health services for older adults faces two main challenges: … 1 The world population is ageing, leading to increased numbers of elderly patients (Fig. 18.1). 2 These patients are more likely to present with multiple, complex co- morbidities which must be managed alongside acute or chronic psychiatric problems…. To provide effective care, services must combine treatment for mental, physical, and social needs of older people. The multidisciplinary team is key to delivering this, often in specialized environments such as a day centre programme. A huge number of physical, psychological, and social changes occur within the normal process of ageing. A basic understanding of these is necessary in order to identify those individuals in whom there is pathology. Covering theories behind the ageing process is outside the scope of this text, but some references are given on p. 220. The following changes are seen in the brain during normal ageing: … ● The weight of the brain decreases by 5– 20 per cent between 70 and 90 years, with a compensatory increase in ventricular size. ● There is neuronal loss, especially in the hippocampus, cortex, substantia nigra, and cerebellum. ● Senile plaques are found in the neocortex, amygdala, and hippocampus. ● Tau proteins form neurofibrillary tangles, found normally only in the hippocampus. ● Lewy bodies are seen in the substantia nigra. ● Ischaemic lesions (reduced blood flow, lacunar infarcts) are seen in 50 per cent of normal people over 65 years…. From mid life there is a decline in intellectual functions, as measured with standard intelligence tests, together with deterioration of short- term memory and slowness. IQ peaks at about 25 years, remains stable until 60– 70 years, and then declines. Problem- solving reduces after about age 60. There may be alterations in personality and attitudes, such as increasing cautiousness, rigidity, and ‘disengagement’ from the outside world. Later life presents a series of major changes. Many individuals retire, lose partners, lose their physical health, and are forced to live on much lower incomes and in poorer- quality housing than younger people. These are difficult transitions which may predispose to mental illness. The majority of older people remain living at home: half with a partner, and 10 per cent with other family members. Those who live alone may become isolated and lonely.
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The provision of mental health services for older adults faces two main challenges: … 1 The world population is ageing, leading to increased numbers of elderly patients (Fig. 18.1). 2 These patients are more likely to present with multiple, complex co- morbidities which must be managed alongside acute or chronic psychiatric problems…. To provide effective care, services must combine treatment for mental, physical, and social needs of older people. The multidisciplinary team is key to delivering this, often in specialized environments such as a day centre programme. A huge number of physical, psychological, and social changes occur within the normal process of ageing. A basic understanding of these is necessary in order to identify those individuals in whom there is pathology. Covering theories behind the ageing process is outside the scope of this text, but some references are given on p. 220. The following changes are seen in the brain during normal ageing: … ● The weight of the brain decreases by 5– 20 per cent between 70 and 90 years, with a compensatory increase in ventricular size. ● There is neuronal loss, especially in the hippocampus, cortex, substantia nigra, and cerebellum. ● Senile plaques are found in the neocortex, amygdala, and hippocampus. ● Tau proteins form neurofibrillary tangles, found normally only in the hippocampus. ● Lewy bodies are seen in the substantia nigra. ● Ischaemic lesions (reduced blood flow, lacunar infarcts) are seen in 50 per cent of normal people over 65 years…. From mid life there is a decline in intellectual functions, as measured with standard intelligence tests, together with deterioration of short- term memory and slowness. IQ peaks at about 25 years, remains stable until 60– 70 years, and then declines. Problem- solving reduces after about age 60. There may be alterations in personality and attitudes, such as increasing cautiousness, rigidity, and ‘disengagement’ from the outside world. Later life presents a series of major changes. Many individuals retire, lose partners, lose their physical health, and are forced to live on much lower incomes and in poorer- quality housing than younger people. These are difficult transitions which may predispose to mental illness. The majority of older people remain living at home: half with a partner, and 10 per cent with other family members. Those who live alone may become isolated and lonely.
Rebecca McKnight, Jonathan Price, and John Geddes
- Published in print:
- 2019
- Published Online:
- November 2020
- ISBN:
- 9780198754008
- eISBN:
- 9780191917011
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780198754008.003.0029
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
Variations in mood are part of normal experience; we all have our ‘good’ and ‘bad’ days and different ways of managing these. Sadness is a natural ...
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Variations in mood are part of normal experience; we all have our ‘good’ and ‘bad’ days and different ways of managing these. Sadness is a natural response to loss, adversity, stress, or other negative life experiences and is not necessarily abnormal. The main difference between normal sadness and a mood disorder is that normal sadness is usually a temporary state strongly relating to the person’s current situation, whereas mood disorder is a more persistent pervasive change in mood which affects social and occupational functioning. Primary mood (or ‘affective’) disorders are very common, and are also seen in most other psychiatric disorders or co-morbid to a physical illness. The distribution of mood variation in the general population is probably continuous, producing a spectrum of severity (see Fig. 21.1). As with all psychiatric disorders, classification is descriptive and based on clinical characteristics. The most useful current approach to classification is based on the clinical course. Fundamental elements of this approach include: … ● classifying an illness as a single episode, recurrent, or persistent; ● distinguishing between people who have only low mood (unipolar depression) and those who also have elated mood (bipolar disorder); ● classifying episodes of illness according to severity: depressive episodes are mild, moderate, or severe; elated mood is hypomanic or manic (Table 21.1). … The classification includes two categories for less severe and more chronic illnesses: … ● Dysthymia: chronic mildly low mood which lasts at least several years but does not meet criteria for a recurrent depressive disorder. ● Cyclothymia: chronic instability of mood with periods of mild depressive and elation, none of which are severe enough to meet criteria for bipolar disorder or recurrent depressive disorder. It is often seen in relatives of those who have bipolar disorder, and some patients may eventually meet criteria for bipolar disorder themselves. The prevalence of mood disorders is hard to accurately ascertain, as many patients with low mood do not seek professional help. This is especially common in men. However, data from research studies (which tend to use structured diagnostic criteria) and large national surveys (self- report) give very similar results, outlined in Table 21.2. Bipolar disorder epidemiology is well captured, as patients tend to seek help and the diagnostic criteria are well defined.
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Variations in mood are part of normal experience; we all have our ‘good’ and ‘bad’ days and different ways of managing these. Sadness is a natural response to loss, adversity, stress, or other negative life experiences and is not necessarily abnormal. The main difference between normal sadness and a mood disorder is that normal sadness is usually a temporary state strongly relating to the person’s current situation, whereas mood disorder is a more persistent pervasive change in mood which affects social and occupational functioning. Primary mood (or ‘affective’) disorders are very common, and are also seen in most other psychiatric disorders or co-morbid to a physical illness. The distribution of mood variation in the general population is probably continuous, producing a spectrum of severity (see Fig. 21.1). As with all psychiatric disorders, classification is descriptive and based on clinical characteristics. The most useful current approach to classification is based on the clinical course. Fundamental elements of this approach include: … ● classifying an illness as a single episode, recurrent, or persistent; ● distinguishing between people who have only low mood (unipolar depression) and those who also have elated mood (bipolar disorder); ● classifying episodes of illness according to severity: depressive episodes are mild, moderate, or severe; elated mood is hypomanic or manic (Table 21.1). … The classification includes two categories for less severe and more chronic illnesses: … ● Dysthymia: chronic mildly low mood which lasts at least several years but does not meet criteria for a recurrent depressive disorder. ● Cyclothymia: chronic instability of mood with periods of mild depressive and elation, none of which are severe enough to meet criteria for bipolar disorder or recurrent depressive disorder. It is often seen in relatives of those who have bipolar disorder, and some patients may eventually meet criteria for bipolar disorder themselves. The prevalence of mood disorders is hard to accurately ascertain, as many patients with low mood do not seek professional help. This is especially common in men. However, data from research studies (which tend to use structured diagnostic criteria) and large national surveys (self- report) give very similar results, outlined in Table 21.2. Bipolar disorder epidemiology is well captured, as patients tend to seek help and the diagnostic criteria are well defined.
Rebecca McKnight, Jonathan Price, and John Geddes
- Published in print:
- 2019
- Published Online:
- November 2020
- ISBN:
- 9780198754008
- eISBN:
- 9780191917011
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780198754008.003.0030
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
Schizophrenia and related disorders are a group of conditions characterized by psychotic symptoms which lead to impairments in thinking, feelings, ...
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Schizophrenia and related disorders are a group of conditions characterized by psychotic symptoms which lead to impairments in thinking, feelings, behaviour, and social interactions. There is a spectrum of severity. In schizophrenia, the patient suffers from both psychotic symptoms and functional impairment. In delusional disorders, the patient experiences delusions, but there is no evidence of hallucinations and their functional level may remain normal. Schizophrenia can be a particularly disabling illness because its course, although variable, is frequently chronic and relapsing. The care of patients with schizophrenia places a considerable burden on all carers, from the patient’s family through to the health and social services. GPs may have only a few patients with chronic schizophrenia on their lists but the severity of their problems and the needs of their families will make these patients important. This chapter aims to provide sufficient information for the reader to be able to recognize the basic symptoms of schizophrenia and related disorders and to be aware of the main approaches to treatment. As the clinical presentation and outcome of the disorder vary, schizophrenia can be a confusing illness to understand. It is best to start by considering simplified descriptions of two common presentations: (1) the acute syndrome, and (2) the chronic syndrome. It is then easier to understand the core features as well as the diversity of schizophrenia. In the acute syndrome, the patient gains symptoms; they start to have unusual experiences or thoughts they did not previously, and act in bizarre or atypical ways. This is in contrast to the contrast to the chronic syndrome, in which there is a loss of function— the negative symptoms. The positive symptoms of schizophrenia may appear within a few days, or more insidiously over a period of weeks. A typical presentation is described in Case study box 22.1, and symptoms outlined in Table 22.1. It is not necessary for the patient to have all of these symptoms; they usually have a selection which may change over time.
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Schizophrenia and related disorders are a group of conditions characterized by psychotic symptoms which lead to impairments in thinking, feelings, behaviour, and social interactions. There is a spectrum of severity. In schizophrenia, the patient suffers from both psychotic symptoms and functional impairment. In delusional disorders, the patient experiences delusions, but there is no evidence of hallucinations and their functional level may remain normal. Schizophrenia can be a particularly disabling illness because its course, although variable, is frequently chronic and relapsing. The care of patients with schizophrenia places a considerable burden on all carers, from the patient’s family through to the health and social services. GPs may have only a few patients with chronic schizophrenia on their lists but the severity of their problems and the needs of their families will make these patients important. This chapter aims to provide sufficient information for the reader to be able to recognize the basic symptoms of schizophrenia and related disorders and to be aware of the main approaches to treatment. As the clinical presentation and outcome of the disorder vary, schizophrenia can be a confusing illness to understand. It is best to start by considering simplified descriptions of two common presentations: (1) the acute syndrome, and (2) the chronic syndrome. It is then easier to understand the core features as well as the diversity of schizophrenia. In the acute syndrome, the patient gains symptoms; they start to have unusual experiences or thoughts they did not previously, and act in bizarre or atypical ways. This is in contrast to the contrast to the chronic syndrome, in which there is a loss of function— the negative symptoms. The positive symptoms of schizophrenia may appear within a few days, or more insidiously over a period of weeks. A typical presentation is described in Case study box 22.1, and symptoms outlined in Table 22.1. It is not necessary for the patient to have all of these symptoms; they usually have a selection which may change over time.
Rebecca McKnight, Jonathan Price, and John Geddes
- Published in print:
- 2019
- Published Online:
- November 2020
- ISBN:
- 9780198754008
- eISBN:
- 9780191917011
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780198754008.003.0032
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
In the community, the term ‘anxiety’ is frequently associated with a stressful Western lifestyle and thought of as a modern phenomenon— but this is far ...
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In the community, the term ‘anxiety’ is frequently associated with a stressful Western lifestyle and thought of as a modern phenomenon— but this is far from the case. Anxiety disorders were clearly described as early as the writings of Hippocrates, and have been prevalent in literary characterization to the present. Anxiety disorders are the most common type of psychiatric disorder, with one in three people experiencing them during a lifetime. They are characterized by marked, persistent mental and physical symptoms of anxiety, that are not secondary to another disorder and that impact negatively upon the sufferer’s life. Anxiety disorders may be primary psychiatric conditions, or a secondary response to the stress associated with physical illness and its treatment. Many people with anxiety disorders never seek medical attention, but these are commonly seen conditions in both primary and secondary care, and they may present with either mental or physical complaints. Obsessive– compulsive disorder is also considered in this chapter. Its relationship to anxiety disorders is uncertain— classification systems currently separate the two— but there are some important common features. Normal anxiety is the response to threatening situations. Feelings of apprehension are accompanied by physiological changes that prepare for defence or escape (‘fight or flight’), notably increases in heart rate, blood pressure, respiration, and muscle tension. Sympathetic nervous system activity is increased, causing symptoms such as tremor, sweating, polyuria, and diarrhoea. Attention and concentration are focused on the threatening situation. Anxiety is a beneficial response in dangerous situations, and should occur in everyday situations of perceived threat (e.g. examinations). Abnormal anxiety is a response that is similar but out of proportion to the threat and/ or is more prolonged, or occurs when there is no threat. With one exception, the symptoms of anxiety disorders are the same as those of a normal anxiety response. The exception is that the focus of attention is not the external threat (as in the normal response) but the physiological response itself. Thus in abnormal anxiety, attention is focused on a symptom such as increased heart rate. This focus of attention is accompanied by concern about the cause of the symptom.
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In the community, the term ‘anxiety’ is frequently associated with a stressful Western lifestyle and thought of as a modern phenomenon— but this is far from the case. Anxiety disorders were clearly described as early as the writings of Hippocrates, and have been prevalent in literary characterization to the present. Anxiety disorders are the most common type of psychiatric disorder, with one in three people experiencing them during a lifetime. They are characterized by marked, persistent mental and physical symptoms of anxiety, that are not secondary to another disorder and that impact negatively upon the sufferer’s life. Anxiety disorders may be primary psychiatric conditions, or a secondary response to the stress associated with physical illness and its treatment. Many people with anxiety disorders never seek medical attention, but these are commonly seen conditions in both primary and secondary care, and they may present with either mental or physical complaints. Obsessive– compulsive disorder is also considered in this chapter. Its relationship to anxiety disorders is uncertain— classification systems currently separate the two— but there are some important common features. Normal anxiety is the response to threatening situations. Feelings of apprehension are accompanied by physiological changes that prepare for defence or escape (‘fight or flight’), notably increases in heart rate, blood pressure, respiration, and muscle tension. Sympathetic nervous system activity is increased, causing symptoms such as tremor, sweating, polyuria, and diarrhoea. Attention and concentration are focused on the threatening situation. Anxiety is a beneficial response in dangerous situations, and should occur in everyday situations of perceived threat (e.g. examinations). Abnormal anxiety is a response that is similar but out of proportion to the threat and/ or is more prolonged, or occurs when there is no threat. With one exception, the symptoms of anxiety disorders are the same as those of a normal anxiety response. The exception is that the focus of attention is not the external threat (as in the normal response) but the physiological response itself. Thus in abnormal anxiety, attention is focused on a symptom such as increased heart rate. This focus of attention is accompanied by concern about the cause of the symptom.
Rebecca McKnight, Jonathan Price, and John Geddes
- Published in print:
- 2019
- Published Online:
- November 2020
- ISBN:
- 9780198754008
- eISBN:
- 9780191917011
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780198754008.003.0037
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
Archaeological evidence has demonstrated that for at least the past 10,000 years humans have been using psychoactive substances. From the chewing of coca ...
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Archaeological evidence has demonstrated that for at least the past 10,000 years humans have been using psychoactive substances. From the chewing of coca leaves in Ancient Peru (c.4000– 3000 bce) to the popular use of laudanum in Victorian England, the recreational, cultural, and medicinal use of ‘mind- altering’ substances has been widespread. As of 2016, alcohol and other psychoactive substances remain a leading cause of medical and social problems worldwide: humans are clearly vulnerable to their attraction. Although a myriad of substances are available, only a few are commonly used, and all tend to produce similar harms upon the individual and society. This chapter will provide a general approach to managing a patient presenting with a problem stemming from substance misuse. It is extremely difficult to gather accurate data on the use of substances in the general population, especially if they are illegal. It is therefore likely that most figures are underestimations of the true incidence. The WHO estimates that tobacco, alcohol, and illicit drugs are a factor in 12.4 per cent of all deaths worldwide. This is a stark reminder of the severity that problems associated with substance usage can reach, but the morbidity surrounding them affects a much wider section of society. In the UK, 80 per cent of adults drink alcohol, 19 per cent smoke tobacco, and 30 per cent admit to having used an illegal drug at least once in their lifetime. Worldwide, the highest prevalence of drug misuse is found in the 16- to 30- year age group, with males outnumbering females at a ratio of 4 to 1. Table 29.1 shows a selection of epidemiological figures associated with commonly used substances. Substance misuse is associated with an array of confusing terminology, the majority describing different disorders that may occur due to use of any substance. The following terms are internationally agreed and appear in major classification systems:… ● Intoxication is the direct psychological and physical effects of the substance that are dose dependent and time limited. They are individual to the substance and typically include both pleasurable and unpleasant symptoms.
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Archaeological evidence has demonstrated that for at least the past 10,000 years humans have been using psychoactive substances. From the chewing of coca leaves in Ancient Peru (c.4000– 3000 bce) to the popular use of laudanum in Victorian England, the recreational, cultural, and medicinal use of ‘mind- altering’ substances has been widespread. As of 2016, alcohol and other psychoactive substances remain a leading cause of medical and social problems worldwide: humans are clearly vulnerable to their attraction. Although a myriad of substances are available, only a few are commonly used, and all tend to produce similar harms upon the individual and society. This chapter will provide a general approach to managing a patient presenting with a problem stemming from substance misuse. It is extremely difficult to gather accurate data on the use of substances in the general population, especially if they are illegal. It is therefore likely that most figures are underestimations of the true incidence. The WHO estimates that tobacco, alcohol, and illicit drugs are a factor in 12.4 per cent of all deaths worldwide. This is a stark reminder of the severity that problems associated with substance usage can reach, but the morbidity surrounding them affects a much wider section of society. In the UK, 80 per cent of adults drink alcohol, 19 per cent smoke tobacco, and 30 per cent admit to having used an illegal drug at least once in their lifetime. Worldwide, the highest prevalence of drug misuse is found in the 16- to 30- year age group, with males outnumbering females at a ratio of 4 to 1. Table 29.1 shows a selection of epidemiological figures associated with commonly used substances. Substance misuse is associated with an array of confusing terminology, the majority describing different disorders that may occur due to use of any substance. The following terms are internationally agreed and appear in major classification systems:… ● Intoxication is the direct psychological and physical effects of the substance that are dose dependent and time limited. They are individual to the substance and typically include both pleasurable and unpleasant symptoms.
Edward Shorter
- Published in print:
- 2013
- Published Online:
- November 2020
- ISBN:
- 9780199948086
- eISBN:
- 9780197563304
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780199948086.003.0013
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
History has always known antidepressant remedies. In an era of faith, the faithful held to the Word as an augury of recovery: “cast down, but not destroyed.” But in a ...
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History has always known antidepressant remedies. In an era of faith, the faithful held to the Word as an augury of recovery: “cast down, but not destroyed.” But in a secular era and certainly by the middle of the twentieth century, pharmacological remedies were required. Indeed they were urgently indicated, for the diagnosis of depression itself was starting to spread. Because of Kraepelin and Freud, by 1940 depression had become a common term for serious psychiatric disease. An editorial in the Lancet called depression “perhaps the most unpleasant illness that can fall to the lot of man.” Depression was thus, while not terribly common, a considerable public health issue. What is puzzling in this story is that around 1940 depression began an inexorable, irreversible climb from awful but unusual to epidemic status. With the 1960s, depression started to become epidemic. One reason for the upswing in depression in mid-twentieth century was the cheering of the pharmaceutical industry. The drugs of the first generation of psychoactive medications were indicated for nervous disease, but there after the firms switched to depression because here were clearly the markets of the future. The early drugs represented an effective treatment for nervous disease. Their effect was sedation, and sedative drugs in medical practice go back to opium and to members of the belladonna family that have been known since Ancient times. Sedation means the process of calming, or allaying excitement. It does not necessarily involve the obtunding of consciousness, although large doses of sedatives may do that. Sedation means easing the pain of being, soothing the griefs and worries of existence, and calming the depressive and anxious agitation of the nervous syndrome. Although we all have worries and anxieties, we do not all have a pathological syndrome called nervousness. Historically, it was those with nerves who benefited from the early psychopharmacological treatments, beginning with the bromides at mid-nineteenth century. The first sedative made by chemical synthesis, chloral hydrate, was used clinically in 1869. A succession of sedatives from the organic chemical industry followed.
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History has always known antidepressant remedies. In an era of faith, the faithful held to the Word as an augury of recovery: “cast down, but not destroyed.” But in a secular era and certainly by the middle of the twentieth century, pharmacological remedies were required. Indeed they were urgently indicated, for the diagnosis of depression itself was starting to spread. Because of Kraepelin and Freud, by 1940 depression had become a common term for serious psychiatric disease. An editorial in the Lancet called depression “perhaps the most unpleasant illness that can fall to the lot of man.” Depression was thus, while not terribly common, a considerable public health issue. What is puzzling in this story is that around 1940 depression began an inexorable, irreversible climb from awful but unusual to epidemic status. With the 1960s, depression started to become epidemic. One reason for the upswing in depression in mid-twentieth century was the cheering of the pharmaceutical industry. The drugs of the first generation of psychoactive medications were indicated for nervous disease, but there after the firms switched to depression because here were clearly the markets of the future. The early drugs represented an effective treatment for nervous disease. Their effect was sedation, and sedative drugs in medical practice go back to opium and to members of the belladonna family that have been known since Ancient times. Sedation means the process of calming, or allaying excitement. It does not necessarily involve the obtunding of consciousness, although large doses of sedatives may do that. Sedation means easing the pain of being, soothing the griefs and worries of existence, and calming the depressive and anxious agitation of the nervous syndrome. Although we all have worries and anxieties, we do not all have a pathological syndrome called nervousness. Historically, it was those with nerves who benefited from the early psychopharmacological treatments, beginning with the bromides at mid-nineteenth century. The first sedative made by chemical synthesis, chloral hydrate, was used clinically in 1869. A succession of sedatives from the organic chemical industry followed.
Edward Shorter
- Published in print:
- 2013
- Published Online:
- November 2020
- ISBN:
- 9780199948086
- eISBN:
- 9780197563304
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780199948086.003.0016
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
Consider the current landscape of depression. In an ABC poll in 2002, 15% of Americans said they felt “really depressed” once a week or more. Another 17% said once a ...
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Consider the current landscape of depression. In an ABC poll in 2002, 15% of Americans said they felt “really depressed” once a week or more. Another 17% said once a month. That means that one-third of the American population believes itself to be depressed in a given month. If you are riding on a subway train with a hundred other people, one-third of them will be currently depressed, or have just been, or are about to be. That is a lot. In fact, it is way too many. We know that only 3% of the population is chronically sad. We know that the serious disease, melancholia, is only a fraction of the ranks of the depressed. Far too many people have received the diagnosis of depression. Whose fault is this? At the beginning of our story, psychiatry spoke German. From around 1870 to 1933, German-speaking Europe was the epicenter of world psychiatry. This was so for two reasons. One, German, Swiss, and Austrian psychiatrists saw large numbers of very sick individuals because they practiced in mental hospitals, leaving outpatients to other practitioners. Of course this was true of alienists elsewhere, but there were more mental hospitals in Germany affiliated with universities because Germany had so many universities. Almost all had university psychiatric hospitals. This was not true elsewhere. So German psychiatry was oriented toward the academic study of large numbers of patients, and a genial figure such as Emil Kraepelin used these resources to make big strides. Second, German psychiatrists had a thorough familiarity with internal medicine because they were also trained as neurologists. From the viewpoint of subject matter, neurology has always been treated as a subspecialty of internal medicine, even though in Central Europe it was hived off to the nerve specialists. In learning so much neurology, German psychiatrists acquired a feeling for brain illness as involving the entire body: They were indeed attuned to looking at the body as a whole, in contrast to Anglo-Saxon psychiatrists, who usually did not also train as internists.
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Consider the current landscape of depression. In an ABC poll in 2002, 15% of Americans said they felt “really depressed” once a week or more. Another 17% said once a month. That means that one-third of the American population believes itself to be depressed in a given month. If you are riding on a subway train with a hundred other people, one-third of them will be currently depressed, or have just been, or are about to be. That is a lot. In fact, it is way too many. We know that only 3% of the population is chronically sad. We know that the serious disease, melancholia, is only a fraction of the ranks of the depressed. Far too many people have received the diagnosis of depression. Whose fault is this? At the beginning of our story, psychiatry spoke German. From around 1870 to 1933, German-speaking Europe was the epicenter of world psychiatry. This was so for two reasons. One, German, Swiss, and Austrian psychiatrists saw large numbers of very sick individuals because they practiced in mental hospitals, leaving outpatients to other practitioners. Of course this was true of alienists elsewhere, but there were more mental hospitals in Germany affiliated with universities because Germany had so many universities. Almost all had university psychiatric hospitals. This was not true elsewhere. So German psychiatry was oriented toward the academic study of large numbers of patients, and a genial figure such as Emil Kraepelin used these resources to make big strides. Second, German psychiatrists had a thorough familiarity with internal medicine because they were also trained as neurologists. From the viewpoint of subject matter, neurology has always been treated as a subspecialty of internal medicine, even though in Central Europe it was hived off to the nerve specialists. In learning so much neurology, German psychiatrists acquired a feeling for brain illness as involving the entire body: They were indeed attuned to looking at the body as a whole, in contrast to Anglo-Saxon psychiatrists, who usually did not also train as internists.