COCAINISM

From Big Medical Encyclopedia

COCAINISM — the form of drug addiction, at a cut a subject of addiction serves cocaine (alkaloid from leaves of the South American bush). In Europe and North America cocaine is known since 1884 as mestnoanesteziruyushchy means (see. Kokain ); it was used as cold medicine. Since the beginning of 20 century ability of cocaine to cause narkomanichesky addiction (see was found. Drug addiction ). The proximity of therapeutic and euphoric doses, difficulty of precision measurement of quantity very quickly led to use of cocaine in not medical purposes. After World War I «epidemic» To. captured Europe, having stopped by the end of the 20th. In the second half of 20 century in the USA and Europe short-term flashes were noted

K. Kokain is used with the narcotic purposes intravenously, is more rare by inhalation of powder.

The clinical picture

Intoxication is expressed by raising of the general tone, desire of actions, communication, ease of movements and thinking, cheerful mood. Pallor of integuments, dryness of mucous membranes, mydriatic pupils, raising of the ABP, increase of pulse and breath, increase in a muscle tone, strengthening of reflexes, increase in a diuresis is noted. Appetite and a sleep is interrupted. Got drunk it is mobile, verbose, cannot concentrate, it is easily irritated. At the first receptions of cocaine uneasiness and fear, the ideas of the relation is sometimes observed. Intoxication lasts to 3 hours and passes into a condition of weakness, exhaustion, at beginners — through a phase of a dream.

Are the first signs of a disease: an inclination to frequent reception of cocaine, experience of euphoria, increase of a dose necessary for reproduction of initial effect (falling of effect of drug, rise in tolerance), sleeplessness, lack of appetite, sharp weight loss. The way of life is broken — patients lose ability to organized purposeful daily activity, become chaotic, fussy. The malignancy, irritability disappearing only for the period of intoxication, intensity and time prevails to-rogo are reduced. Tolerance can rise to 6,0 — 10,0 g of crystal drug a day.

The abstinence syndrome arises depending on intensity of abuse, 2 — 6 months later. The first days abstinence is expressed by motive concern and alarm. Then the general comes: weakness, melancholy, sluggish depression, sleeplessness, perversion of a rhythm of a dream. Against the background of vascular dystonia there can be attacks of heartbeat, an asthma, unconscious states. The hyperacusia (hypersensitivity to a sound), a muscular atony with a small tremor, awkwardness of movements and gait is observed. Duration of an abstinence syndrome is 2 — 3 weeks. In the period of abstinence acute psychoses are not observed.

With disease the Cachexia develops, there comes a senilism. At intranasal reception of cocaine — atrophic rhinitis and perforation of a nasal partition. Patients are mentally incapable of concentration, intellectual efforts, distracted, fussy, are accepted to several cases at the same time, are chaotic, confused, memory (imprinting and keeping) is broken. They emotionally grow coarse, become suspicious, irascible, can be aggressive, the mood constantly fluctuates from raised to alarming, moral representations disappear. At the progressing weak-mindedness of the critic to a disease and the state it is lost, along with the raised self-assessment grafomanichesky and prozhektersky tendencies are found.

Complications To. in the form of psychosis are observed throughout all disease. The first receptions of cocaine at insignificant overdose or the increased individual sensitivity can cause a delirium (see. Delirious syndrome ) with dominance visual mikropsichesky (objects seem excessively small) mobile hallucinations, auditory hallucinations with abundance of the menacing voices and tactile (feelings of crawling of insects, goosebumps on skin and under skin — so-called hallucinations of Manyan). Duration of psychosis 3 — 5 hour. At moderate intoxication the delirium is allowed by a long dream. In process of accustoming the probability of a delirium from one-time overdose decreases. At hron. To. psychoses develop not in the period of abstinence, and in a condition of intoxication; at the same time are possible a delirium (multi-day with a residual persecution complex and a long adynamy), paranoid acute and long (against the background of formally clear consciousness frightening visual, auditory and tactile hallucinations, nonsense physical. influences and prosecutions). At long-term cocaine addicts the paranoiac nonsense is possible (jealousy, erotic, prosecutions). At cocaine psychoses patients are inclined to aggression.

The diagnosis

the Diagnosis is made on the basis of characteristic outward and behavior of patients, by exhaustions, changes of conditions of psychomotor excitement and depression. The differential diagnosis should be carried out with morphinism (see), at Krom physical. exhaustion, emotional excitability, malignancy, fussiness, disorganization of behavior are not so sharply expressed, and hasheeshism (see), at Krom intellectual decrease is combined with an adynamia, the appearance of the patient is similar with suffering from organic lesion of a brain. Cocaine intoxication differs from morphinic and gashishny in high extent of psychomotor excitement.

Cocaine psychosis even without data of the anamnesis is distinguished on characteristic mikropsichesky and tactile hallucinations, irascibility, «a gallop of the ideas». Quite often combined form of a morfokokainizm is diagnosed only in a hospital where at a syndrome of deprivation it is possible to observe symptoms, specific to an opiizm (the vasculomotor phenomena, ponosa, muscular pains).

Treatment

Treatment is performed in the conditions of a psychiatric hospital. Complete cessation of reception of cocaine regardless of prescription of a disease is shown at once. In order to avoid a collapse appoint means of peripheral sympathomimetic action, and also neuroleptics in small doses. Further biostimulators, massive vitamin therapy, suralimentation. Aminazine, propazine and other strong fenotiazinovy drugs are contraindicated in view of danger of a collapse.



Bibliography: Clinical psychiatry, under ред^Г. Grule, etc., the lane with it., page 244, M., 1967; With t r e of l h at to I. V. Klinik and treatment of drug addiction, M., 1956; In e j of e-@ about t N. A comparison of the effects of cocaine and synthetic central stimulants, Brit. J. Addict., v. 65, p. 35, 1970; Gay G. R. a. o. Cocaine, Clin. Toxicol., v. 8, p. 149, 1975; Nieschulz O. Kokais-mus und Kokainismus, Munch, med. Wschr., S. 2276, 1969; Post R. M. Cocaine psychoses, Amer. J. Psychiat., v. 132, p. 225, 1975.

And. H. Pyatnitskaya.

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