Signs & Symptoms Myths & Misconceptions - PowerPoint Presentation

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Signs & SymptomsMyths & Misconceptions

Dr. C.Lalremruati

District Consultant

National Tobacco Control Programme

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DRUG / PSYCHOACTIVE SUBSTANCE

Eng

thil pawh kan lakluh a, kan khawvel hmuh dan te, rilru sukthlek te, kan chezia leh nunphung te, leh kan awm dan ti danglam thei hi Ruihhlo( Drugs/ Psychoactive Substance)Chung thil chu dan phal emaw phal loh ani thei. Mahse tih chhunzawm zel chakna leh a lova awm theih lohna a thlen thin

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2

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Substance use disorderUSE Disorders

(

E.g. The ingestion of alcohol or other drugs without the experience of any negative consequences)

AbuseDependenceINDUCE Disorders(Continuous use of a substance despite NOT being prescribed or recommendedMaladaptive pattern of use resulting in physical, mental, social, legal harmContinued use in spite of negative consequences)IntoxicationWithdrawal3

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Terminology Dependence

Drug taken in

larger amounts or over longer periodPersistent desire or unsuccessful efforts to cut downA great deal of time is spent in: obtaining the drug using the drug recovering from its effects Important social, occupational, or recreational activities given up or reduced Continued use despite harmToleranceWithdrawalAddiction - older term, still used (physical & psychological)-4-

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Type of substancesMental & behavioral disorders due to…

(F10) use of

alcohol

(F11) use of opioids(F12) use of cannabinoids(F13) use of sedatives or hypnotics(F14) use of cocaine(F15) use of other stimulants,including caffeine(F16) use of hallucinogens(F17) use of tobacco(F18) use of volatile solvents(F19) multiple drug use and use of other psychoactive substances5

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DSM IV TRSubstance-related disorders

4.1

Alcoho

l-related disorders4.2 Amphetamine (prescribed drug,ADHD, narcolepsy) related disorders4.3 Caffeine-related disorders4.4 Cannabis-related disorders4.5 Cocaine-related disorders4.6 Hallucinogen-related disorders4.7 Inhalant-related disorders4.8 Nicotine-related disorders4.9 Opioid-related disorders4.10 Phencyclidine (PCP, angel dust) related disorders4.11 Sedative-, hypnotic-, or anxiolytic-related disorders4.12 Polysubstance-related disorder4.13 Other (or unknown) substance-related disorder6

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RUIHHLO HNATHAWH DAN

Physical and Physiological (

Taksa

bung hrang hrang a khawih buai dan)Pyschological (Rilru leh ngaihtuahna lam a khawih buai dan)Social (an khawsakna leh khawsak dan a nghawng)Economic (eizawnna emaw chhungkaw sum pai a khawih pawi dan)

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First Marijuana Use, (Percent of Initiates)

1.5%

67%

5.5%<12 12-1718-25>25Addiction is a Developmental Disease:It Starts Early26%

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When Reading Emotion…Adults Rely More on the Frontal Cortex

While Teens Rely

More

on the AmygdalaSource: Deborah Yurgelon-Todd 2000.

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Rats Exposed to Nicotine in AdolescenceSelf-Administer More Nicotine Than Rats First Exposed as Adults

Sources: Collins et al, 2004, Levin et al, 2003, NIDA Notes v19.2

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Source: Adapted from Volkow et al., Neuropharmacology, 2004.

Drive

Saliency

Memory ControlNon-Addicted BrainNO GOAddicted BrainDriveMemoryControlGOSaliency Why Can’t Addicts Just Quit?

Because Addiction Changes Brain Circuits

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COMORBIDITY

Example: SMOKING EPIDEMIOLOGY

normal population: 23%

alcoholism: 90%+ other addictions: 90%+ schizophrenia: 85% depression: 80%

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Factors influencing drug abuse and dependencePharmacological & physiochemical properties of drugs

Personality & Psychiatric disorder - increased risk associated with schizophrenia, BPAD, depression, ADHD.

Genetic factors (that influence metabolism and the effects of drugs)

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Why do some people become

addicted while others do not?

VULNERABILITY

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VULNERABILITY TO ADDICTIONVulnerability = Susceptibility= Proneness

Vulnerability

(Potential risk) = Hazard x 1/Preparedness (Coping capacity)

Hazard = Nature and NurturePreparedness (Coping capacity) = Mental, Physical, Social, Religious, etc.15

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16

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There’s a

Big

Biological / Genetic

Contribution to Drug Abuse and Addiction…….Overlapping with Environmental Influences that Help Make Addiction a Complex Disease.17

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Biology/genes

Environment

Biology/

EnvironmentInteractions18

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Research Study Conducted Under Project HIMNA-MADAT

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21Classification of Psychoactive Drugs

b. Stimulant

Cocaine

ATS (meth,estacy)TobaccoCannabis a. DepressantAlcoholOpioids (codane, morphine, heroin)Sedative – hypnotics (diazepam,alprazolam)Volatile solventsCannabis c. HallucinogenLSDCannabis

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Drugs hnathawh dan

Depressant

– an

taksa khawl, a bikin thluak hnathawh a ti muang, a ti zawi. Chuti chung chuan a tir lamah phurna a awm fo bawkStimulant – anmahni a ti phur a, an hah har a, muthilh a ti harsa a, chaw ei peih lohna a thlenHallucinogen – An thil hmuh emaw hriatna (sense) a khawih danglam

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Withdrawal symptomsUsually opposite of acute effects

Depressants: withdrawal-excitation

Stimulants: withdrawal-lethargy/’crash’

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Alcoholic beverages24

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25

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Alcohol: Psychological effects

Alcohol is a brain depressant.

In small amounts it relieves anxiety

it may also give a sense of strength and result in boisterous behaviourIt heightens the mood prior to intake, be it sadness or happinessImpairs judgement and performance -26-Effects of alcohol

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Alcohol withdrawal: mildAnxietyRestlessness

Insomnia

Tremors

CravingPalpitation Sweating Breathlessness 27

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Alcohol withdrawal: severeSevere Alcohol Withdrawal: “Delirium Tremens”

All features of mild withdrawal

Disorientation (unawareness of self and surroundings – time, place and person)

Hallucinations Seizures (fits – ‘rum fits’)Can be fatal28

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Alcohol related physical problems

GIT –

oesophagitis

, gastritis, reflux, m-w tears, varices, pancreatitis, portal HT, ca’sLiver – hepatitis, fatty liver, cirrhosis, haemochr, hepatic Ca, hepatic encephalopathyCardiovascular – arrythmias, cardiomyopathy, coronary/cerebrovascular disease, hypertensionMetabolicEndocrine e.g. pseudocushings, hypogonadism, infertility, low libido/impotenceMusculoskeletal e.g. gout, fractures, osteoporosisHaematological e.g. anaemia, thrombocytopaeniaRespiratory Dermatological e.g. spider naevi, palmar erythema, eczema, worsening psoriasis

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Alcohol – Neurological problems

Amnesic

(

Korsakoff’s) syndrome & Wernicke’s encephalopathyCerebellar degenerationCentral pontine myelinosisDementia, amnesia/blackouts etcFetal alcohol syndrome

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Opoids31

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Heroin (Smack)32

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Opioids: Psychological effects

The effects differ widely between new and dependent users

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33-New users Who is not in pain  an unpleasant reaction / vomitingWho has pain or anxiety  some reliefDependent users Short lived in-tense experience – “rush”A state of profound euphoria A dreamlike state lasting longer

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Opioid withdrawal

Very distressing, but never fatal !

Opening of all holes !

Watering from eyes, noseVomitingLoose motionsBodyache / painAnxiety, restlessness, insomnia34

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Cannabis (Bhang, Charas

, Ganja, Hashish)

35

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Cannabis products Bhang (leaves)

Ganja (dried flowering stem of the plant)

Charas

/ Hashish (extracted from the resin covering the plant)Hashish Oil (extracting THC using chemical methods)-36-OralSmokedSmokedSmoked

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Cannabis: Psychological effects

A dreamy state with an increased tendency to fantasize

State of euphoria, well being and enjoyment

Generally followed by a period of drowsinessPerceptual and sensory distortionsCan prolong reaction time and impair coordination Sounds and colours may become more intense Restlessness, fear and even panic may spoil the experience (“bad trip”)There may be driven activity (subject knows that one’s activities are meaningless, yet is unable to control them)-37-

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Cannabis withdrawalNon specific

General discomfort

Intense craving

Anxiety, restlessness38

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Sedative – hypnotics Valium,

Avil

, Cough Syrups

39

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Sedative – hypnotics & other pharmaceuticalsMedications for:

Sleep (Diazepam)

Allergy (

Promethazine, pheniramine)Pain (Pentazocine, Propoxyphene)Cough (Codiene)Diarrhea (Diphenoxalate)Anesthesia (Ketamine)-40-General brain depressantsOpioid like actions Hallucinogen

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Cocaine and other stimulants

41

Coca leaf and cocaine powder

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Amphetamine Type Stimulants (ATS)

-

42

-

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Stimulants: Psychological effectsImmediately after smoking the drug or injecting it- extremely pleasurable ‘rush’ or ‘flash’.

Enhanced mood and body movement, euphoria

Increased respiration

Increased heart rate, blood pressureInsomniaReduced appetite-43-

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LSD

(Lysergic acid diethylamide)

44

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Tobacco45

Tobacco use reduce life span (7-10yrs)

Tobacco kills around 6 million people each year

Direct tobacco use results to 5 million deaths (WHO)

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Volatile solvents (Inhalants)46

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Stimulant withdrawalLethargy

Hypersomnia

/ sleepiness

Fatigue / sad moodCravingAnhedonia (inability to feel pleasure)47

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RUIHHLO TITE LAN CHHUAH DANTuizawng leh

rilru

puthmang inthlakthlen hi chu tleirawlte zia ve reng a nih lain, heng a hnuaia tarlante erawh hi chu chik zualin ngaihven ila:thian kawm duhzawng sikul/class kal loh, examnaa tih chhiat zuala thil neih leh thiltih sawithat vak duh lohnasum hman dan sawi tha duh lothil rimna chi leh rimtui hman nasat – thil dang rim thahna atan Thinchhiat uchuak, rilru puthmang danglam thut thutMutdan leh ei /in lama danglamna te Thil pakhatah rilru an pe reng thei loChaw ei mumal lo, vun dang, luak leh ringawt thin, Haihawt em emSawi ngai tul lova sawi nawn sawi nawnIntifai an thatchhe tial tialHnar/hmai bawr hiah neuh neuhRihna tlahniam leh a dangte. Bathroom/room ah a inkhung rei zual em

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Ruihhlo hmansual

tir

theitu leh hmansual tiawlsam theitu (Causative and Risk Factors)Chhungkuaa ruihhlo hmangsual awm vangChhungkua boruak zir loh vangThiante nawrna (Peer Pressure)Rilru lam harsatna engemaw ber an neih sa inHarsatna an neih chhawk nana an hmanin Chak lohna engemaw bik an neihinSource: National Institute on Drug Abuse (NIDA)

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Substance use disorders (Addiction)

Indirect suicide???

50

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The usual drug-use ‘career’From ‘softer

’ to ‘

harder

’ drugs-51-TobaccoCharas / GanjaHeroin / SmackInjection TidigesicAlcohol

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Relationship between tobacco dependence and alcohol dependence Correlation between Tobacco Dependence and Alcohol Problem Severity

 

Fagerstrom

AUDITCorrelation Coefficient1.000.238**Sig. (2-tailed)..001**Correlation is significant at <.01 level

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MythFactYou can stop using drugs anytime

Withdrawal sickness, believing you must have drugs, and being around people who use can make stopping drug use difficult. But there are people and programs that can help

You have to use drugs for a long time before they can really hurt you

Drugs can cause the brain to send the wrong signals to the body. This can make a person stop breathing, have a heart attack or go into a coma. This can happen the first time the drug is used If you only buy drugs from friends, you'll get the pure stuffBecause drugs are illegal, no one can know what is really in them

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MythFactTeenagers are too young to get addicted

Addiction can happen at any age. Even unborn children can get addicted because of their mother's drug use

If you're pregnant and use drugs, your body protects the baby

Drugs affect an unborn child as much or more than the mother. Drug use during pregnancy can cause the baby to die or be born too early. It can damage the baby's mind and bodyIf you smoked pot on the weekend, you'd be fine by MondayThe effects of pot (marijuana) can last for up to 3 days. It impairs memory, reflexes and coordination

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MythFact If you get drunk, coffee will sober you up

Once alcohol is in the bloodstream, only time will make a person sober

Snuff and chewing tobacco are safe because there's no smoke

Smokeless tobacco can cause mouth and throat cancer, high blood pressure and dental problems. It can also lessen the senses of taste and smell and can cause bad breath Sniffing glue gives an instant rush. There isn't time for it to hurt youInhalants enter the blood and go through the body in seconds. Sniffing larger amounts can cause a heart attack or death from suffocation because inhalants replace oxygen in the lungs

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MythFactPot isn't as bad for you as cigarettes

Marijuana smoke has more cancer causing chemicals than tobacco

Drugs relieve stress. They help deal with problems

Drugs only make people forget and not care about their troubles. When the drug wears off, the problem is still there As soon as a person feels normal, all the drug is out of the body Long after the effects of the drug stop being felt, the drug can still be in the body. For example, cocaine can be found in the body up to one week and marijuana up to 3 months after a single use

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SUPPORT SYSTEMSSELF

FAMILY

&

SOCIETY Can help in copingIn social activities – YMA, MHIP, MUP etcIn Religious activities – KTP, Pavalai etc

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Baseline survey on extent & pattern of Drug use in Mizoram (SWD)

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Note: The 1st

drug use is tobacco & solvents and progressively move on to alcohol and cannabis and so on..

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Second Hand Smoke Exposure Mizoram

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Universal women’s helpline2016-17 calls & cases received

Quarter

July-Sept

2016Oct-Dec 2016Jan-Mar2016TotalTotal no. of calls received193397222812Total no. of cases received276356146Total no. of calls attributable to alcohol97199111406(50%)Total no. of cases attributable to alcohol14322874(50.68%)

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Mizoram synod social front booklet no.49

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MLPC Act 2014 Study Group Report in a tarlan danin

:

23.38% (

Hospital pali atanga damlo record an neih) -zu vang19% -alcohol related deaths

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KTP Rorel Inkhawm

2019 Report

Sl.no

Member thi zat4701Mipa 4282Hmeichhia42

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KAN SUM LEH PAI A NGHAWNG DAN(

Zu

)

MLPC Act hman atanga thla 8 chhungin Govt. Of Mizoram in zu zawrhna atangin Rs.19.44 crore tax a la lutZu kaihhnawih vanga accident thleng vangin Rs.16 lakhs Zu ruih vanga accident inenkawlna senso zat Rs.4.09 croreZu in nasat vanga natna enkawl nan Rs.6.35 croreJudicial cost atan Rs.2.67 croreRs.1.20 crore zu vanga lungin tang te tan sen ral ani bawk

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KAN SUM LEH PAI A NGHAWNG DAN(

Vaihlo

)

NI TINA KAN SUM HMAN RAL ZAT(Mizoram Presbyterian Kohhran Hmeichhe Report 2004)Rs. 8,93,933.35CIGARETTES = ₹ 718/- Per MonthApprox. Figure3,20,000 smokers X ₹ 718 = ₹ 22,97,60,000/-

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NO.1 POSITIONS IN CANCER IN INDIA(INDIA RAMA PAKHATNA KAN NIHNA)

1

Cancer

zawng zawng belhkhawm ah (Mipa & hmeichhe)2Hrawk & hnar cancer/ Nasopharynx Cancer (Mipa & hmeichhe)3Chuap Cancer (Mipa & Hmeichhia)4Pumpui Cancer (Mipa & Hmeichhia)5Chhulhmawr cancer (Hmeichhia)6Thisen cancer chi khat / Myeloid leukemia (Mipa)7Chaw dawt cancer (Mipa)

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THE CIGARETTES AND OTHER TOBACCO PRODUCTS

(PROHIBITION OF ADVERTISEMENT AND REGULATION OF TRADE AND COMMERCE, PRODUCTION, SUPPLY AND DISTRIBUTION) ACT, 2003

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MAIN PROVISIONS OF THE ACT

1

Prohibition of smoking in public places

Sec-42Prohibition of advertisement of cigarettes and tobacco products Sec-53Prohibition of tobacco products to minors saleSec-6(a)4Prohibition of sale of tobacco products near educational institutions Sec-6(b)5Regulation of health warning on tobacco products packs Sec-7

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VAIHLO NGHEI DUH TAN DISTRICT HOSPITAL tin ah

AH OPD HUN CHHUNGA PAN THEIH RENG KAN NI