Hyperstimulants – action
Among teenagers it was not necessary to face abuse by atropine. In the late sixties – the beginning of 70th years there were separate cases of intoxication Asthmatolum. Under such name the cigarettes which smoking is recommended for discontinuing of an attack of a bronchial asthma are issued. Asthmatolum contents includes 20 % of leaves of a belladonna, 10 % of leaves of a henbane, 60 % of leaves of a datura and 10 % of sodium of Sodium nitritum. All leaves contain alkaloids from atropine bunch – Scopolaminum, Hyoscyaminum, etc. At abuse with a view of intoxication do not smoke Asthmatolum, as it is officially recommended, and drink the infusion prepared from it. Some teenagers who have been hospitalised in an insane hospital at delirium height have appeared a subject of our observations. Its pattern did not differ from described at adults. Patients looked around, at something looked narrowly, unplumed arms of a wall and furniture, for something searched on a floor, tried to begin to smoke a nonexistent cigarette. Contact has been extremely complicated, answered not always and sometimes inattentively. Did not perceive, where are also who them surrounds.
Among the personnel and other patients saw former acquaintances. Have been disoriented in time-even found it difficult to tell, morning now or evening. Hardly named itself. With sketchy replicas confirmed presence of visual hallucinations which accepted for a reality. Saw gangsters in masks, terrorists, militiamen, “the children”, and also cursorial small animals, a horde of hexapods. Sometimes declared that the surrounding situation seems to them surprisingly beautiful – “all shines and flows over different paints”. Among vegetative symptoms the hyperemia of the person, wide pupils, a quick pulse attracted attention. After an aminazine injection there came long sound sleep. At delirium awakening any more was not, but the next days in the evenings there could be again delirious episodes, routinely quickly passing. The full amnesia full or nearly so for hallucinative experiences was a delirium distinctive feature. About hallucinations only separate sketchy or vague memoirs could be conserved.
The events descending at this time actually, also dropped out of memory. A state during a delirium and the subsequent amnesia transformed teenagers into helpless objects for malicious intentions from outside contemporaries and the senior criminals. Them robed, did by a subject of violations. But even if intoxication descended in “the company” and similar danger was excluded, the subsequent amnesia did not yield possibility to share with friends the content of the unusual experiences and the similar mean of an intoxication has lost appeal for teenagers. There are indicatings that small doses of decoction are capable to invoke the original euphoria combined with a predelirious state in adults – sensation of unusual brightness of paints surrounding, “beauty” of a situation, etc. Deliriums at adults were a consequence of an unforeseen overdosage. Pass drug test for cocaine
The postdelirious state differs an adynamia, flabbiness, indifference to the surrounding. It can be bound to proceeding action of Scopolaminum also containing in Asthmatolum. Fast fatigability shows at the slightest mental strain – performance of operations, necessities that or to recollect, concentrations of attention. Delirium treatment could be carried out by means of the antagonist of atropine – Physostigminum (Eserinum). However for this purpose it is necessary to be firmly convinced that the delirium is invoked by Asthmatolum, i.e. Materials containing in it. The similar confidence happens seldom. Besides, Physostigminum for injections should solve directly ahead of the use. At standing its solution quickly loses activity (a sign of that appearance of pink colouring is). Delirium cupping would need the big dose of Physostigminum (to 10-15 mg). All it complicates its utilisation. For delirium cupping routinely resorted to aminazine injections (50-100 mg intramusculary) after which soon there come abirritation and a sleep. However for the patient careful observation in connection with collapse possibility is required.
The clinical pattern has been described by D.D.Fedotovym, A.S.Tchudin and S.A.Sarkisov (197b). Abuse by Cyclodolum among narcomaniacs has come in the stead of Asthmatolum and was extended since second half 70th years. Under our data, Cyclodolum in the doses invoking deliriums and demanded hospitalisation in an insane hospital, used about 10 % of teenagers of a male among arrived in teenage psychiatric abjointing in connection with toxicomanias and abuse by various stupefying materials. Cyclodolum accept at once in the big dose (to several tens tablets on 0,002) and quite often wash down not with water, and beer or wine. At a combination to alcohol deliriums lasts more longly and proceeds more hardly. Pristine reaction to the big dose of Cyclodolum has mainly character of emotional disturbances – either euphoria educes, or there is a pavor, sometimes fun and alarm alternate with each other.
Babayan and Gonopolsky (1987) have conditionally secured 4 stages of an intoxication: euphoria, narrowing of consciousness, a phase hallucinative and a yield. On our observations, at teenagers 2 stages distinctly act: euphoria, it is frequent with experiences, and deliriums. Sometimes between them there is a sleep season. If the accepted dose only in 3-4 times exceeded therapeutic and Cyclodolum action has not been aggravated by alcohol method, the intoxication pattern confined only euphoria without the subsequent delirium. Routinely in these cases teenagers do not get under observation of the psychiatrist, the intoxication can pass even not noticed for surrounding adults. During euphoria the pleasant state of health is combined with garrulity. The behaviour can choronomicly remind alcoholic intoxication a facial expression and gesticulation. Sometimes there is a sensation of that a situation around 1 fans LSD when hallucinations got frightening character resorted To Thorazinum in the USA. Somehow strange varies, all becomes unusually bright, “interesting”. There can be separate visual and acoustical illusions to which the criticism is conserved. At method of the big doses of Cyclodolum in the suicidal purposes euphoria was absent.
Against euphoria vegetative disturbances are reduced to a hyperemia of the person, a tachycardia, fluctuations of arterial pressure, a mydriasis, sometimes to an accomodation paralysis (sight worsens, it is impossible to read a small print). Locomotions of dactyls and brushes of arms can be observed – something invisible all time twist in arms. At the big doses of Cyclodolum and especially at its combination to alcohol after euphoria there can come a stage of a narcotic sleep. Are in the sleep restless, in bed spin, something mutter, scream. Probably, there are bright dreamings which subsequently almost remember nothing. To wake during this sleep very difficultly, something is almost impossible-in the answer muffledly mutter and immediately again fall asleep. After several hours of a sleep (sometimes till 8-12) wake up. At a part of narcomaniacs in the subsequent the asthenia is observed only, at others the delirium educes. The delirium pattern can be developed also at once-through 1-2 h after method of the big doses of Cyclodolum without the season of a narcotic sleep. During a delirium bright colourful visual hallucinations prevail. Their content (as well as an affective background on which they arise) depends on a situation previous an intoxication, and emotional reaction of the teenager to this situation. If Cyclodolum has been accepted in the company of friends, during fun and carefree chatter also visions represent iridescent patterns, the ridiculous incidents entertaining scenes. If intoxications preceded interferences, fights, quarrels, fears to be beaten or Other frightening events and in a delirium pattern prevail pavor, see gangsters, persecutors, scenes of offences, etc. But in all cases of hallucination differ fast change of various episodes and patterns. At the same time the same scenes can be retried several times. Oculomotor distresses can affect perception disturbances: visible subjects fork ‘, apparently, that at the interlocutor two heads, four arms, forms of figures are deformed, elongate, bent. Auditory hallucinations if happen remain on the second plan and always act in a uniform complex with visual, being thematically with them bound.
“The symptom of a disappearing cigarette”, characteristic for the psychoses invoked by cholinolytic agents is quite often observed original. When the narcomaniac does not see own arm, it has a sensation that between dactyls the cigarette is cliped. As soon as he tries to bring it to a mouth and the arm appears in the field of sight-cigarette “disappears”. The teenager bewildered examines the arm. Thinking that it has dropped a cigarette, starts to search for it on a floor, examines clothes, etc. The tsiklodolovyj delirium often interrupts light interspaces – they last from several minutes till several o’clock. In these seasons of hallucination are stopped, the consciousness clears up, but (unlike a delirium) teenagers well remember the former hallucinative experiences. Them willingly share with associates, subject to critical processing. Crazy ideas on the basis of the former hallucinations does not educe.
At method of very big doses of Cyclodolum the delirium can pass in a sopor and to whom, but it meets extremely rarely. At neurologic inspection during a psychosis wide pupils are visible, the hyperemia of the person, a tremor, a moderate tachycardia often become perceptible. Duration of a psychosis is insignificant-nearby days. Then within several days the asthenia, flabbiness, drowsiness and a sleeplessness are observed in the afternoon at night. Through put-other there can be short relapses of a delirium th some hours. It at all does not mean that the teenager has undergone to a repeated intoxication. The residual delirium does not happen. At repeated methods of Cyclodolum the part of teenagers has a desire with the help concerning small doses to achieve only euphoria with a predelirious state which is treated as a high. The tendency to euphoria (high) differs from intention to test hallucination (”to catch glitches”) that gives the grounds to part mental dependence on euphoric and hallucinative.
Treatment. Delirium cupping is carried out by means of aminazine injections (50-100 mg intramusculary) or Sibazonum (Relanium, Seduxenum) also is intramuscular – 24 ml of 0,5 % of solution (i.e. 10-20 mg). After an injection soon there comes a long sleep. At awakening there is only an asthenia. However these agents should be added further described in the head. 6 disintoxication measures to prevent delirium relapses.
Relapses can arise within the next few days without repeated method of hallucinogens and without visible provoking factors. In the American psychiatric literature them name flashback that in English means “back fires of a motor vehicle” literally. Similar relapses are promoted by various concomitant exogenous diseases (a virus grippe, feverish reaction to bacterination, etc.) . During relapses all pattern tolerated before a hallucinosis, and its separate fragments is routinely replicated not. There are elementary visual hallucinations (someone’s persons, colour flashes, geometrical figures), illusions, sensation of the special brightness of paints, a ring in a head, etc. is more often. Similar relapses are short, their duration – from several minutes till several o’clock, but no more than days. The natural sleep stops them. If relapse is tightened, speech goes about a debut of a hallucinative syndrome of other aetiology (alienations at a residual organic lesion of a brain, paranoica schizophrenia) which have been provoked by hallucinogen method more likely.
The paranoica syndrome educes after the hallucinogen use, against the hallucinosis invoked by it when there can be a belief that all unusual experiences, really, reflect a reality that all it descends actually, instead of it seems. The critical attitude to hallucinations is completely lost. Their crazy interpreting can be conserved also after the hallucinosis termination. However in some days the hallucinogenic paranoid weakens, and fractionally crazy experiences estimate critically. If crazy interpretation of hallucinations keeps for many days and the more so if crazy ideas start to be systematised, dress new details it testifies to provocation by a hallucinogen of an attack or a debut of paranoica schizophrenia more likely. In cases when after the termination of a hallucinosis or the proximate 2-3 days endured critically estimates transitional crazy interpreting does not give some any grounds for the schizophrenia diagnosis. However such teenagers compound a contingent of high risk of the yielded disease – of schizophrenia on And. V.Snezhnevskomu (1972).
The described transitional paranoica attacks can be surveyed as “summer lightning” harbingers-. Treatment is made by means of psychotropic drugs. But it is not necessary to hasten with therapy by Triphtazinum (Stelazinum) or Haloperidolum. Within several days it is better to try to confine Sibazonum (Relanium, Seduxenum), Thioridazinum (Mellerilum), and for the night to yield Levomepromazinum (Tisercinum). However, if the paranoid is tightened more than for 5-7 days it is necessary to start treatment by Triphtazinum, as at paranoica schizophrenia, in doses to 2030 mg a day. If at similar treatment there is a criticism to former crazy statements within 1-2 weeks it is possible to reduce fractionally a dose before full cancellation.
The depression arises at once behind method of a hallucinogen or the proximate days-two after the tolerated hallucinosis. More often the pattern of agitated disturbing depression is observed. The patient is verbose, sometimes almost continuously speaks. In its statements self-reproaches sound, self-reproaches, charges of in all sins, pavor to go mad, for ever to remain in similar restlessly-depression. Nevertheless for short time patients are capable to give in to belief, willingly to him auscultate. Sometimes note burls of thoughts. At alarm and despair height suicidal attempts are possible. Suffer a sleeplessness. Meal do not recollect, but persistent abandonings of nutrition it is not necessary to meet. Duration of similar depressions is various-sometimes only days, sometimes they are tightened for weeks. In the latter case it is possible that the hallucinogen has appeared the provoker of a phase of a schizoaffective psychosis. However the similar diagnosis is proved only when depression is tightened for some weeks or when its pattern starts to dress new symptoms and the more so if after a light interspace there are repeated psychotic depressions. Treatment by antidepressants is better for beginning only if are tried and there were without effect tranquilizers (Seduxenum) or neuroleptics with antidepressive action (Tisercinum). Application of antidepressants, especially Imizinum (Melipraminum) or amitriptyline at teenagers is interfaced to high probability of change of a phase-transferring in a hypomaniacal state with hyperactivity, garrulity, subitaneous change of ideas of self-charge with ideas of greatness. It is possible to use Seduxenum combination (on 10-20 mg 2-3 times a day) with Tisercinum (25 mg for the night). At a grave condition it is necessary to use intravenous injections of Seduxenum (Relanium) on 2 ml of solution of 5 %. It is necessary to introduce into its vein sluggishly, having solved in 10-20 ml of an isoosmotic solution of sodium of Sodium chloridum. In the same dose Relanium can be introduced intramusculary. If depression does not weaken, amitriptyline (on 25-50 mg 2-3 times a day) is preferable for attaching to proceeding treatment by Seduxenum.
The hallucinosis can be invoked not only hallucinogens, but also other toxicants, for example hashish. Action allows to distinguish a specific odour from a mouth. Invoked by a serious poisoning hashish a hallucinosis to distinguish difficultly, when there is no the authentic anamnestic data. If the used material is not known, the exact diagnosis is possible only on the basis of a blood analysis and urine on the content of suspected psychoactive materials. The clinical pattern allows to make only pre-award diagnosis. The tremens at teenagers meets seldom ly happens a consequence of long and serious drunkenness. Similar with described a hallucinosis pattern can arise in the presence of the epileptogenic locus in temporal and occipital lobes of a brain. Them distinguish presence of epileptic attacks in the anamnesis and activity in these ranges on an electroencephalogram.