F17. Acute nicotine intoxication
Symptoms arising from nicotine poisoning: nausea, vomiting, excessive salivation and abdominal pain; tachycardia and hypertension (early onset of symptoms); bradycardia and hypotension (late manifestation), tachypnea (an early symptom) or respiratory depression (late manifestation); miosis; confusion and impulse (late manifestation); mydriasis; seizures and coma (later manifestation).
In the process of systematic smoking of tobacco, a disease is gradually formed - tobacco dependence, which has its own clinical features, dynamics of development, stages and complications.
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(F 17.2) Clinical picture of nicotine addiction
It is presented by syndromes of the organism's altered reactivity to the action of nicotine (change in tolerance, disappearance of the protective reactions observed during the first tobacco samples, change in the form of consumption), pathological craving for smoking tobacco, withdrawal syndrome, personality change syndrome.
When the first smoking samples are normal, the toxic effect of tobacco smoke on the body as a whole manifests itself - a psychosomatic reaction develops: a drop in blood pressure, fainting, tachycardia, a feeling of nausea, severe dizziness, agonizing muscular weakness, vomiting, a feeling of insufficiency of breath, melancholy, anxiety, fear of death protective reaction of the body). People who have suffered a similar form of response, as a rule, no longer smoke. In other body reactions, tobacco smoke is split (a symptom of psychosomatic dissociation). They experience a slight dizziness, calm, a sense of mental comfort, simultaneously combined with muscle weakness, nausea and vomiting. The symptom of psychosomatic dissociation, along with the traditions of the micro-social environment, contributes to the smoking of tobacco in such people.
When using tobacco, an increase in tolerance in the dynamics of the disease and its change during the day are observed. After a day of smoking for 6-8 hours, the resistance to the effects of tobacco the next morning disappears. That is why many smokers describe the strong effect of the first cigarette. With each subsequent cigarette smoked tolerance increases.
The core disorder that characterizes tobacco dependence is a pathological attraction to tobacco smoking, while abstaining from smoking causes a complex of psychosomatic disorders. For most people, the syndrome of pathological craving occurs after a few years from the onset of systematic smoking. In other cases, tobacco addiction does not occur in people who systematically smoke, the habit of smoking is formed. The syndrome of the pathological attraction to tobacco smoking is a psychopathological symptom complex, including ideatorial, vegetative-vascular and psychological components.
The presence of a mental, figurative, or mental-figurative memory, a view, a desire to smoke tobacco, perceived by patients, is characteristic of an ideator component. Thoughts of smoking become painfully obsessive, stimulating the search for tobacco products.
The vegetative-vascular component manifests itself in the form of individual transient symptoms: cough, thirst, dry mouth, pain of different localization, dizziness, tremor of the fingers of outstretched hands, hyperhidrosis, instability of blood pressure, gastrointestinal dyskinesias.
The mental component is expressed asthenic and affective disorders. When abstaining from smoking, psychogenic asthenic reactions occur with transient fatigue, exhaustion, restlessness, irritable weakness, sleep disorders, appetite, decreased performance, deterioration of health. Asthenic or anxiety subdepression is characteristic of affective disorders. Patients complain of depression, weakness, tearfulness, irritability, anxiety, anxiety. Expressed manifestations of the syndrome of the pathological craving for smoking tobacco can be represented by illusory and hallucinatory disorders in the form of a sense of taste and smell of tobacco smoke.
Syndrome of the pathological attraction to smoking tobacco in development goes through several stages (initial, formation, final). At the initial stage, lasting up to 1 month, a symptom of psychosomatic dissociation is observed. Formed during the first tests of tobacco smoking and manifested in different directions of mental and somatic forms of response to the toxic effect of tobacco smoke. The stage of formation lasts up to 2-3 years, characterized by the formation of the syndrome of a pathological desire to smoke tobacco with the simultaneous disactualization of the symptom of psychosomatic dissociation. At the final stage, the dominance in the clinical manifestations of the disease of the syndrome of a pathological desire for smoking of tobacco determines the behavior of an individual, aimed at finding a tobacco product and its smoking (occurs on the 3-4th year of systematic smoking).
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(P17.3) Quitting Nicotine Use
It causes the development of withdrawal syndrome (AS, deprivation syndrome), its manifestations reach a peak in 24-28 hours after the last smoking. These include: anxiety, sleep disturbance, irritability, intolerance, overwhelming desire to smoke, impaired concentration, drowsiness, increased appetite and headache. The intensity of the symptoms decreases after 2 weeks. Some symptoms (increased appetite, difficulty concentrating) may remain for several months.
There are two types of flow of nicotine addiction: periodic and permanent. For the periodic type of the course, there are light periods during the day, when patients forget about smoking for 30-40 minutes. The intensity of smoking tobacco with a periodic type of flow - smoking 15 to 30 pieces of tobacco products. The constant type of flow is characterized by the presence of a constant craving for smoking tobacco, despite ongoing activities. With this type of patient smoked during the day from 30 to 60 pieces of tobacco products.
The clinical picture of the syndrome of the pathological craving for tobacco smoking, the types of the course of the disease determine the main forms of nicotine addiction described in the literature: ideatorial, psychosomatic and dissociated.
For the ideator form, a combination of the ideator and vegetative-vascular component in the structure of the syndrome of the pathological craving for tobacco smoking in individuals with schizoid traits in premorbid is characteristic. The ideator form is peculiar: the early age of the first sample of tobacco smoking (10-12 years), the absence of the episodic smoking stage, the rapidly emerging need for systematic smoking, the gradual excess of the initial tolerance by 8-10 times, the late onset of tobacco smoking during the day (after 1 4 hours after awakening), an early awareness of smoking, a periodic type of the disease, the possibility of self-cessation of smoking for a period of 2-3 months to 1 year.
In the psychosomatic form of nicotine addiction, a combination of the ideator, vegetative-vascular and mental component in the structure of the syndrome of a pathological craving for smoking tobacco in people with epileptoid traits and premorbid is noted. This form is characterized by a relatively late age of the first sample of smoking (13-18 years old), the absence of an episodic smoking stage, the late age of the onset of systematic smoking, a rapid increase in tolerance with an excess of the initial 15-25 times, early morning smoking (immediately after waking up, on an empty stomach), a late awareness of smoking, a constant type of the course of the disease, unsuccessful attempts at self-cessation of smoking.
The dissociated form of nicotine addiction is distinguished by the presence in the structure of the syndrome of pathological craving, not perceived at the ideational level, the desire to smoke tobacco. Its manifestation is internal undifferentiated vital vital sensations that appear during long breaks in smoking. They are localized in different areas of the body: in the pancreas, tongue, throat, trachea, lungs, back, shoulder blade, etc. Early initiation of smoking (the first test at 8-9 years), a periodic type of the disease, a short stage of episodic smoking are characteristic of a dissociated form. Smoking on an empty stomach. The peculiarity of this form should be considered "flickering" tolerance. A patient can smoke 2-3 cigarettes in one day without experiencing the need for more, but on other days it smokes 18-20 cigarettes. Compared to other forms of nicotine addiction, the most recent awareness of craving for tobacco, which appears in the structure of withdrawal syndrome, is revealed. In the process of self-cessation of smoking tobacco, remissions can last from 5 days to 2-3 months. The dissociated form is characterized by the presence of a delayed withdrawal syndrome (can be qualified as an actualization of a pathological desire for tobacco).
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Smoking is very common among people addicted to alcohol, cocaine or heroin. Because nicotine is a legal substance, many addiction treatment programs in the past have ignored nicotine addiction and concentrated mainly on alcohol or illegal drugs. In recent years, hospitals have begun to fight smoking, prompting hospitalized patients to quit smoking with nicotine patches. This measure can be an excellent opportunity to begin treatment of nicotine addiction, even if it requires the simultaneous correction of other forms of addiction. The same principles can be applied to patients undergoing outpatient treatment for dependence on certain substances. Nicotine addiction, which has a destructive effect, should not be ignored. Treatment can be started with the correction of the most acute problems, but patients' attention should be paid to nicotine addiction, correcting it with the help of the above combination of remedies.
Nose Drug Abuse
In recent years, among children and adolescents living in Central Asia, Kazakhstan, in some regions of Russia, the use of nasa has become widespread - mixtures of crushed tobacco leaves, lime and ash in water or vegetable oil. Depending on the technology of preparation, there are three types of nasa: on water from tobacco and ash; on water from tobacco, ash, lime; on the oil of tobacco, ash, lime. We lay in the oral cavity under the tongue or lower lip.
Studies of recent years, conducted by various experts, indicate the toxic effect of us on many human organs and systems. In an experiment on animals, it was established that we are affected by lesions of the stomach and liver, and precancerous changes. Persons consuming us are many times more likely to get cancer than those who do not use it. If among 1000 examined persons who use us, pretumor processes of the oral mucosa were found in 30.2 cases, then among those who do not use us this figure was 7.6.
The most pronounced pathological changes in individuals consuming us are observed in the oral cavity. Mainly in places of laying. If we are laid under the tongue, we are more likely to get cancer of the tongue; among residents of Kazakhstan, where we are laid on the lower lip, the lower gum is most often affected.
In children and adolescents, addiction to nasa as an intoxicating substance usually begins with curiosity, imitation, and the desire to keep up with peers. The particular harm of its use by children and adolescents lies in the fact that they are laying under the tongue secretly from adults, often under unforeseen circumstances, are forced to swallow it, which aggravates the pathological effects of nasa due to its direct effect on the esophagus, stomach, intestines.
The first in the life of laying a nasa causes a pronounced sensation of tingling and tingling under the tongue, enhanced saliva secretion. Mixing with nasom, it accumulates in large quantities, it causes the need to spit it out after 2-3 minutes. A part of nasa is involuntarily swallowed with saliva. The state of acute intoxication is characterized by mild dizziness with increasing intensity, palpitations and sharp muscle relaxation. In children and adolescents, when trying to get up, the surrounding objects begin to spin, “the earth goes out from under their feet.” Against the background of increasing dizziness, nausea occurs, then vomiting, which does not bring relief, about 2 hours you feel unwell: worried about general weakness, dizziness, nausea, this makes it necessary to stay in a horizontal position. Unpleasant memories of this persist for 6-7 days.
Some of the children and adolescents who have the most pronounced manifestations of intoxication during the first use of nasa do not resort to it later. Others, having the information of others about the fact that during subsequent methods of forceful sensations are not observed, but. On the contrary, a pleasant state arises, continue its use. In such cases, after 2-3 doses, the clinical picture of intoxication changes. The disappearance of the protective reaction of the body nausea, vomiting, increased salivation is characteristic. There is a slight euphoria, looseness, a sense of comfort, vigor, a surge of strength. Drunk become talkative, sociable. The described condition continues for 30 minutes. Over the next 2-3 months, the frequency of receiving NASA increases from 2-3 times a week to 7-10 per day. At this stage, the number of nasa used at one time increases, a need appears longer (15-20 minutes) to keep it in the mouth to prolong the state of intoxication.
Systematic reception of NASA contributes to the formation of the syndrome of pathological craving, manifested by a decrease in mood, irritability, irascibility, deterioration of efficiency. Thoughts about Nasa interfere with focus, make it difficult to perform familiar work. 2-3 days after the cessation of nasa use (for various reasons), signs of withdrawal syndrome appear: headache, dizziness, feeling of weakness, sweating, palpitations, loss of appetite, irritability, nastiness, decreased mood, insomnia. The described condition is accompanied by a pronounced attraction to receiving NASA and lasts up to 2-3 days. At this stage, the systematic use of NASA is caused not only by the desire to cause a state of intoxication, but also by the need to stop the withdrawal symptoms described above. The formation of an abstinence state is accompanied by a further increase in the single and daily dose. Persons who use us for a long time can observe a decrease in tolerance to it.
The most noticeable mental disorders in the use of NASA are in children and adolescents who detect signs of cerebral insufficiency (cranial trauma, residual neuroinfection, personality anomalies). They are manifested by a sharp aggravation of their incompatibility, irritability, conflict, aggressiveness. They note a progressive decrease in memory, a weakening of concentration of attention, ingenuity - the reasons for the decline in academic performance, discipline, and hostility in the school team.
The appearance of those who show signs of common substance abuse is quite characteristic: the skin is flabby with an earthy tint, and looks older than his years. They more often observe chronic diseases of the digestive organs.
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