Adelinah

• When does gambling become a disorder

  • According to DSM-5, the disorder is defined as persistent and recurrent problematic gambling behavior leading to clinically significant impairment and distress
  • The initial transition of gambling to becoming a disorder is usually associated with "the big win" which brings about self gratification, feeling of grandiose, power and omnipotence
  • The adolescents then increasingly depends on the activity to cope with disappointments, familial problems and negative emotional states thus pulling away from attachment figures
• Aetiology of gambling disorder

  • Social and peer influence
  • Advertising and media exposure portrayals of gambling as glamorous, exciting and potentially lucrative
  • Curiosity and thrill-seeking
  • Accessibility - Easy access to gambling opportunities that include online gambling, websites
  • Family influence - family dynamics and parental behavior regarding gambling
  • Personality traits such as impulsivity, sensation, seeking
• Therapeutic Interventions for gambling disorder

  • Cognitive-behavioral therapy (CBT)
  • Counselling - Individual and group counselling sessions
  • Financial Counseling
  • Support Groups - Gamblers Anonymous
  • Medication - Selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers
• Alcohol induced disorders is a cluster of cognitive, behavioral, and physiologic symptoms indicating that the individual continues using alcohol despite significant alcohol related problems
• Other alcohol induced disorders

  • Alcohol induced psychotic disorder
  • Alcohol induced bipolar disorder
  • Alcohol induced anxiety disorders
  • Alcohol induced sexual dysfunction
  • Alcohol induced major/ mild neurocognitive disorders
  • Alcohol induced depressive disorder
• Alcohol induced conditions except alcohol induced neurocognitive disorders are likely to improve without formal treatment in a matter of days or weeks after cessation of severe intoxications and withdrawal even without psychotropic medications
• Etiology of alcohol induced disorders

  • Social factors - Peer pressure
  • Psychological factors - Underlying mental health conditions such as depression, anxiety/ trauma
  • Environmental factors - Exposure to a culture or environment that promotes heavy drinking
  • Genetic factors - Family history of alcohol induced disorders
• With onset during withdrawal


  If criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, withdrawal
• Substance-induced psychotic disorder


  Distinguished from a primary psychotic disorder by considering the onset, course, and other factors
• Substance-induced psychotic disorders


  1. Arise during or soon after substance intoxication or withdrawal

  2. Can persist for weeks

  3. Primary psychotic disorders may precede the onset of substance use or may occur during times of sustained abstinence

  4. Once initiated, the psychotic symptoms may continue as long as the substance use continues
• Factors that suggest the psychotic symptoms are better accounted for by a primary psychotic disorder include persistence of psychotic symptoms for a substantial period of time (i.e., a month or more) after the end of substance intoxication or acute substance withdrawal or a history of prior recurrent primary psychotic disorders
• Prevalence of substance/medication-induced psychotic disorder in the general population is unknown. Between 7% and 25% of individuals presenting with a first episode of psychosis in different settings are reported to have substance/medication-induced psychotic disorder
• Alcohol-induced psychotic disorder is typically severely disabling and consequently is observed most frequently in emergency rooms, as individuals are often brought to the acute-care setting when it occurs. However, the disability is typically self-limited and resolves upon removal of the offending agent
• Alcohol-induced psychotic disorder


  Differentiated from a primary psychotic disorder by the fact that alcohol is judged to be causatively related to the symptoms
• Alcohol-induced anxiety disorder


  A diagnosis given after an individual uses alcohol that leads to prominent symptoms of panic or anxiety
• Diagnostic criteria for alcohol-induced anxiety disorder

  1. Panic attacks or anxiety is predominant in the clinical picture

  2. The symptoms developed during or soon after substance intoxication or withdrawal

  3. The involved substance/medication is capable of producing the symptoms

  4. The disturbance is not better explained by an anxiety disorder that is not alcohol-induced

  5. The disturbance does not occur exclusively during the course of a delirium

  6. The disturbance causes clinically significant distress or impairment
• Alcohol-induced anxiety disorder


  If panic or anxiety symptoms occur exclusively during the course of delirium, they are considered to be an associated feature of the delirium and are not diagnosed separately
• Once alcohol is discontinued, the panic or anxiety symptoms will usually improve or remit within days to several weeks to a month (depending on it's half-life and the presence of withdrawal)
• The prevalence of substance-induced anxiety disorder is not clear. General population data suggest that it may be rare, with a 12-month prevalence of approximately 0.002%. However, in clinical populations, the prevalence is likely to be higher
• Alcohol-induced sleep disorder


  A sleep disorder characterized by a severe change to sleeping patterns enough to warrant independent clinical attention and judged to be primarily caused by the pharmacological effects of alcohol
• Effects of alcohol on sleep

  1. During acute intoxication, alcohol produces an immediate sedative effect

  2. Following these initial effects, there may be increased wakefulness, restless sleep, and vivid and anxiety-laden dreams

  3. With habitual use, alcohol continues to show a short-lived sedative effect in the first half of the night, followed by sleep continuity disruption in the second half

  4. During alcohol withdrawal, there is extremely disrupted sleep continuity, and an increased amount and intensity of REM sleep, associated frequently with vivid dreaming
• Alcohol-induced sleep disorder


  Distinguished from another sleep disorder if alcohol is judged to be etiologically related to the symptoms
• Diagnostic criteria for alcohol-induced sleep disorder

  1. A prominent and severe disturbance in sleep

  2. The symptoms developed during or soon after substance intoxication or after withdrawal from the substance

  3. The involved substance is capable of producing the symptoms

  4. The disturbance is not better explained by a sleep disorder that is not substance-induced

  5. The disturbance does not occur exclusively during the course of a delirium

  6. The disturbance causes clinically significant distress or impairment
• Specifiers for alcohol-induced sleep disorder

  • Insomnia type
  • Daytime sleepiness type
  • Parasomnia type
  • Mixed type
• Substance use generally precipitates or accompanies insomnia in vulnerable individuals. Thus, presence of insomnia in response to stress or change in sleep environment or timing can represent a risk for developing substance/medication-induced sleep disorder
• During periods of substance use, intoxication, or withdrawal, individuals frequently complain of dysphoric mood, including depression and anxiety, irritability, cognitive impairment, inability to concentrate and fatigue
• Alcohol-induced major or mild neurocognitive disorder


  Neurocognitive impairments associated with alcohol use, misuse , intoxication or withdrawal
• Diagnostic criteria for alcohol-induced major or mild neurocognitive disorder

  1. The criteria are met for major or mild neurocognitive disorder

  2. The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal

  3. The involved substance and duration and extent of use are capable of producing the neurocognitive impairment

  4. The temporal course of the neurocognitive deficits is consistent with the timing of substance and abstinence

  5. The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder
• The prevalence of these conditions is not known. Prevalence figures for substance abuse are available, and substance-induced major or mild NCDs are more likely in those who are older, have longer use, and have other risk factors such as nutritional deficits. For alcohol abuse, the rate of mild NCD of intermediate duration is approximately 30%- 40% in the first 2 months of abstinence
• Risk factors for substance-induced NCDs

  • Older age
  • Longer use
  • Persistent use past age 50 years
  • Long-term nutritional deficiencies
  • Liver disease
  • Vascular risk factors
  • Cardiovascular and cerebrovascular disease
• Pharmacologic Management


  To permit safe withdrawal from alcohol, sedative-hypnotics, and benzodiazepines and to prevent relapse
• Pharmacologic treatments


  • Benzodiazepines
  • Disulfiram
  • Acamprosate
  • Methadone
  • Levomethadyl
  • Naltrexone
• Managing alcohol-induced disorders in adolescents

  1. Medical Management

  2. Psychological Interventions

  3. Social Support

  4. Education and Prevention

  5. Continued Monitoring and Follow-Up
• Overall, a collaborative and holistic approach involving healthcare professionals, families, schools, and communities is essential for effectively managing alcohol-induced disorders in adolescents and promoting long-term recovery
• Intellectual Disability/ Mental Retardation

  Significant sub-average intellectual functioning associated with concurrent impairments in adaptive behaviour manifested during the developmental period
• Mental retardation is a group of heterogeneous disorders associated with generalized developmental delay during infancy and early childhood, while impairment in cognitive functions and adaptive behaviors became generally apparent during pre-school and early school years depending on the severity of the condition
• The World Health Organization is still using the term mental retardation in its ICD-10 publication, while the American Psychiatric Association has recently called the condition "Intellectual disability"
• Prevalence of Mental retardation

  • 2% to 4% of the population have mental retardation
  • Most have mild retardation
  • Approximately 20% have moderate retardation
  • 5% have severe or profound retardation
• Classification of Mental Retardation (DSM V)

  • Mild Mental Retardation
  • Moderate Mental Retardation
  • Severe Mental Retardation
  • Profound Mental Retardation
• Individuals with Intellectual Disability

  • Have the same wide variety of characteristics as people with normal IQ
  • Have their own preferences just as others do
  • Sometimes have a limited range of emotions & lack personality traits such as self-control & perseverance
  • Find difficulty to grasp abstract concepts & have a limited understanding of the choices that may be put before them
  • Usually have less drive, energy & motivation than people with normal IQ
  • Limited intellect impairs normal development
  • More vulnerable to personal & emotional problems such as poor self-esteem, acting out behaviour & excessive attachment
  • Unable to give adequate meaning to the realities surrounding them & it is almost impossible for them to interpret abstract reality
  • Have fragmented perception of their world & often miss the meaning of complete experiences