06 Mar MENTAL DISORDERS CAUSED BY RECEPTION OF TRANSCILIZERS AND SEDATIVE MEANS
Contents
- Horrible Stepfather Gave Sleeping Pills To Teen And Creampie Her Pussy While She Was Passed Out
- Charges: Minneapolis woman robs roommate of $20K, forces him to take sleeping pill
- Sleepy Sleeping Pill GIF by Saturday Night Live – Find & Share on GIPHY
- ‘The Iron Dome has become a sleeping pill’
- Why I will never take another sleeping pill ever again
MENTAL DISORDERS CAUSED BY RECEPTION OF TRANSCILIZERS AND
SEDATED MEANS
MENTAL DISORDERS CAUSED BY RECEPTION
TRUNKILIZERS AND SEDATED MEANS
A. Yu. Frolkov
BUZ Voronezh
Voronezh Regional Clinical Drug Dispensary Russia,
Voronezh
Annotation. For addictions
and substance abuse a common problem is that a person is initially deprived
free choice. And the matter is not at all in the degree of availability of substances, as someone
might think not. The fact is that a truly free choice
implies the ability to predict the consequences of this very choice, in
including the most negative ones.
The article is devoted to the main varieties.
drug and substance abuse as a result of the abuse of sedative-hypnotic drugs
means and tranquilizers, taking into account the peculiarities of their manifestations. Types and dynamics are described.
addiction development, clinical manifestations, diagnosis of intoxication and
the effects of anesthesia above these funds.
Key
words: abstinence syndrome, mental dependence, psychosis, tolerance, physical
addiction, euphoric effect.
Relevance. Causing
addiction sleeping pills consist of two groups – derivatives
Horrible Stepfather Gave Sleeping Pills To Teen And Creampie Her Pussy While She Was Passed Out
barbituric acid and non-barbitural substances. Abuse
hypnotics listed as drugs are treated as addicts, and
abuse of other hypnotics – like substance abuse [REF _Ref473311163 \ r \ h 1
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].
From the group
Barbituric acid derivatives include etamininal sodium.
(Nembutal) and amital – sodium (barbamil). From hypnotic non-barbitur series,
referred to as drugs, first of all it should be called Noxiron. Mechanism of them
actions as well
nature of dependencies are similar. According to the terminology adopted by the commission
drug experts WHO, this type of addiction is called
barbituric
When barbitur dependence is available
many common features with alcohol abuse. They are determined by
that both alcohol and barbiturates, possessing some stimulating properties,
have a more pronounced sedative effect [REF _Ref473311163 \ r \ h 1
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, REF _Ref473387067 \ r \ h 12
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].
Among the abusers
hypnotics distinguish two groups of patients. Patients of the first group begin
take sleeping pills in therapeutic doses as prescribed by a doctor or
independently in various diseases. Persons belonging to the second, immediately
begin to take sleeping pills in order to induce euphoria [REF _Ref473311165 \ r \ h 2
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, REF _Ref473387066 \ r \ h 11
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].
To the first group
primarily individuals with neurotic mood disorders,
disorders of social adaptation, patients with alcoholism. Sleeping pills on
First, they improve their subjective state – they stop insomnia,
affective disorders are smoothed, experiences are less relevant,
associated with insufficient adaptation in the environment. But at constant
prolonged use of even therapeutic doses occurs mental
addiction. At the first stage, it is insignificant and medication may be
discontinued without marked discomfort. However, with prolonged regular
Acceptance of hypnotic drugs former therapeutic dose gradually ceases
have the desired effect, there is a need to increase the dose, i.e.
there is tolerance. Increases mental addiction. The patient thinks
that sleeping is impossible without normal sleep. Gradually dose
begin to exceed therapeutic, which leads to the formation of physical
dependencies. Many patients with all sorts of agripnic neurotic
Disorders can take double for years
therapeutic doses of sleeping pills, they have a very slow growth
tolerance, although mental dependence on drugs and
there are slight organic changes in personality
memorization, slowness, mood disorders). Terms of formation
Dependencies are determined by the dose, the frequency of taking the drug and the method of administration. Minimum
daily dose of barbiturates, which can for 3 months. daily intake
cause physical dependence, is 0.5 gr. amytal — sodium; daily
reception 0.8 gr. barbiturate may cause a rise in tolerance first,
formation of mental, then – after 1-1.5 months. physical dependence [REF _Ref473311163 \ r \ h 1
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].
Transition from abuse
to addiction usually occurs unnoticed by the anesthetic himself.
Symptoms of the disease develop in a very short time. One of the important
signs of formed what is ambien addiction is taking sleeping pills in
daytime hours. Although patients are often not aware of this and believe that the daily
taking sedatives only “calms” them; this can serve as an important
differential – diagnostic sign of the developing disease.
Patients related to
the second group immediately begin taking sleeping pills in search of euphoria, using
for this double and triple therapeutic doses. In these cases it is especially important.
setting to receive euphoria. The onset of the disease in this group
patients occurs quickly, especially when administered intravenously [REF _Ref473311163 \ r \ h 1
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].
Euphoric
the effect of barbiturates in the two groups is different. In the first group
patients who for a long time took therapeutic doses, and then became
to increase them, the euphoria is smoother, occurs when taking doses of 0.4–0.5 g,
manifested in the improvement of emotional state, elevation of mood, and also in
intensification, a surge of strength, energy, desire to move, speak, strengthen
appetite. This state lasts up to 4 hours and goes to sleep with light and pleasant
dreams. Wake up
patients with a sense of cheerfulness, rest and good mood. Usually they do not
regard this state as intoxication and claim to take elevated
doses of barbiturates to improve performance [REF _Ref473311163 \ r \ h 1
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, REF _Ref473387058 \ r \ h 6
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].
Sick second
groups, having a setup not for falling asleep, but for an euphorizing effect, take
drugs from the outset in an environment that prevents falling asleep. Moreover, they
use intravenous administration, in which the initial dose of 0.3 g can immediately
same cause euphoria, which lasts 6 hours and turns into a dream. On waking
almost always noted amnesia intoxication [
REF _Ref473311163 \ r \ h 1
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, REF _Ref473387060 \ r \ h 7
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, REF _Ref473387067 \ r \ h 12
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].
Gradually in the process
anesthesia the initial euphoric effect begins to decrease and
tolerance develops. In the first group of patients the need for increasing doses
occurs after a longer period – in 6–12 months, reaching the level of
0.6–2 g. In the second group, intravenous tolerance develops.
very quickly – for several days of continuous use of the drug in doses
exceeding therapeutic, and in oral administration – in 1–1.5 months. There is
cross tolerance of barbiturates with alcohol. Further formation
drug addiction is in both groups according to the same laws [REF _Ref473311163 \ r \ h 1
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].
2-3 years of regular
receiving barbiturates the need for further increasing doses is reduced,
tolerance reaches a certain limit. Duration of the stabilization period
doses in the first group – a few years, in the second – 4-6 months. Then there is a trend.
to reduce doses. During this period, patients suffering from barbituromania,
overdoses are often observed [REF _Ref473311163 \ r \ h 1
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].
As known,
the physiological effect of hypnotics consists of two phases: in the first –
short phase – a stimulating effect appears, in the second, longer –
sedative. Tolerance
develops primarily to the sedative effect [REF _Ref473311163 \ r \ h 1
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].
Unlike
opium addiction, with barbituromania, the upper limit of the dose that the patient
can tolerate, not so dramatically different from the initial dose, capable of
cause euphoria, i.e. range between narcotic and lethal doses
is small. AT
In this case, when taking a constant dose, the stimulating effect may become predominant,
which forces the patient to increase the dose in order to get the desired sedative
effect, sometimes to life-threatening values. This leads to overdoses [REF _Ref473311163 \ r \ h 1
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, REF _Ref473387066 \ r \ h 11
Charges: Minneapolis woman robs roommate of $20K, forces him to take sleeping pill
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360036000000
].
After
discontinuation of barbiturate tolerance decreases very quickly: after 2–3
weeks after discontinuation, the maximum tolerated dose returns to
original level. Hence the frequency of overdose and death after discharge of patients
from the hospital.
Overdose of barbiturates
accompanied by dizziness, nausea, vomiting, marked profuse perspiration,
hiccups, nausea, pain in eyes, drooling. After vomiting can
come relief. In the process of anesthesia after 4-6 months after the first
an overdose receiving large doses is no longer accompanied by the above phenomena,
and without any precursors, loss of consciousness occurs, followed by
amnesia.
Depending on barbiturates outside of their reception
develops a state of dissatisfaction and weakness, accompanied by
“dark thoughts”, alarming fears, fears,
irritability, worse in the evening. Also characteristic
insomnia. Reception of barbiturates becomes a source of calm in these cases.
and satisfaction.
When administered intravenously, as well as
in opiomania, barbituric drug addicts secrete the first phase of the action of sleeping pills
– “coming”. It arises immediately and according to the descriptions of patients continues
few seconds. Patients say they have “turned off the mind”,
“the head went round”, “dark in the eyes”, the surrounding is not perceived.
After a few seconds, the second phase of the sleeping pill begins, resembling
alcohol intoxication. It is characterized by motor activity, causeless
fun, desire to move and at the same time, irregular movements,
distractibility attention, reduced judgment, irritability.
Merry sometimes sometimes turns into anger. Patients are either disinhibited or
drowsy. Observed progressive deterioration in motor coordination, euphoria
or oppression. Possible paradoxical motor stimulation, bradycardia,
blurred speech.
In somatic condition draws on
attention to a decrease in urination, a decrease in blood pressure and body temperature,
hypersalivation, hyperemia of the sclera and skin, increased sweating; leather
with characteristic greasy tint; tongue is covered with a dirty gray coating. Neurological
examination marked lateral nystagmus, diplopia, dysarthria, dysmetria,
lack of coordination of movements, instability when walking and standing, reducing
tendon and abdominal reflexes, dilated pupils, lethargy of their reaction to
shine. This state lasts 2–3 hours. Gradually, mental and motor
activity decreases, and the patient falls asleep. Sleep hard, deep, wake up
anesthetized hard. Muscle hypotension is expressed. If sleep comes in the afternoon,
he is brief. The next night, falling asleep is difficult. On waking
there are sluggishness, weakness, weakness, inability to concentrate. Sometimes
there are muscle weakness, tremor, often a headache. Nausea and
vomiting. There is no appetite, often thirst. In some
cases, a glass of hot water resumes the feeling of intoxication: dizziness,
rise in mood, increase in activity [REF _Ref473311163 \ r \ h 1
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360033000000
, REF _Ref473311165 \ r \ h 2
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360035000000
, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
, REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, REF _Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref463817655 \ r \ h 10
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400360033003800310037003600350035000000
, REF _Ref473387066 \ r \ h 11
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360036000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
Diagnostics
barbiturate intoxication. Rough neurological symptoms distinguish it.
intoxication from alcoholic. Therefore, the attention of the physician should attract
dysarthria, ataxia, impaired coordination of movements, large lateral
nystagmus, a sharp dilation of the pupils with a sluggish reaction to light, hypersalivation,
hyperhidrosis, tendency to anger and aggression. From opiate addiction
intoxication with sleeping pills is characterized by impaired consciousness, the above
neurological symptoms, pupil size, skin color,
hypersalivation, hyperhidrosis, inability to dissimulate, lack of
ease of emotion [
REF _Ref473311163 \ r \ h 1
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, REF _Ref473311165 \ r \ h 2
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360035000000
, REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, REF _Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
After about 6
months with regular intake of barbiturates, physical dependence is formed,
characterized by the onset of withdrawal symptoms. By this time
tolerance is established at the same level – 1g, less often 1.5–2g. Is changing
character of intoxication. Intoxication retains mobility, but movement is sufficient.
coordinated. Locks and rough awkwardness of movements disappear.
Intoxication, if there is no overdose, is not accompanied by a violation of consciousness. Not
that disinhibition and talkativeness, which are observed in the initial period.
There is a jam of affects, possible attacks of anger, aggression. During the period
intoxication, speech is monotonous and monotonous, oligophasic, with perseverations.
Malicious, stagnant affect, resembling the affect of a patient with epilepsy. More
disturbed sleep. Sleep patient can only when taking an increased dose
sleeping pills. In case of overdose, vomiting does not occur, sleep does not occur, immediately without
Stage sleep develops coma. Loss of quantity is very characteristic
control intoxication and as a result of intoxication a deep disorder
consciousness with subsequent amnesia. More often observed overdose, often with
fatal. Expressed compulsive attraction to the drug. Abstinence
syndrome with the abuse of hypnotics heavy. It occurs during the first
24 hours after taking the drug, reaches a peak of severity at 3–4– e day and
slowly reduced. By the end of the first day after taking the drug mood
in patients it becomes anxious and dreary, and the alarm is on the first
plan. Expressed
irritability, resentment, irascibility, tearfulness, sleep upset.
The first 1-2 nights the patients sleep, although not enough (no more than 5-6 hours), with nightmarish
dreams, severe sweating. On days 2–3, sleep disorders reach
maximum up to complete insomnia. In the same period reach a maximum
and affective disorders, dysphoria, agitation. Frequent suicidal tendencies
demonstrative self-cutters. Further progressive weakness is observed.
dizziness, distortion of visual perception. HELL unstable,
there may be a sharp drop in it until collapse and death [REF _Ref473311163 \ r \ h 1
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, REF _Ref473311165 \ r \ h 2
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, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
]. Such cordially
– vascular disorders are especially characteristic of barbituromanim who use
high doses of drugs. On days 3–4, unpleasant feelings arise in different
parts of the body, pain in large joints (knee, shoulder, elbow), aching
pain in the stomach, nausea, vomiting, weight loss. All patients have eyelid tremor,
fingers of outstretched hands, tongue. Very characteristic involuntary muscle
twitching, mainly in the calf muscles [REF _Ref473311165 \ r \ h 2
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, REF _Ref473387052 \ r \ h 3
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, REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, REF _Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref463817655 \ r \ h 10
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, REF _Ref473387066 \ r \ h 11
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360036000000
].
Withdrawal syndrome with
abuse of sleeping pills is dangerous by the occurrence of convulsive seizures and
psychosis. They are observed when taking large doses of drugs and can replace
each other. So, a patient may have 1 or 2 convulsive seizures during the first
days after discontinuation of the drug, and psychosis develops on the 2-3rd day (usually
at night).
Convulsive phenomena occur more often on 3-5
– day of deprivation or significant reduction in doses of sleeping pills. They
characterized by developed convulsive seizures, indistinguishable from seizures
with genuinic epilepsy [
REF _Ref473311163 \ r \ h 1
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, REF _Ref473311165 \ r \ h 2
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, REF _Ref473387055 \ r \ h 5
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, REF _Ref473387060 \ r \ h 7
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, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref473387063 \ r \ h 9
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, REF _Ref473387066 \ r \ h 11
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, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
Psychoses arise
on days 3–8, to deprive or sharply reduce large daily doses of sleeping pills. Psychoses are presented
usually delirium, less often – verbal hallucinosis. Delirium caused
deprivation of sleeping pills, on the clinical manifestations is similar to alcohol. He is distinguished
a greater severity of anxiety, tension, viciousness of patients, rarity
tactile hallucinations, a greater proportion of auditory hallucinations, the presence
muscle jerking. Rarely occurring hallucinatory delusional psychosis
resemble schizophrenic. In their structure, hallucinations and delusions are noted;
patients can be in a staged or, on the contrary, to show panic
reactions [
REF _Ref473311163 \ r \ h 1
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, REF _Ref473387053 \ r \ h 4
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, REF _Ref473387058 \ r \ h 6
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, REF _Ref473311175 \ r \ h 8
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, REF _Ref473387063 \ r \ h 9
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, REF _Ref463817655 \ r \ h 10
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, REF _Ref473387067 \ r \ h 12
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].
Abstinence syndrome with abuse
sleeping pills lasts on average 3 weeks, sometimes up to 4-5 weeks. The longest can
hold on to mood disorders, intermittent craving for
drug, poor sleep, dysphoric reactions, decreased appetite. Fracture in
Withdrawal occurs with appetite – on the 10–14th day. Considering
the possibility of developing epileptic seizures and psychosis, a tendency to
suicides, as well as severe somatic consequences, withdrawal syndrome with
abuse of sleeping pills is life threatening to patients [REF _Ref473311163 \ r \ h 1
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, REF _Ref473387052 \ r \ h 3
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, REF _Ref473387053 \ r \ h 4
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, REF _Ref473387055 \ r \ h 5
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, REF _Ref473311175 \ r \ h 8
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, REF _Ref473387063 \ r \ h 9
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, REF _Ref463817655 \ r \ h 10
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, REF _Ref473387067 \ r \ h 12
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].
In advanced cases
withdrawal syndrome can transform. It becomes protracted
(up to 2 months or more), although its symptoms seem to be losing their sharpness. Less pronounced pain
syndrome, decreases the intensity of pain, dysphoria is replaced
sluggish apathetic subdepression. Sometimes to the forefront persistent
depression with suicidal tendencies. In somatic status prevail
functional disorders of the cardiovascular system: collapses, signs
myocardial dystrophy on ECG. Convulsive seizures are often serial.
(5–10 seizures per day), are not stopped by anticonvulsants. To this
epileptiform changes on the EEG correspond. Observed and heavy
delirious states [
REF _Ref473311163 \ r \ h 1
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, REF _Ref473311165 \ r \ h 2
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, REF _Ref473387052 \ r \ h 3
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, REF _Ref473387053 \ r \ h 4
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, REF _Ref473387058 \ r \ h 6
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, REF _Ref473387060 \ r \ h 7
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, REF _Ref473311175 \ r \ h 8
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, REF _Ref473387063 \ r \ h 9
Sleepy Sleeping Pill GIF by Saturday Night Live – Find & Share on GIPHY
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref463817655 \ r \ h 10
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].
With long
abuse of sleeping pills is very quickly formed a kind of defect,
resembling psychopathic organic. Fatigue, exhaustion appear
attention, lack of ability to concentrate, inability
intense mental activity. Performance gradually decreases:
patients work only for short periods, provided they receive a sufficient dose and
achieving a state of mental and physical comfort in the period
intoxication. The circle of interests is narrowing. Patients become irritable, dysphoric,
vicious [REF _Ref473311165 \ r \ h 2
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, REF _Ref473387052 \ r \ h 3
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, REF _Ref473387053 \ r \ h 4
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, REF _Ref473387055 \ r \ h 5
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, REF _Ref473387058 \ r \ h 6
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, REF _Ref473387060 \ r \ h 7
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, REF _Ref473387063 \ r \ h 9
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, REF _Ref463817655 \ r \ h 10
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].
Characteristic external
kind of sick: they are pale, pasty, complexion with a dirty – sallow
shade, tongue overlaid. Trophic disorders are noted: wounds do not heal for a long time,
fester; many skin pustular rash; eyes lose their shine;
hair becomes brittle.
Gradually, patients develop
state of toxic encephalopathy, manifested in the slowness of mental
processes and speech, expressed intellectually – mnestic reduction. Characteristic develops
barbitural dementia with reduced acumen, difficulty with
the slightest mental effort, slow thinking, slow speech,
limitation of vocabulary, gross memory impairments. Patients are not critical to
your condition and disease in general. They have no moral or ethical standards.
behavior. They are dirty and sloppy. The state of lethargy and apathy is often replaced.
gross dysphoric reactions with nastiness, sometimes aggressiveness. Face
Ammonic, Maskoobrazno. Expressed personality changes. Patients are selfish, false.
Moral degradation exceeds that in all other forms of drug addiction. All this together
creates the characteristic appearance of patients who have long abused hypnotics [REF _Ref473311163 \ r \ h 1
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, REF _Ref473311165 \ r \ h 2
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, REF _Ref473387052 \ r \ h 3
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, REF _Ref473387058 \ r \ h 6
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, REF _Ref473387060 \ r \ h 7
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, REF _Ref473311175 \ r \ h 8
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, REF _Ref473387063 \ r \ h 9
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, REF _Ref473387066 \ r \ h 11
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, REF _Ref473387067 \ r \ h 12
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].
Substance abuse caused by the abuse of tranquilizers.
To tranquilizers
includes a large group of substances that have a calming, anti-anxiety
(anxiolytic) action.
Abuse of tranquilizers has become
currently one of the most common forms of substance abuse. This is because
they are relatively affordable drugs that are widely
appointed by doctors of all specialties, and many people use them without
doctor’s appointments. Especially widely used derivatives
benzodiazepines (along with cardiovascular agents, they are
most common drugs in the world). Benzodiazepines widely
used in medical practice as anti-anxiety (anxiolytic),
hypnotics, anticonvulsants, muscle relaxants. Most often
means of abuse are diazepam (seduksen, Relanium, sibazon),
lorazepam (ativan), nitrazepam (radeorm, eunookin), phenazepam, alprazolam
(Xanax), clonazepam, less often – chlordiazepoxide (Elenium). They are used inside,
intravenously and intramuscularly [ref_Ref473311163 \ r \ h 1
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, REF _Ref473311165 \ r \ h 2
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, REF _Ref473387052 \ r \ h 3
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, REF _Ref473387053 \ r \ h 4
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, REF _Ref473387060 \ r \ h 7
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, REF _Ref473311175 \ r \ h 8
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, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref463817655 \ r \ h 10
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400360033003800310037003600350035000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
Clinical practice
shows that the effectiveness of benzodiazepines with their prolonged use
going down. This leads to the development of tolerance and “withdrawal syndrome”, i.e. arise
The main signs of addiction are substance abuse. Benzodiazepine tolerance
develops at different times in relation to the various effects of the latter: in
first of all to sedative, muscle relaxant, and then to anti-anxiety. It is believed that
benzodiazepine tolerance is more associated with pharmacodynamic
mechanisms (change in receptor activity), rather than with metabolic. There is
cross tolerance with barbiturates, alcohol, other sedative-hypnotic
drugs.
Characteristic for getting used to
benzodiazepines are circadian rhythm sleep disorders – wakefulness with
nocturnal awakening and inability to fall asleep without taking the next dose
drug.
The risk of developing physical dependence
increases with prolonged (over 6 months) medication and when used
excessively high doses. But described the cases of development of withdrawal syndrome with
the abolition of benzodiazepines and after less than a long reception (2-3 months) Severity of abstinence
syndrome depends on the dose of the drug. Most often addictive and
development of abstinence syndrome with the abolition cause lorazepam (ativan),
alprosolam, clonazepam and diazepam. Manifestations of abstinence syndrome after
cancellations of tranquilizers may resemble the symptoms of the disease itself.
Differential diagnosis in these cases presents known difficulties. Staging
diagnosis may be based on the rate of development of the corresponding symptoms:
its slow increase indicates the resumption of primary symptoms
diseases for which tranquilizers were prescribed, the rapid development
withdrawal syndrome [
REF _Ref473311165 \ r \ h 2
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360035000000
, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
, REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, REF _Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref463817655 \ r \ h 10
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400360033003800310037003600350035000000
, REF _Ref473387066 \ r \ h 11
‘The Iron Dome has become a sleeping pill’
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360036000000
].
In addition to patients who have a long time to
dependency formations took benzodiazepines for therapeutic purposes,
There is a group of people who immediately begin taking tranquilizers in search of
euphoria.
With a narcotic purpose, tranquilizers are used as
separately and in combination with other psychoactive substances. Most
frequent is the combined use of tranquilizers and alcohol. In some
cases it is a question of wine narcosis [REF _Ref473311163 \ r \ h 1
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360033000000
, REF _Ref473387053 \ r \ h 4
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, REF _Ref473387055 \ r \ h 5
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, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
Clinical
picture of substance abuse caused by benzodiazepine abuse
similar to that of barbitur addiction, but with abuse
benzodiazepines development of the corresponding symptoms occurs more slowly,
and the severity of affective disorders and the depth of the intellectual and mnestic
reductions are less and they are not so brutal [REF _Ref473311163 \ r \ h 1
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360033000000
, REF _Ref473311165 \ r \ h 2
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360035000000
, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
, REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref463817655 \ r \ h 10
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400360033003800310037003600350035000000
, REF _Ref473387066 \ r \ h 11
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360036000000
].
The clinical picture of intoxication caused by
benzodiazepines, resembles that of barbituric intoxication, but partially depends
and from the drug taken. So, radedorm causes intoxication, similar to
alcoholic, combined with severe inhibition, drowsiness,
myorelaxation; phenazepam causes disinhibition, unmotivated
motor activity; diazepam causes euphoria. It should, however, be noted
that patients abusing benzodiazepine derivatives alternate most often
or combine different drugs of this group.
The dose required to achieve euphoria, usually in
several times the therapeutic. With a single dose of 4-5 tablets
(20-25 mg) diazepam (seduxena, Relanium) orally, you can experience
euphoria. The latter is characterized by elevated mood, restlessness,
the desire to go somewhere, to do something. This may decrease clarity.
perception of the environment, it is difficult to switch attention, reduced speed
reactions. Some patients note the feeling of flight, weightlessness. Externally, patients in
the described state make an impression of people in a state of pronounced
alcohol intoxication. Their coordination is impaired, their gait becomes uncertain, with
staggering. They are lively, talkative. Speech dizarthrichna. In speech production
Perseverations are detected. Pallor of integuments, faces is noted. Pupils
dilated, with a sluggish reaction to light. The tongue is covered with a dense whitish bloom.
The mucous membranes are dry. Muscle tone (especially lower limbs) sharply
reduced Intoxication ends in sleep or gradually passes and turns
a state of lethargy, physical weakness, “hands do not rise, legs like
wadded “. Disrupted appetite. After discontinuation of diazepam condition
normalized in a day. Intravenous administration of diazepam in excess of
therapeutic, causes euphoria, similar to the barbituric. At the same time in action
Intravenous diazepam clearly pronounced hypnotic effect.
3-4 weeks after the start
systematic administration of benzodiazepines, previous doses no longer cause euphoria. The number of accepted
drug increases. Growing tolerance. The shape gradually changes.
intoxication. Restlessness, gabbiness remain, but dysmotility, statics
almost not pronounced. As the sobering up to a much greater degree
becomes pronounced post-toxic state in the form of lethargy, indifference,
weakness, apathy, depression. Along with this marked irritability,
angry reactions, tearfulness. Doses far in excess of therapeutic
may cause psychomotor agitation, sometimes accompanied by illusions and
hallucinations, disorders of consciousness of the twilight type. Psychoses are described
caused by acute intoxication with benzodiazepines, in particular phenazepam,
developing mainly as a delirium [REF _Ref473311165 \ r \ h 2
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360035000000
, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
, REF _Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref463817655 \ r \ h 10
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400360033003800310037003600350035000000
, REF _Ref473387066 \ r \ h 11
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360036000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
With an overdose
benzodiazepine derivatives develop a soporous disorder of consciousness,
passing into a coma. Danger to life are disturbed breathing,
cardiovascular and kidney functions. Areflexia and mydriasis are noted [REF _Ref473311165 \ r \ h 2
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360035000000
, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
, REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, REF _Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
In the structure of abstinence
syndrome after the abolition of benzodiazepines there are mental and
somatoneurological disorders. The first are irritability,
down to severe dysphoria, tension, depressed mood, significant
increased anxiety and anxiety, agitation or, conversely, lethargy, increased
fatigue, and also depersonalization and severe sleep disorders, often with
nightmares. Somatoneurological disorders include
autonomic disorders: increased sweating, hyperhidrosis, tachycardia (up to 100
strokes and more per minute), hypotension, sometimes hyperthermia. Besides,
marked anorexia, nausea, vomiting. There may be dizziness, headache.
There are small-scale tremor of the fingers of outstretched arms, incoordination
movements, vision, speech difficulties. 2-3 days after cancellation
benzodiazepines are possible fibrillar twitching of the muscles of the face and limbs. The skin is pale.
Pupils are wide, sluggish to light. Small horizontal nystagmus is expressed
with extreme abduction of the eyeballs [REF _Ref473311163 \ r \ h 1
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360033000000
, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
, REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref473387063 \ r \ h 9
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360033000000
, REF _Ref473387066 \ r \ h 11
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360036000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
There are three groups.
symptoms of benzodiazepine withdrawal: mental, somatic, disorders
perception. The latter include paresthesia, photophobia, hyperacusia, olfactory and
tactile hypersensitivity, feeling of heat and cold [REF _Ref473311163 \ r \ h 1
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360033000000
, REF _Ref473311165 \ r \ h 2
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100360035000000
, REF _Ref473387052 \ r \ h 3
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350032000000
Why I will never take another sleeping pill ever again
, REF _Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
, REF _Ref473387060 \ r \ h 7
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360030000000
, REF _Ref473311175 \ r \ h 8
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300310031003100370035000000
, REF _Ref463817655 \ r \ h 10
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400360033003800310037003600350035000000
, REF _Ref473387067 \ r \ h 12
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000360037000000
].
After cancellation
benzodiazepines, as well as after the abolition of barbiturates, can be observed
seizures and psychosis, developing mainly in the type of delirium. In abstinence can
be paranoid psychosis with hallucinations, delirious syndrome with a sub-stopper and
agitation; schizophrenia-like paranoid-hallucinatory syndrome; anxious – depressive
syndrome; psychosis in which fancy sensations come to the fore
body changes and depersonalization phenomena.
Duration of withdrawal syndrome
after the abolition of benzodiazepines – up to 2-3 weeks, sometimes 1 month. In separate
cases of withdrawal symptoms after benzodiazepine withdrawal may continue from
3 to 6 months [
REF _Ref473387053 \ r \ h 4
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350033000000
, Ref
_Ref473387055 \ r \ h 5
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350035000000
, REF _Ref473387058 \ r \ h 6
08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003400370033003300380037003000350038000000
].
Thus, it should be noted that
addiction and substance abuse cause great economic damage to the state and
to society. how
As a rule, people suffering from drug and substance abuse have low productivity.
labor, they are characterized by a pronounced decline in morals, drug abuse
detrimental to family relationships and parenting.
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MENTAL DISORDERS DUE TO THE USE OF TRANQUILIZERS AND
SEDATIVES
Frolkov A. Yu.
BUZ Voronezh region “Voronezh regional clinical narcological dispensary”, Russia, Voronezh
Abstract. For addiction and
substance abuse is a problem
choice. Can it be
think, no. Implies the possibility of
predicting the effects of the selection, including the most negative.
Deals with main types of addictions and
substance abuse result from the abuse of sedative and
tranquilizers, taking into account the peculiarities of their manifestations.
Clinical manifestations,
diagnosis of intoxication and the effects of anesthesia of the above mentioned
funds.
Key words: withdrawal syndrome,
psychological dependence, psychosis, tolerance, physical dependence, euphoric
effect.
About the author:
Frolkov Alexander Y. – doctor – psychiatrist–
narcologist BUZ VO “Voronezh Regional Clinical Drug Dispensary”, frolckow.aleks@yandex.ru
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