Drugs and Behavior Exam 3
Opiate Use in the 20th Century and Today
1914 Harrison Narcotics Act: marked the beginning of drug crime in the U.S. Although opiate drugs remained important in medicine, heroin became a major criminal drug 1990s: heroin use in the U.S. increased dramatically 2000s: leveled off at high rates Now: levels are again increasing
The Age of Chlorpromazine
1950: the greatest advance in psychopharmacology: the drug chlorpromazine as an antipsychotic medication Followed by new drugs: antianxiety medications (including meprobamate, a muscle relaxant); antidepressant medications (including the cyclic antidepressants and monoamine oxidase inhibitors)
Drug Sales
370 billion a year. Psychiatric medications are second most prescribed
What's the difference between the varieties?
A Cannabis indica plant may have a (Cannabidiol) CBD/THC ratio 4-5 times that of Cannabis sativa. Cannabis with relatively high ratios of CBD:THC is less likely to induce anxiety. This is be due to CBD's antagonistic effects at the cannabinoid receptor, compared to THC's partial agonist effect. CBD is also a 5-HT1A agonist, which contributes to an anxiolytic effect of cannabis. The relatively large amount of CBD contained in Cannabis indica, means, compared to a sativa, the effects are modulated significantly. The effects of sativa are well known for its cerebral high, hence used daytime as medical cannabis, while indica are well known for its sedative effects and preferred night time as medical cannabis.
MMT (Methadone Maintenance Treatment)
A form of opiate replacement therapy, reduces and/or eliminates the use of illicit opiates, the criminality associated with opiate use, and allows patients to improve their health and social productivity. In addition, enrollment in methadone maintenance has the potential to reduce the transmission of infectious diseases associated with opiate injection, such as hepatitis and HIV. The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with opiates. Methadone maintenance has been found to be medically safe and non-sedating. It is also indicated for pregnant women addicted to opiates.
Allen Ginsberg
An American poet and one of the leading figures of the Beat Generation of the 1950's. Best known for his epic poem "Howl" where he denounced capitalism and conformity in the United States. After experiencing a vision of a world of peace and love during a psilocybin mushroom trip, beatnik poet Allen Ginsberg coined the term "flower power" to encompass this idea. The term soon came to symbolize sixties counterculture as a whole.
Views of Mental Illness: Ancient Greeks and Romans
Ancient Greeks and Romans thought mental illness was the result of chemical imbalances The ancient Greeks and Romans used potions and herbs to restore balance to bodily humors, phlegms and biles.
Anticholinergic Hallucinogens
Anticholinergic hallucinogens: include atropine and scopolamine, chemicals found in plants such as the deadly nightshade, mandrake, jimsonweed, henbane These drugs: produce semi-sleep state characterized by vivid visions and poor memory of the experience later
Antipsychotics
Antipsychotic medications, (aka neuroleptics or major tranquilizers): used to treat schizophrenia ,mania, agitated depression, toxic psychoses, emotionally unstable personalities, psychoses associated with old age. Primarily affect the reticular activating system, the limbic system, the hypothalamus
Cannabis Continued
Approximately 0.6 percent (22.5 million) of people used cannabis daily. Since the early 20th century cannabis has been subject to legal restrictions with the possession, use, and sale of cannabis preparations containing psychoactive cannabinoids currently illegal in most countries of the world the United Nations has said that cannabis is the most used illicit drug in the world
Epidemiology
About one-quarter of the U.S. population: experience some form of mental disorder in any given year Most common: symptoms associated with anxiety, depression, alcohol abuse Psychotherapeutic drug use: more likely among women, older people, people living alone, the more educated, those with higher incomes
Jim Morrison of the Doors
According to a sixties survey, in 1962 only 25,000 Americans had even tried LSD, but just four years later, at the end of 1965, this number had reached nearly four million. Seventy percent of them were high school or college age (Shapiro 139).
Endorphin Pain Relief
Acupuncture may relieve pain by releasing endorphins
Physiological Effects
Acute effects of marijuana: generally benign Effects include: bloodshot eyes, increased heart rate and pulse rate, decreased motor activity Psychological effects of cannabis: decreased psychomotor activity, happy feelings and relaxation, impaired short-term memory, altered time perception Has not been shown to enhance social skills or induce aggression or violence
Adverse Effects of Serotonergic Hallucinogens
Adverse effects: acute psychotic reactions (bad trips), flashbacks, long-term psychological deficits Bad trips: acute panic or paranoid reactions to the drug Bad trips: can cause an acute psychotic state during which users may harm themselves or others
Ken Kesey
American author, best known for his novel One Flew Over the Cuckoos Nest (1962), and as a counter-cultural figure who considered himself a link between the Beat Generation of the 1950s and the hippies of the 1960s. At Stanford in 1959, Kesey volunteered to take part in a CIA- financed study named Project MKULTRA at the Menlo Park, Veterans Hospital, where he worked as a night aide with Brian Samuels, who later became his partner in a trip around California in a Volkswagen. The project studied the effects of psychoactive drugs, particularly LSD, psilocybin, mescaline, cocaine, AMT, and DMT on people.
Timothy Leary
American psychologist and writer, known for his advocacy of psychedelic drugs. During a time when drugs such as LSD and psilocybin were legal, Leary conducted experiments at Harvard University under the Harvard Psilocybin Project,. Leary and his associate Richard Alpert were fired from the university. Leary believed LSD showed therapeutic potential for use in psychiatry..
Behavioral and Cognitive Effects
Amotivational syndrome: Loss of effectiveness and reduced capacity to accomplish conventional goals Data on cannabis causing an amotivational syndrome are mixed Both preexisting personality characteristics and drug effects probably account for lack of motivation in cannabis users
Views of Mental Illnesses: Asian Cultures
Asian cultures viewed mental illness as angry ancestors who were either disrespected or not buried properly Middle ages, mental illness was viewed as evil spirits, the devil or demons. The Asian cultures would try to make amends with the ancestors and during the middle ages there was blood letting , leeches, drilling holes in the skulls to release evil spirits.
Atypical Antidepressants
Atypical antidepressants include: Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL) Duloxetine (Cymbalta) Maprotiline (Ludiomil) Mirtazapine (Remeron) Nefazodone (Serzone) Trazodone (Desyrel) Venlafaxine (Effexor). Atypical anti-depressants are often prescribed when tricylics or SSRI's have not been successful. Wellbutrin for example works as a norepinepherine and dopamine re-uptake inhibitor. Remeron is an antagonist/inverse agonist to multiple receptor sites and inhibits the transport of norepinepherine. Cymbalta is a serotonin/norepineoherine reuptake inhibitor.
Bipolar I vs Bipolar II
Bipolar 1: To receive a diagnosis of Bipolar I disorder, a person must have a manic episode, an MDE may also occur Bipolar II: Presence (or history) of at least one major depressive episode (MDE), Presence (or history) of at least one hypomanic episode, No history of manic episodes, These symptoms (either the depression or the cycling between the depression and the hypomania) are creating problems with functioning or significant distress
Bipolar Disorders
Bipolar disorders: mood disorders in which a person's mood is often persistently and abnormally upbeat or shifts inappropriately from upbeat to markedly down
Understanding Bipolar Disorders - Neurological factors
Brain Systems The amygdala is enlarged in people who have been diagnosed with a bipolar disorder Researchers found that the amygdala is more active in people who are experiencing a manic episode than those in a control group of people who are not manic Neural Communication Serotonin, norepinephrine, and glutamate play a role Genetics There is a 4-24% risk of bipolar disorder for those who have a first degree relative with bipolar disorder There is a 40-70% chance for monozygotic twins
Historical Overview
Cannabis sativa: plant more commonly known as marijuana Originally, harvested primarily for its fiber; now most often grown for its psychoactive effects Marijuana: leafy top portion of the plant; hashish is made from the resin the plant produces for protection from the sun
Modern Treatments?
Chaining to the bed Isolation Ice water baths Cattle prods Isolation chairs Frontal Lobotomies Electroconvulsive shock therapy (ECT) Insulin induced comas
The Symptoms of Schizophrenia - Cognitive Symptoms
Cognitive deficits (also called neurocognitive deficits) include difficulties in sustaining and focusing attention Working memory, which consists of short-term memory and a set of executive processes that operate on information in short-term memory, is adversely affected People with schizophrenia often have difficulty with executive functioning which are mental processes involved in planning, organizing, problem solving, abstract thinking, and exercising good judgment Executive functions are required to organize, interpret, and transform information in working memory Cognitive deficits exist in childhood, long before a first episode of schizophrenia has emerged These deficits persist even when positive symptoms have lessened or remitted
Methylated Amphetamines
Created in 1910 has similar properties to amphetamine and mescaline, Used as a mood elevator and as an adjunct to psychotherapy. Can be used to enhance sexual behavior, which is where it got its popularity again in the 1990's. These drugs produce many other effects similar to LSD, but generally do not produce visual hallucinations Causes you to grind your teeth (bruxism) and tense the muscles of neck and jaw. The methylated amphetamines are both stimulants and hallucinogens and have been around for almost a century. MDMA is probably the one most people are familiar with due to its popularity in the Rave culture. Studies show that recreational doses of this drug kills off significant numbers of serotonin brain cells, which severely alters mood and cognitive abilities. Very dangerous drug for everybody and even though there rumors that by taking SSRI's you protect the brain, it is not true. It also may raise your body temperature to 110 degrees or higher and cause death.
Oxycontin Continued
Critics have accused Purdue Pharma of putting profits ahead of public interest. For failing to adequately warn consumers of the risks of OxyContin such as dependence For promoting the drug "aggressively" and by means such as "promotional beach hats, pedometers and swing-music CDs". In May 2007 Purdue Pharma "agreed to pay $19.5 million" in fines relating to aggressive off-label marketing practices of OxyContin in 26 states and the District of Columbia. In specific, the company encouraged dosing more frequent than the recommended interval of 12 hours, and did not fully disclose the risk of hazardous or harmful use. May 2007 Purdue Pharma and three of its top executives pled guilty in a Virginia federal court to charges. They misbranded OxyContin by representing it to have "less euphoric effect and less abuse potential" than it actually has. Claiming that people taking the drug at low doses could stop taking it suddenly without symptoms of withdrawal.
Cyclothymic Disorder
Cyclothymic disorder: chronic, fluctuating mood disturbance with numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for an MDE The lifetime prevalence is 0.4-1.0% and affects men and women equally The disorder unfolds slowly during early adolescence or young adulthood and it has a chronic course Approximately 15-50% with cyclothymia go on to develop some type of bipolar disorder
Disorganized Behavior
Disorganized behavior involves behavior that is so unfocused and disconnected from a goal that the person cannot successfully accomplish a basic task or the behavior is inappropriate in the situation Catatonia is a condition in which an individual remains in an odd posture or position, with rigid muscle, for hours
Theory of Depression
Depression is not caused by too much or too little of a neurotransmitter The disorder arises from complex interactions among numerous neurotransmitter substances The catecholamine hypothesis which posits that symptoms of depression arise when levels of norepinephrine fall too low When the brain does not have enough of a neurotransmitter, it attempts to compensate by increasing the number of receptors that respond to it Depression involves not only norepinephrine but serotonin as well
Myths Surrounding Hallucinogens
Destroys your chromosomes so you will have children with severe deformities Shrinks your spinal cord Drains your cerebral spinal fluid Stays in your body for ever If you use hallucinogens a specific number of times you are automatically clinically insane Flashbacks can occur for the rest of your life These are some common myths I have been asked over the years, mostly by students. It is true that LSD for example may alter chromosomes, but it is in white blood cells only not in reproductive cells. How could a drug shrink your spinal cord or drain your spinal fluid?? Unless you have metabolic problems or some liver damage or you are ingesting some heavy metals, all drugs are excreted from the body without a trace. As for hallucinogens causing you to become mentally ill, that is also not true unless the user has an undiagnosed condition or is borderline for a psychotic episode. As for flashbacks there is no scientific evidence that they exist.
Disorganized Speech
Disorganized speech involves the individual speaking incoherently Word salad is disorganized speech consisting of a random stream of seemingly unconnected words Neologisms are words that the patient makes up such as "easterhorned head" or "wish-bell"
Psychotherapeutic Drugs and Pregnancy
Decision to use psychotherapeutic medications during pregnancy: difficult, involves risk to mother and fetus Certain anxiolytic, antidepressant, and antipsychotic medications have relatively lower risk profiles
Delusions
Delusions are incorrect beliefs that persist, despite evidence to the contrary Delusions focus on a particular theme Paranoid delusions involve the theme of being persecuted by others Delusions of control revolve around the belief that the person is being controlled by other people (or aliens), who put thoughts into his or her head (thought insertion) Delusions of grandeur involve one believing that he or she is more powerful, knowledgeable, or capable more than is actually the case Delusions of reference involve the belief that external events have special meaning for the individual
Initial Side Effects from Antipsychotics
Drowsiness Restlessness Muscle spasm Tremor, Dry mouth Blurring of vision Most of these can be corrected by lowering the dosage or can be controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs
Persistent Depressive Disorder (Dysthymia)
Dysthymia is a depressive disorder that involves fewer of the symptoms of a major depressive episode, but the symptoms persist for a longer period of time Last at least 2 years and do not remit for longer than 2 months at any time during that period People with dysthymia are less likely to experience the vegetative signs associated with Major Depressive Episodes
Treatment of Schizophrenia
Early days used drugs like Thorazine, Haldol, Navane, and Stellazine All drugs act as dopamine antagonists since the disease may be caused by excessive dopamine at the receptor Newer selective drugs specifically target the dopamine receptor involved in schizophrenia. A more targeted pharmaceutical has fewer side effects. An example would be the drug Clozaril also known as Clozepine. These new drugs are called Atypical Antipsychotics such as Risperdal, Seroquel, Zyprexa, and Abilify
The Pre-Chlorpromazine Era
Early efforts to deal with mental illness included many cruel speculative approaches: bloodletting, hot irons, flogging, starvation Mid-1800s: cannabis was studied as a treatment for depression and mania First half of1900s: amphetamines treated depression; carbon dioxide treated psychosis
Early Psychiatric Hospitals
Early psychiatric hospitals did not have the advantages of psychotherapeutic drugs to treat patients with mental illness. This drawing depicts a patient with mental illness during the early 1800s
Discovery of Endorphins
Endorphins: some natural brain chemicals have morphine-like structure and properties, "brain's own opiates" One explanation: endorphins are part of a natural pain-relief system; produce analgesia or pain relief after certain kinds of pain or stress
Depressive Disorders Symptoms
Feelings of sadness or unhappiness Irritability or frustration, even over small matters Anhedonia:Loss of interest or pleasure in normal activities Reduced sex drive Insomnia or excessive sleeping Changes in appetite — depression often causes decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still Depression can happen as a result of loss or tragedy or even joyful occasions such as the birth of a child. Once a depressive episode happens it has a greater likelihood of reoccurring. Greatest risk associated with depression is suicidal behavior. Those in the grip of depression may often feel worthless or guilt-ridden and may evaluate themselves negatively for no objective reason There is a tendency to ruminate over past events and feelings They may feel unwarranted responsibility for negative events to the point of delusions Self-deprecating May have poor concentration, difficulty thinking, remembering, and making decisions Depression is heterogeneous
Negative Symptoms - Flat Affect
Flat affect is marked by a narrowed range of emotional expression Emotionally neutral, refrain from making eye contact They experience emotion, but it is not apparent from causal observation
Causes of Schizophrenia
Genetics Excess Dopamine at D2 receptors Enlarged Ventricles Fewer Pathways Virus theory Trauma Cell Loss
Hallucinations
Hallucinations are vivid sensations that seem real, even though they are not Auditory hallucinations are the most common Persons can have visual, tactile, olfactory, and gustatory hallucinations
Hallucinogens
Hallucinogens like so many drugs we have talked about during this course, have been around for thousands of years. There are many naturally occurring hallucinogens and many of them have been used for centuries as part of religious ceremonies. In fact there are certain people in the southwestern part of the U.S. who are allowed to still use hallucinogens as part of their religious ceremonies. They are allowed to do this because there are specific people who allowed to use them in the group and there are very tight controls surrounding the use of these products. These drugs are mostly used for information regarding group in terms of spiritual answers and guidance for tribal issues.
Overview of Hallucinogens
Hallucinogens: group of drugs that have the capacity to alter perceptual, cognitive, and emotional states Four classes of hallucinogens: serotonergic hallucinogens, methylated amphetamines, anticholinergic hallucinogens, dissociative anesthetics
New laws in Massachusetts
Like alcohol, marijuana would be legal for adults 21 years of age and older. But unlike alcohol, there would be limits on how much you could have with you at a given time. Adults could possess 1 ounce of dried weed or 5 grams of concentrate in public. You could have an additional 9 ounces in your home, but it would have to be secured with a lock. Gifts of 1 ounce would be legal. Marijuana stores would be allowed in every city and town unless voters in the municipality approve a local ban. The first licenses would be issued on Jan. 1, 2018. Existing medical marijuana dispensaries would have preference.
Mood Stabilizers
Lithium Carbonate Divalproex Sodium Carbamazepine Lamotrigine Eskalith CR, Lithobid Depakote Tegretol Lamictal
Natural Hallucinogens
Here is a partial list of the natural hallucinogens found in the environment. Psilocybin found in mushrooms was a very popular drug and still is today. Lewis Carroll who wrote Alice in Wonderland was a mushroom fancier and if you read Alice in Wonderland you can see the influence of his drug experience in the story. Alice eats something and gets big, drinks something and gets small, there is the hookah smoking catepiller, and all the other characters seem right our of a hallucinogenic experience. As for nutmeg, the active ingredient called myristica oil is the halllucinogen. For you to achieve hallucinations with nutmeg though you need to be very close to the lethal dose of this spice. Morning glory seeds that lead to hallucinations are not for sale in the local gardening section, but a variety of this seed does and can produce hallucinations. The peyote cactus contains mescaline, which can cause a loss of sense of time for the user. Short acting, about 2 hours. First reported use was in the 1500's. Ergot is a fungus that grows on rye plants. It has been speculated that the women who were accused of being witches in Salem MA were actually the victims of ergot poisoning. If the rye had ergot and then the women ground the rye into flour and then used that tainted flour to bake bread, they would have had a tremendous exposure. This may explain why they were seeing things and hearing things because they were hallucinating.
Treatment pt. 2
Heroin addiction has come back full force mostly due to the fact that the heroin on the street today is cheap and more potent than the heroin of the 60's and 70's. This increase in potency also allows the addict to either smoke or snort the drug and avoid using needles, which eliminates the risk of HIV and hepatitis B and C. People who had been afraid of heroin were no longer to it was not only in the cities, but was also spreading to the suburbs as well. In terms of long term treatment, it is very difficult to have success with this addiction. It is very difficult to stop using because the habit has become such a huge part of their life. It gets to the point where all they do is find and use. Narcotics Anonymous like the other 12 step programs is fairly successful, but many opiate addicts turn to the methadone maintenance programs. Needle exchange programs were created to decrease the spread of HIV and Hepatitis. Many people felt it was just promoting drug abuse, but at least the rate of disease would decrease. Because they are addicts people are less likely to help them due to the stereotypes especially following opiate addiction. Methadone was originally created as a synthetic alternative to morphine. Morphine was in such a short supply during World War II due to demand and since it was derived from the poppy, it could only be produced as fast as the plant could grow. So originally called Dolophine after Adolph Hitler, it was marketed as a long acting synthetic opiate that would only require once/day dosing instead of the very 4-6 hours with morphine. Methadone programs were originally designed as a multi faceted treatment program that required counseling, job coaching, family counseling etc, plus the drug. The programs were never fully funded so the counseling pieces and job training parts were severely cut and they became free-drug programs. These programs are not looked upon too kindly because many people do not want to pay for someone's addiction. There is such a shortage of these programs as well that there is often a 6 month waiting list. To the addict, to be told to come back in 6 months is killing them because they will not come back or they will literally die from their addiction. Studies show that to treat a heroin addict for 6 months with methadone costs about $1800 while an untreated addict costs us about $21,000 for 6 months. LAAM is another synthetic opiate, but the advantage of this drug is the addict only needs to take this drug three times/week, which would improve treatment outcome.
Two key features distinguish manic and hypomanic episodes:
Hypomania does not impair functioning; mania does Symptoms of a hypomanic episode must last for a minimum of 4 days, compared to 1 week for a manic episode
Hypomanic Episode:
Hypomanic episode: a distinct period of persistent and pervasive elated, irritable, or euphoric mood Less distressing than mania and doesn't impair functioning Clearly different from the individual's nondepressed state Does not have psychotic features nor requires hospitalization Rarely includes flight of ideas People are uncritically self-confident but not grandiose May talk loudly, but they can be redirected
Depressive Disorders
In any particular year, about 8% of Americans experience a mood disorder The DSM-5 distinguishes between two categories of mood disorders: Depressive disorders and bipolar disorders There are three types of episodes: Major Depressive episode Manic episode Hypomanic episode
Mechanisms of Action of LSD-like Drugs
LSD and the other drugs in this class: alter activity of brain systems mediated by the neurotransmitter serotonin Serotonin: widely dispersed throughout the brain, so LSD-like hallucinogens have varied effects Serotonin: essential to mood, so these drugs have powerful emotional effects
New laws in Massachusetts (cont.)
Labels on marijuana sold inside stores would include: a marijuana symbol, the names of the grower and manufacturer, the amount of THC and other cannabinoids, and the number of suggested servings in certain marijuana products, such as edibles. To protect against use by children, marijuana would be sold in childproof packaging. The CCC could limit the amount of marijuana grown in Massachusetts if it appears the legal supply has exceeded demand and is fueling the black market Current penalties for consuming marijuana while driving a car, boat, bus or train or for operating under the influence would remain in effect. But police say these laws would be difficult to enforce because there is no equivalent of a breathalyzer test for marijuana at this time.
MDMA
MDMA- similar to mescaline, synthesized in 1912, get enhancement of the sense of touch which was why it was later called Ecstacy. Associated with The Rave culture and became a schedule I drug in 1985. Can be taken orally, snorted or smoked and is a neurotoxin to serotonin neurons with repeated use.
Toxicity
MDMA: toxic reactions and death Toxic reactions: dehydration, heatstroke, heat exhaustion, muscle breakdown, kidney failure, stroke, seizures, heart attack
Mechanisms of Action
Main actions of marijuana: in the brain, resulting from the drug's effect on neurotransmitters. Specification of the drug action is unknown Recent advances include work on THC receptors in the brain
Major Depressive Disorder
Major depressive disorder (MDD) is marked by five or more symptoms of depression lasting more than 2 weeks More than half of those who have had a single depressive episode have at least one additional episode - MDD, recurrent depression As people with depression grow older, they are free of depression for increasingly shorter periods Up to 20% of Americans will experience depression in their lifetimes The rate of depression is increasing in the U.S. Commonly associated with more than $30 billion dollars of lost productivity
Medical Use of Opiate Drugs
Major medical use for opiate drugs: treatment of severe pain, but interestingly they don't eliminate the pain rather they alter your perception of the pain Opiate analgesics: relieve pain without causing unconsciousness Morphine: used primarily for severe pain Anti-tussives- All opiates work great as cough suppressants, but the only one still available is codeine, which is a less potent opiate About 50% of cancer patients never receive enough medication to adequately reduce their pain because doctors are afraid of addiction.
Bipolar Disorders - Manic Episode
Manic episode involves a period of at least 1 week characterized by abnormal and persistent euphoria or expansive mood or irritability Expansive mood involves unceasing, indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions A person in a manic episode may begin projects even though they have no skills or special training They may also believe they have special relationships with famous people or have superior abilities There is a need for less sleep They may talk rapidly and loudly, pressured speech They rarely sit still Flight of ideas: thoughts that race faster than they can be said Those in a manic episode may be highly distractible, have poor judgment resulting in reckless gambling, spending, or sexual behaviors A manic episode is briefer and ends more abruptly than a Major Depressive Episode
Marijuana
Marijuana is the most commonly abused illicit drug in the United States. A dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the hemp plant Cannabis sativa, it usually is smoked as a cigarette or in a pipe. It might also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish and, as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.
Epidemiology - Marijuana
Marijuana is the most frequently used illicit drug in the United States Past decade: use has decreased over the last decade Most common and efficient procedure for ingesting cannabis: smoking
What is the definition of Mental Illness?
Mental illness is defined by the culture and society that you live in and the current times.
Effects of PCP and Ketamine
Moderate doses: feelings of euphoria, numbness, slurred speech, motor discoordination, catatonia, rigid with blank stare or aggressive and hyperactive Effects include: profuse sweating, increased heart rate and blood pressure, rapid jerky eye movements (nystagmus) Overdoses (more than 20 mg): may result in seizures, prolonged coma, and sometimes death from respiratory failure
Treating Bipolar Disorders - Neurological Factors
Mood stabilizers are medications that minimize mood swings Lithium is the oldest mood stabilizer and is administered as a salt Affects several neurotransmitters Small therapeutic window between therapeutic and toxic effect Half of the patients taking lithium cannot tolerate the side effects or do not respond, especially rapid cyclers Mood stabilizers are used for those intolerant to lithium
Opiate Use in the 19th Century
Morphine: major active agent in opium, was isolated in 1803 Morphine: more potent than opium, became a major dependence problem Heroin: chemical compound based on an alteration of morphine, discovered in 1874. Even more likely than morphine to cause dependence By 1900 there were approximately 1 million opiate addicts in the United States and their addictions were enhanced by these three facts. Laborers from China were brought in to work on the railroad and they brought with them their custom of smoking opium The availability of purified morphine and the syringe through places like the Sear's catalog There were no controls on patent medicines
Classes of Drugs
Most common way of classifying psychotherapeutic drugs: by therapeutic use Four major categories: antipsychotics, antidepressants, antianxiety agents, mood-stabilizing drugs
Common natural hallucinogens
Mushrooms containing psilocybin Nutmeg Morning Glory Seeds Peyote cactus THC in marijuana Ergot
Treatment for opiate addiction
Narcotics anonymous- 12 Step program Needle exchange programs Methadone maintenance program Suboxone LAAM
Side Effects of Opiates
Nausea Vomiting Itching Decrease in blood pressure Clouded thinking Some experience a Dysphoria, which is unpleasant Takes about 2-3 weeks to see noticeable tolerance Overdose leads to respiratory arrest due to its sedative properties. Treatment of overdose is with Narcan which is an opiate antagonist.
Which Conditions Does Medical Marijuana Help?
Nausea associated with chemotherapy and AIDS treatment Glaucoma Migraines Fibromyalgia Multiple Sclerosis Amyotrophic Lateral Sclerosis About 20 other conditions as well
The Symptoms of Schizophrenia - Negative Symptoms
Negative symptoms are marked by the absence or reduction of normal mental processes, mental contents, and behaviors
Ethical Issues with Modern Treatments
Obviously the question mark at the end should let you know that these treatments were rather barbaric and many people died, but the mentally ill had very few if any rights. They were forgotten souls, left to live out the rest of their lives in these horrible institutions. Out of all of these techniques only ECT remains and it is done very differently today, but it is fairly common. In 1953, when no other treatments seemed to be helping, the notion of creating a chemical strait jacket appealed to many of the facilities. They used a major tranquilizer called Thorazine also known as Chlorpromazine, which was going to be used to sedate the patients so they will be easier to care for. What they didn't bargain on was it helped people who had been diagnosed with schizophrenia. It was the first successful treatment of the mentally ill and revolutionized the field of Psychiatry.
Opiate Withdrawal
Once addicted the addict really no longer lives to get high rather they work at avoiding withdrawal. There is a huge psychological component to withdrawal. If you had a heroin addict and showed them a syringe and told them the syringe was filled with narcan, but it was really saline, and injected them, they would instantly go into withdrawal. In this instance the withdrawal becomes classically conditioned just like Pavlov's dogs. There was also some evidence that since addicts are such creatures of habit i.e. they like to go to the same place with the same familiar people to take their drug, that their bodies become classically conditioned to the environment, so right before they inject, their bodies get ready and go into a compensatory state and their heart rate goes up as does their blood pressure and respiration. Once the drug gets into the system then their bodies return to normal levels. What is so fascinating about this is that if the addict goes to a different location or takes their drug in an unfamiliar environment then the body does not prepare and the addict may die at a dose that they had tolerated before. The only thing different is the environment. Narcan produces almost an instantaneous reversal of the effects of an opiate. If you ever saw the movie Pulp Fiction where Uma Thurman thought she was taking a line of cocaine, but she really snorted heroin and then they inject her into her heart with adrenaline and she instantly sits up!! It happens the same way with Narcan. Interestingly enough, the addict, whose life was just saved is often angry at the paramedic who got rid of his high
Jerry Garcia
Once the Warlocks moved away from their Acid Test days, they changed their name to Grateful Dead in order to signify a change in playing style. Since the Grateful Dead was surrounded almost entirely by people using psychedelic drugs while touring, this is reflected in the music that they created (Brown).
Pharmacokinetics
Onset of THC action: occurs within minutes of inhalation Peak concentrations: occur 30 to 60 minutes later Effects usually last two to four hours Excretion: most of the THC metabolites are excreted slowly, approximately half within several days and the remainder by the end of about a week
How do opiates work?
Opiates work by mimicking the endogenous opioid system of the endorphins. They are technically endorphin agonists Most opiates: absorbed by gastrointestinal tract, also nasal mucosa and lungs Create effects greater than the body could ever create Endorphins are released everyday into your body especially when under physical or psychological stress, but never to the degree that an exogenous substance like morphine provides. The highest levels of endorphins released in response to pain is at the end stage of childbirth, which is still not enough to eliminate the pain.
Opium poppy bulb
Opium exudes from incisions of the poppy pod
History of the Opiates
Opium: produced from the sap of the poppy plant Consumed orally or smoked Has been used for medicinal purposes for centuries; used as anagelsic for pain relief 1700s: first recognized as an addictive drug, in China
Oxycontin
OxyContin Abuse is becoming a wide spread problem in America. OxyContin is a leading treatment for chronic pain, but officials fear it may succeed crack cocaine on the street. The DEA says it is only a matter of time before every community in the country is confronted with the problem of OxyContin abuse. No prescription drug in the last 20 years has been so widely abused after its release, federal officials say. Rather than ingesting the pill as indicated, people who abuse OxyContin use other methods of administering the drug. To avoid the controlled-release, they chew, snort, or inject the medication to get an instant and intense "high". Improper prescribing practices by unscrupulous physicians are a way of diverting pharmaceuticals, according to law enforcement sources survey by the NDIC. The abuse of OxyContin, as with the abuse of most prescription drugs, creates a cycle of health care fraud. For example, a corrupt physician writes a patient a prescription for OxyContin for a nonexistent injury. The physician bills the insurance company for that, and subsequent visits. The patient uses a portion of the OxyContin and sells the rest for a substantial profit. The Huntington Drug and Violent Crime Task Force reports "There are too many doctors supplementing their income by writing improper prescriptions."
Oxycodone
Oxycodone is an analgesic medication synthesized from poppy-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, heroin, and codeine. Oxycodone oral medications are generally prescribed for the relief of moderate to severe pain. Currently it is formulated as single ingredient products or compounded products. Some common examples of compounding are oxycodone with acetaminophen/paracetamol or NSAID's such as ibuprofen. The formulations are available as generics but are also made under various brand names. OxyContin is Purdue Pharma's brand for time-release oral oxycodone.
Dissociative Anesthetic Hallucinogens
Phencyclidine (PCP) and ketamine are classified as dissociative anesthetic hallucinogens Moderate doses: produce a potent intoxication Higher doses: complete surgical anesthesia
PCP
Phencylidine was first created to be an I.V. anesthetic for humans and the medical world was excited about this because it did not cause respiratory depression in patients during surgery. Unfortunately it did cause wild hallucinations and the person was technically conscious during surgery and was aware of what was happening to them even though they felt nothing. This drug was moved to the veterinary medical world and was mostly used for large animals. Once the word got out though that this drug if smoked or snorted caused these feelings of empowerment, it became a pretty popular street drug and was often added to marijuana. There were wild stories about how people would take this drug and commit terrible crimes and it would turn you into a psychotic monster even if you were mild mannered. There was a classic scene on 60 minutes of a man with a hospital gurney strapped to his back ripping apart an E.R. and it showed the perils of PCP and scared many people. This and other things caused its banning in the mid 1980's. As it turns out, the drug does not turn you into something you are not. The patient in the E.R. had a very long history of violence so the drug just enhanced what he already was. PCP is still around and is classified as a dissociative anesthetic much like nitrous oxide and ketamine (Special K) where you are aware of what is happening, but don't care.
Effects of Serotonergic Hallucinogens
Physiological effects: pupil dilation, and increased heart rate, blood pressure, body temperature, sweating Psychological effects: visual hallucinations, alterations of mood and thought, dreamlike visions Synesthesia: experience of sensing a sound stimulus as a visual one
Schizophrenia brain scans
Pink areas indicate significant cell loss over time
The Symptoms of Schizophrenia - Positive Symptoms
Positive symptoms are marked by the presence of abnormal (or distorted) mental processes, mental contents, and behaviors and include: Hallucinations Delusions Disorganized speech Disorganized behavior Positive symptoms are distinguished by their extreme nature These symptoms are in excess, are intrusive The delusions are extensive Hallucinations, delusions, disorganized speech, and disorganized behavior constitute four of the five DSM-5 symptom criteria for schizophrenia. The fifth criterion is any negative symptom A person must have two out of five symptoms to be diagnosed with schizophrenia
Potency of Cannabis
Potency of cannabis: varies widely Marijuana grown in U.S.: lower THC content than that imported from overseas THC potency of marijuana smoked in the U.S.: typically 8% to 10% Potency of hashish and hash oil: higher,; hash oil contains up to 60% THC
Active Ingredients
Principal psychoactive agent in cannabis, delta-9-tetrahydrocannabinol; more commonly known as D-9-THC or simply THC THC was isolated in 1964 There are more than 400 compounds in the plant, including other cannabinoids, such as cannabidiol (CBD), cannabinol (CBN), and tetrahydrocannabivarin (THCV), which can produce sensory effects unlike the psychoactive effects of THC
Purpose of Psychotherapeutic Medication
Psychotherapeutic medications: prescribed in hopes of providing some relief for people with mental illness, and ideally the opportunity to function better in their environments
LSD continued
Rapid tolerance, so can't use too often Classified as both a psychotomimetic and a sympathomimetic Dose used today is significantly less than that used in the 1960's. Typical user is high school or college student, white, middle class and risk taker.
Residual Effects of MDMA
Research about long-term effects are inconclusive; tablet doses vary widely MDMA and related drugs pose risks of acute toxic effects and possible deficits in neuropsychological functioning, particularly among heavy users
Longer-Term Effects
Research on the long-term effects of marijuana is sparse Some effects associated with long-term marijuana use appear to be reversible with termination of its use. Possible exception: association between marijuana and lung cancer
Antipsychotics
Risperidone Paliperidone Aripiprazole Olanzapine Risperdal Invega Abilify Zyprexa
SSRIS vs SSNRIs vs TeCA
SSRI'S- Takes 2-6 weeks to work, targets the reuptake mechanism of serotonin. Side effects involve drowsiness, hyperactivity, sexual dysfunction. Examples of SSRI's are Prozac, Zoloft, Paxil SNRI's- Serotonin and norepinepherine reuptake inhibitors. Example Cymbalta TeCA- Tetracylic antidepressants prevent neurotransmitters from binding with nerve cell receptors called alpha-2 receptors. This indirectly increases the levels of norepinephrine and serotonin in the brain. In turn, that may improve and elevate mood. Example Remeron
Salvinorin A (Salvia)
Salvinorin A: hallucinogenic chemical found in a species of plant in the sage family (Salvia divinorum) Often called diviner's sage Only hallucinogen that acts on kappa receptors in the brain Generally smoked; cause short, intense trancelike states
Schizophrenia
Schizophrenia is characterized by psychotic symptoms that significantly affect emotions, behavior, and mental processes and mental contents The DSM-5 lists schizophrenia as a single disorder but research suggests it is not a unitary disorder Schizophrenia is a set of related disorders
Serotonergic Hallucinogens: LSD and Related Compounds
Serotonergic hallucinogens: include LSD, psilocybin, mescaline Psilocybin comes from mushrooms of the Psilocybe genus Mescaline come from the peyote cactus Early Native American peoples: used these drugs for religious purposes
Committee Reports on Marijuana
Several influential reports have appeared on the use of marijuana and its effects 1894 Indian Hemp Drugs Commission Report 1944 LaGuardia Committee Report Findings of such reports: marijuana use overall is not particularly harmful to society at large
Distribution, Metabolism and Excretion
Start in the bloodstream, then distributed throughout the body; accumulate in the kidneys, lungs, liver, spleen, digestive tract, muscles, brain Heroin is more lipid-soluble, more readily penetrates the blood-brain barrier than morphine
Role of the Environment
Stress, Abuse, Significant loss Traumatic experiences may play a role in bipolar disorder
Buprenorphine
Studies have shown that buprenorphine is safer than methadone due to lower overdose related deaths due to the treatment. Buprenorphine sublingual preparations are often used in the management of opiate dependence (that is, dependence on heroin, oxycontin, hydrocodone, morphine, oxymorphone, fentanyl or other opioids). The Suboxone and Subutex preparations were approved for this indication by the FDA in October 2002.
Acute Psychological and Physiological Effects of Opiates
Subjective reports of euphoria produced by opiates: drowsiness, body warmth, and heavy feeling of the limbs Opiates: depress respiration, lower body temperature, cause capillary constriction Most visible sign of opiate drug use: constriction of the pupils
Lysergic Acid Diethylamide
Synthesized by Albert Hoffman in 1938 Odorless colorless and tasteless May hallucinate for up to 12 hours Experience of the user depends on expectations If dosed without knowledge very bad experience May get synesthesia, which is a cross-over of sensory experiences. See sounds, hear colors, etc
History and Music
The American youth used drugs as a form of rebellion and a way for them to assert their defiance of societal norms. In 1964, the Haight-Ashbury district of San Francisco became "the meeting place for those opposed to American culture and mainstream ideals, and the cornerstone of this counter-cultural position was rock music". .
Oxycontin Continued 3
The company and the executives were to pay $634 million in fines for felony and misdemeanor misbranding. In October 2007, officials in Kentucky filed a lawsuit against Purdue Pharma Misleading health care providers and consumers "regarding the appropriate uses, risks and safety of OxyContin" In mid-2008, however, the case had been "consolidated with other lawsuits into a single multi-litigation suit" in a federal court in New York. Purdue Pharma has attempted to reformulate the 10-40 mg strengths of OxyContin Prevent the release of a high percentage of the oxycodone by crushing; however, in 2008 a joint panel convened by the U.S. Food and Drug Administration was "concerned that abusers could find a way to manipulate the new formulation". In 2010, Purdue Pharma introduced 'Oxycontin OP' Purdue Pharma predicted that abuse of higher dose formulations such as 'OxyContin' will go down, This change may have caused heavy recreational users to resort to other drugs such as heroin or may increase the number of deaths caused users attempting to take similar doses of drugs like 'Percocet' or 'Vicodin' to get similar effects. Since 'Oxycontin OP' has now fully saturated the street markets, recreational users find it nearly impossible to find the original Oxycontin formulations.
Deficit Subtypes
The deficit subtype requires the presence of severe neurocognitive deficits in attention, memory, and executive functioning as well as positive and negative symptoms that are manifestations of these deficits These patients are more impaired and their symptoms are less likely to improve
Side Effects of Treatment Medication
The most common side effect from the early drugs is a movement disorder called Tardive Dyskinesia, which occurs in about 15% to 20% of patients today. In many ways this disorder looks like Parkinson's Disease. You see shuffling when walking, pill rolling, lip smacking, and head bobbing. Once you have the disorder it never goes away and leaves permanent damage. Clozaril has fewer side effects, but the patient runs the risk of developing agranulocytosis, which is a destruction of white blood cells. Patients must have blood drawn every two weeks and if white cell count drops then they must get off the medication immediately and switch to the more traditional ones listed above. Newer antipsychotic drugs, such as Risperidone (Risperdal) (Risperdal), Quetiapine (Seroquel)quetiapine (Seroquel), Olanzapine (Zyprexa), and Aripiprazole (Abilify) are safer regarding the movement related side effects (known as tardive dyskinesia) common with first-generation antipsychotics, and they do not have the same risk of lowering white blood cell counts like Clozaril, but many of the atypical antipsychotics can contribute to metabolic side effects such as weight gain, increased glucose and lipids. Some people with schizophrenia may become depressed in addition to their psychosis, so it would not be uncommon to add anti-depressants to their regime. All psych meds have a true cost benefit to them. How much will they effect my body, but in exchange reduces or eliminates the symptoms.
Non-deficit Subtype
The nondeficit subtype requires the presence of primarily positive symptoms in conjunction with relatively intact cognitive functioning These patients are less impaired, and they have a better prognosis
New laws in Massachusetts (cont.)
The tax on marijuana would be 12 percent, of which 6.25 percent would be the state sales tax and 3.75 percent of that would be a new excise tax used to fund the CCC (with any remainder going to the state's general fund). Two percent would go to the city or town in which the marijuana is purchased. Residents would be allowed to grow six plants at home, with a maximum of 12 per household. Marijuana could not be smoked or consumed inside a store or in a public place. But the commission could license marijuana bars or marijuana use at special events, like a festival or a wine tasting.
Pharmacokinetics of LSD-like Drugs
These drugs differ widely in potency, duration of action, and other pharmacokinetic variables. LSD is the most potent of the class, with oral doses as small as 25 micrograms producing effects. Psilocybin is about 1% as potent as LSD
The Drug Addiction Treatment Act of 2000
Title XXXV, Section 3502 of the Children's Health Act of 2000, permits physicians who meet certain qualifications to treat opiate addiction with Schedule III, IV, and V narcotic medications that have been specifically approved by the Food and Drug Administration for that indication. This overturned a series of 1914-1920 Supreme Court rulings that had found that maintenance and detox treatments were not a form of medical treatment. These medications may be prescribed and dispensed by waived physicians in treatment settings other than the traditional Opioid Treatment Program (methadone clinic) setting. Since there is only one narcotic medication approved by the FDA for the treatment of opioid addiction within the Schedules given, DATA 2000 basically refers to the use of buprenorphine for the treatment of opioid addiction. Methadone and LAAM are Schedule II narcotics approved for the same purpose within the highly regulated methadone clinic setting.
Tolerance and Dependence
Tolerance: most likely when high doses of cannabis are used over extended periods of time. Dependence: has been documented; debatable whether it is more psychological than physical
Chronic Effects of Opiates
Tolerance: their effects are generally diminished unless users escalate the dose Withdrawal: abstinence syndrome - flu-like symptoms and intense drug craving More withdrawal symptoms: pupil dilation, anorexia, constant state of goose bumps, elevated blood pressure and heart rate
Types of anti-depressants
Tricyclics- Takes 4-6 weeks to work, toxic, causes dry mouth, dizziness, tachycardia and orthostatic hypotension. Examples of Tricyclics are Elavil, Anafranil, and Tofranil (TCA) MAO Inhibitors- Takes 4-6 weeks to work, can't eat food with tyramine like yeast products, coffee, wine beer, cheese, and chocolate. If consumed you will experience a hypertensive crisis. Examples of MAO inhibitors are Marplan, Nardil, and Iprozid (MAOI) Most commonly prescribed today are the SSRI's because they have the least amount of side effects in comparison with the other two categories, plus for some they tend to work faster than the others by about 2 weeks.
Cannabis in the New World
Use of cannabis for its intoxicating effects: centered in Asia, the Middle East, and North Africa for extended period of time 19th Century: Europe exposed to these effects Cannabis in the New World: began in1543, when the Spaniards brought it to Chile
Heroin
Used for a cough suppressant and available by prescription Very addictive Made illegal in 1924 in the U.S. Still legal by prescription in some countries such as England During the Vietnam war about 40% of U.S. Soldiers used heroin at some time About 7% of the soldiers remained addicted to heroin upon returning to the states.
Effects of Methylated Amphetamines
Usually taken orally but can be injected or absorbed intranasally Absorbed rapidly; duration of action is about six to eight hours Psychological effects: euphoria, increased emotional warmth and empathy, lowered defensiveness, increases in verbal behavior
Synthesis of LSD
While working for Sandoz laboratory, Albert Hoffman was searching for a treatment of migraine headaches. He was experimenting with ergotamines which are a derivative of ergot and he created Lysergic Acid Diethylamide also known as LSD125. He had very little success so he put the drug literally on the shelf. Years later he decided to perform some more experiments and he weighed out some of the drug and spilled it on his hands. He rubbed it off, but was unaware that LS could be absorbed right through your skin. Within a short period of time he needed to be taken home because he was hallucinating, but did not know why. He realized later on that it was the LSD that caused the hallucinations, so being a good scientist he went back to the lab and self administered a specific dose of LSD and kept a journal of his experiences. He brought this information to the head of research and they found two groups who were very interested in this product. The first group was psychiatrists because they thought it would be a good adjunct to psychotherapy so the patient's ego could be freed and you would have a better stream of consciousness. There were some psychiatrists who thought that both the patient and therapist should take LSD together so both parties would have greater insight. This was very popular in the 1950's as an adjunct to psychotherapy. The other group very interested in LSD was the military in the 1950's. We were in what was called the cold war and everyone was afraid of communists taking over the U.S. or dropping a nuclear weapon. The military thought LSD would be an excellent interrogation tool since you could out it in someone's food, drink, clothing, bed sheets or any where and it would be absorbed through the skin and since the person would not know what was happening the hallucinations and the experience in general are terrifying. There are still classified Department of Defense research documents regarding LSD. Harvard University was one of the main research sites as was the University of Minnesota. People who use it for recreational purposes must space out usage otherwise rapid tolerance develops and the user has no hallucinations. The brain only gets about 1% of the dose and about 90% is gone within 24 hours after use. There is no withdrawal or physical dependence associated with LSD.
The Average Opiate User in the late 1800's was:
White Middle aged female From the south Purchased their opium through the Sear's catalog After the civil war there was a tremendous increase in the number or morphine addicts mostly due to the invention of the syringe. This allowed for the first time to be treated for battle injuries using an injection of morphine instead of an oral dose. This quickly increased in popularity and since there were no controls, the market was wide open.
Negative Symptoms - Avolition
marked by a difficulty in initiating or following through with activities
Negative Symptoms - Alogia
marked by speaking less than most other people and responding slowly and/or minimally to questions Poverty of speech
