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INTOXICATION PSYCHOSES CAUSED BY COMBINED DRUG USE
Ibragimova Muazam Holdorovna
Assistant of the department of psychiatry, medical psychology and narcology, Samarkand State
Medical University, Samarkand, Republic of Uzbekistan
Shamshiyeva Zohida Saloxiddin qizi
Samarkand State Medical University Faculty of medicine №1,
516-Group student, Samarkand, Republic of Uzbekistan.
https://doi.org/10.5281/zenodo.10734306
Abstract.
In recent years, there has been a trend in all developed countries of the world for
the rapid spread of the combined consumption of psychoactive substances, the market of which is
increasingly expanding due to the emergence of new synthetic drugs and drugs. Cases of the
appearance of intoxicating psychoses as a result of the combined use of psychoactive substances
of various pharmacological groups have become significantly more frequent, they are practically
not found in the mono-consumption of classical opioids, and rarely occur with an overdose of
natural cannabinoids.
Key words:
synthetic drugs, drugs, psychoactive substances psychoses, classical opioid
cannabinoid.
ИНТОКСИКАЦИОННЫЕ ПСИХОЗЫ, ВЫЗВАННЫЕ СОЧЕТАННЫМ
УПОТРЕБЛЕНИЕМ НАРКОТИКОВ
Аннотация.
В последние годы во всех развитых странах мира наметилась
тенденция быстрого распространения комбинированного потребления психоактивных
веществ, рынок которых все больше расширяется за счет появления новых синтетических
наркотиков и наркотиков. Значительно участились случаи появления интоксикационных
психозов в результате сочетанного применения психоактивных веществ различных
фармакологических групп, они практически не встречаются при монопотреблении
классических опиоидов и редко возникают при передозировке натуральных каннабиноидов.
Ключевые слова:
синтетические наркотики, наркотики, психоактивные вещества,
психозы, классические опиоиды каннабиноиды.
Introduction.
The clinical features of such psychoses have not been sufficiently studied,
and measures to stop them have been poorly developed, a number of researchers [1] argue that the
use of synthetic drugs is currently at the epidemic level, and the real level of their abuse can be
assessed only indirectly – with the appearance of somatic complications and psychotic diseases.
Thus, in particular, clinical observations show that people who consume synthetic catinones are
more likely to develop psychotic disorders when exposed to surfactants than those who use
"conventional" drugs, whose clinical manifestations have symptoms typical of schizophrenia [2-
4]. At the same time, issues related to the prevalence of schizophrenia-like psychotic disorders in
consumers of synthetic catinones and the possibility of transforming them into disorders of the
schizophrenia spectrum have not been fully studied. Currently, great attention is paid to the
biochemical mechanisms of synthetic athinones, the acute toxic effect of their intake, the
description of individual clinical cases of acute poisoning, etc. in some studies, they have been
combined with other designer drugs, notably synthetic cannabinoids (spaysami).") [5-6]. There are
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separate studies in which, on the contrary, mental disorders that occur during the reception of
various groups of "designer drugs" are compared, but such works are of a special nature [7].
The purpose of the study:
analysis of the phenomenological properties of psychotic
disorders of consumers of synthetic catinones based on the results of modern research.
The results and their discussion
are general data on psychotic disorders in those who take
synthetic catinones. M. V. Prilutskaya and S. N. Molchanov, reviewing world literary data on
publications devoted to the clinical aspects of designer drugs, found that the greatest number of
health problems of users of these substances were associated with mental disorders – 64,4%. Often
there were psychotic symptoms, as well as signs of darkening and mind suppression. At the same
time, problems with the cardiovascular system came second with a frequency of about 17% [8]. In
this regard, it should be noted that the presence of psychopathological symptoms in the reception
of "traditional" psychostimulants was previously noted, but was mainly characterized as a
complication of intoxication or withdrawal syndrome [9]. According to the European network for
drug emergencies (Euro-DEN), the incidence rate of psychotic disorders caused by taking
surfactants and leading to hospitalization is 6,3%. From the group of synthetic catinones, the
following were noted: methylene dioxypirovaleron (MDPV) (27,3% of observations), mephedrone
(5,7%) and methedrone (3,3%).
Thus, the ability of drugs to cause psychotic disorders differs significantly not only in
substances of different groups, but also in one of them, in particular, in the group of synthetic
catinones [10]. Taking catinones (in the study they were "natural catinones") was one of the first
to focus on the possibility of causing the development of hallucinatory-delusional symptoms, J.
Giannini and S. Castellani [11]. According to the literature, the most common acute
psychopathological diseases after the adoption of SC are: anxiety, fear, symptoms of
depersonalization and derealization, dysphoria, panic attacks, depressive disorders, acute paranoid
reaction, sleep disorders, hallucinatory and illusory disorders, catatonic symptomatology, suicidal
thoughts and actions, and convulsive seizures. It is noted that these acute psychotic disorders, as a
rule, develop through the nose 0,5–2 hours after smoking or inhaling synthetic catinones and(or)
immediately after intravenous administration [12].
In most sources, intoxication the appearance of psychotic disorders is indicated not only in
the presence of addiction, but also with a single dose of SC [13]. However, risk factors for their
occurrence are: genetic predisposition, history of opioid drug use and brain damage, intravenous
and high-dose SK, experience of use, severity of addiction, early age of abuse, joint psychiatric
disorders and high levels of anxiety [14]. V. D. Mendelevich noted that despite the fact that the
frequency of intoxication psychotic disorders is associated with the duration and frequency of drug
use, in some cases it is determined by individual sensitivity ("weakness"), since even one-time SK
intake in a number of people leads to the development of psychotic diseases. In his opinion, the
predisposing factors of their development were: injection or inhalation methods, repeated use in a
short time, addiction, history of psychotic episodes, use along with other surfactants, long-term
sleep disorders [15]. Examining clinical manifestations caused by drug use, the designer notes that
intoxication is superior to withdrawal symptoms (24% to 76%) of psychotic disorders (54% to
76%). 46%) [16]. In this case, psychotic disorders usually develop within 2 weeks after drug use
(according to the diagnostic categories ICD-10, F15.5x meets the criteria. "mental and behavioral
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disorders caused by taking psychostimulants. Psychotic disorder"). Several clinical variants of
such diseases have been noted in modern literature: polymorphic (45-91%), schizophrenia-like (up
to 55%), mostly delusional (3,3-6%), Mostly hallucinatory (1,7–3,3%) [16]. Many publications
emphasize the superiority of polymorphic psychotic disorders over isolated hallucinatory or
delusional disorders. In addition, polymorphic intoxication psychotic disorders have been noted to
contain symptomatology of the "endogenous" register, allowing them to be identified as
schizophrenia-like psychotic disorders (F15.50) according to ICD-10. It has also been noted that
these psychotic disorders are usually characterized by a longer and more severe course, and in
some cases can develop into a disorder of the Schizophrenia Spectrum [17]. Psychotic disorders
similar to schizophrenia as a result of taking synthetic catinones. In modern literature, there has
been a significant increase in publications about the relationship between the increase in psychotic
disorders similar to schizophrenia and the intake of certain surfactants from the mid-90s of the last
century [18]. Thus, in Japan, cases have been described in which such disorders resulting from the
intake of methamphetamines lasting up to 3 years, auditory hallucinations, imaginary ideas of a
percecutaneous nature, ideator automatisms and spontaneous psychotic relapses (flashbacks) occur
after a psychotic state [19]. Nevertheless, it has been noted that psychotic disorders resulting from"
traditional "drug use are easily characterized by schizophrenia, as psychotic disorders are"
moderate " and more suited to classical intoxication psychoses. V. D. Mendelevich studied the
clinical picture of intoxication psychotic disorders, noting that the appearance of new synthetic
surfactants has made the intoxication sixic diseases clinic more acute and diverse, which
complicates their differential diagnosis with schizophrenia [20].
In modern literature, the most common clinical manifestations of psychotic disorders
similar to schizophrenia are: affective-medial derealization and depersonalization, percecutor
delirium, structural thinking disorder (elements of resonance, sperrung, mentism, disorder),
senestopathic disorders, verbal and visual pseudogallusinations, mental syndromes ("openness"
and "mind reading").) and physical automatism, imaginary ideas of superpowers, catatonic
symptoms [21]. For Example, V. Colley et al. one described catatonic arousal in a 19-year-old
patient, replaced by waxy stiffness and immobility after taking a suspended mephedron within 3
days [22]. In The Study, N. M. Catatonic arousal was reported in 18% of patients with draluk acute
intoxication psychotic disorder [23]. Initially, cases were recorded in which the manifesto of
psychotic disorder occurred according to the exogenous type, and later the clinical picture had a
clear "endogenous color" (the emergence of imaginary ideas of exposure and
pseudogallusinations), with a change in personality deficit [24]. In rare cases, gebephrenic arousal
has been noted, as well as paraphrenization of delusional ideas [25]. In turn, some authors argue
that in such cases the manifestation of mental automatism syndrome (experience of"extraordinary
work of the brain", the phenomenon of "collective reading of thoughts" and "openness of
thoughts", verbal and visual pseudogallusinations) is unstable, has a short-term character and
decreases at the end of an acute psychotic state [26].
A. A. Andrusenko, after studying 12 patients with schizophrenia-like psychotic disorders
caused by taking SC, found that patients are characterized by syntonicity, no deficiency changes,
initial changes in drug-type personality, symptoms of early organic brain damage, infantilism, and
deviant behavior in adulthood. The beginning of the psychotic effect between these individuals, as
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a rule, was acute, and at the same time there was a clear connection with the reception of SK, the
secondary unopened nature of delirium, psychotic disorders had a long-lasting, oscillating
character, but ended with a complete recovery (return to the"original" painful level). The other
group consisted of 8 patients who were the first psychotic episode of undifferentiated
schizophrenia associated with taking PAV (primarily α-PVP). In this group of patients on the
premorbid, manifestations of schizotypal diathesis, mild cognitive and negative disorders were
identified, there was no direct causal relationship with intoxication. At the same time, psychotic
disorders were characterized by the gradual expansion and complication of psychotic disorders,
the absence of criticism, the beginning of subacute with the incompatibility of influence on the
topic of delirium. Characteristic procedural changes in personality were also noted during the
period of resolving the psychotic state [27-30]. In turn, I. V. Dubatova et al., examined 158 male
patients on HDPE in a psychotic condition associated with the administration of designer drugs
(catinones and "spices") and identified two groups of patients. The first group consisted of patients
of the psychotic "exogenous" (45%),and the second group of patients of the "endogenous" (55%)
type. In the first group, the severity of clinical manifestations and the duration of psychosis were
clearly related to the dynamics of intoxication. In 73,6% of cases, psychotic conditions were
stopped within 24 hours, and the rest within 2-3 days. The second group was formed from the very
beginning by patients whose clinical picture included a combination of Affective and characteristic
"schizophrenia" symptoms and often manifested by the consistent development of Affective-
oneiroid attack. Thus, in 74% of patients with psychotic disorders similar to schizophrenia, the
stage of Affective-delusional derealization and depersonalization was recorded with
dramatization, false recognition, delusional disorders, affective and psychomotor disorders [31-
33].
In 26% of patients with psychotic disorders similar to schizophrenia, the development of
psychosis has reached the stage of delusional-fantastic derealization of self-awareness,
disorientation, polar affective fluctuations, fantasy-fantastic perception of the environment,
depersonalization with catatonic inclusions. In this group of patients, psychotic conditions, as a
rule, took a long-term course (up to 4-6 weeks).) and intensive psychopharmacotherapy with
antipsychotic drugs, and in some cases electroconvulsive and insulinocomatous therapy were
required. At the same time, there was no parallel between the reality of intoxication and the
dynamics of mental disorder [34-37].
Recurrence of psychotic disorders similar to schizophrenia was mainly associated with the
recovery of intoxication, but in 8% of patients they occurred autochthonically. The authors
observed a large hereditary severity of mental and Narcological disorders in patients whose
psychotic disorders have a clear schizophrenia-like clinical picture. It was also noted that psychotic
disorders appeared in a certain group of patients independent, from the presence or absence of
addiction syndrome [38]. Mental Disorders at the stage of formation of remission and in the
postabstinent period. The study shows that 80% of psychotic disorders caused by taking synthetic
cannabinoids and catinones persisted within a week, another 8% for 2 weeks, and 12% of patients
for several months. At the same time, there is a tendency to complicate psychopathological
structure, which often led to a revision of the diagnosis [39]. In turn, O. S. Yukov found that the
duration of long-lasting psychoses in SK intake was an average of 2-3 months [40]. Many sources
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indicate that after the cessation of psychotic disorder, critical response to the past condition does
not occur immediately, and some patients retain a residual delusional interpretation even after
discharge from the hospital. At the same time, partial amnesia of painful experiences was noted
[41].
A. V. Pokrovskaya et al. patients dependent on synthetic psychostimulants experience
schizophrenia-like symptoms during the postabstinent period, such as: hypomanic conditions,
relationships, damage, harassment, as well as specific thinking disorders in the form of disorders,
shifts, inconsistencies, resonances. Also, these individuals are characterized by the presence of
individual signs of psychoorganic syndrome: a decrease in mental processes, a weakening of
memory and attention, impoverishment of the emotional sphere, lability of influence, a decrease
in mental activity, a decrease in criticism, etc. [42-45]. In turn, I. V. Pyatayeva et al. it is noted that
in the postpsychotic period, thought disorders such as resonance, diversity, slippage occur in 90%
of patients receiving synthetic catinones (before psychiatric hospitalization) [46]. Some
researchers suggest that a number of patients addicted to" designer drugs "have hallucinogenic-
persistent perceptual disorders (HPPDS), otherwise known as"flashbacks". Often such phenomena
are observed at the stage of formation of remission and are very poorly stopped by antipsychotics
[47]. It is noted that before the appearance of" designer drugs", these symptoms were mainly
associated with the intake of hallucinogens (LSD, psilocybin, mescaline) and, in rare cases,
psychostimulants [48]. Clinical manifestations, as a rule, include visual perception: geometric
pseudogallusinations, halos, light flashes, micropsies, subsequent images, etc [49]. Possibility of
transition to schizophrenia and differential diagnostic criteria. Speaking about the similarity of
psychotic disorders in the reception of synthetic catinones and effective symptoms in
schizophrenia, many authors note that the totality of the pathogenetic mechanisms of the
development of these mental disorders is associated with the dopaminergic neurotransmitter
system.
It should be noted that most modern neurobiological theories come from the study of the
effects of surfactants on neurotransmitters. The initial serotonin model was formed in the process
of studying the effects of LSD on the human div, with amphetamines giving rise to the dopamine
theory, the ketamine-glutamate model [50]. It is noted that dopamine-active surfactants (including
SK) mainly affect effective symptoms and glutamate-active, in addition to affecting effective
symptoms, has negative and cognitive effects [51]. The results of modern studies show that in
schizophrenia, both systems are impaired, and these disorders are correlated [52]. It has been
argued that the dopaminergic psychosis model is more typical of schizophrenia because drugs
acting on D2 receptors are able to effectively suppress ti psychotic disorders [53]. In a study of
methamphetamine psychotic structures, it was noted that early psychosis may be associated with
the risk of more severe psychotic states due to the sensitivity and development of "dopaminergic
hypersensitivity", especially in "vulnerable" people (with excessive expression and sensitivity of
the DRD2 dopamine receptor) [54]. It is known that before the spread of modern "designer drugs",
cannabinoids were considered the main trigger of intoxication of schizophrenia [55]. Thus, the
average risk of psychotic disorder resulting from cannabinoid use becoming schizophrenia was
34%, while amphetamines were 22%, as the risk of psychotic disorder in cannabinoid abuse is
very low– 0,5–5,0% [56]. M. S. K. Starzer et al. A study of psychotic disorders triggered by PAV
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(n=6788) found that in 26% of patients, within the 20 years following the recording of these
disorders, it had become schizophrenia, with about half of them within 5 years. The largest
conversion rate to schizophrenia and bipolar disorder was cannabinoids – 47%, amphetamines –
32.3%. Also, their research shows that the likelihood of such a change is significantly higher in
the younger (16-25 years old) [57]. However, there are publications showing that increasing the
population's cannabinoid intake does not increase the proportion of schizophrenia in this
population [58]. In his study I. V. Dubatova et al. intoxication compared patients with" schizoform
" psychotic disorders and patients with normal endogenous schizoaffective disorders, and found
that those who consume psychoactive substances with schizoaffective structures lacked the
specifics of the clinical picture of psychopathological disorders. True, psychotic disorders caused
by the use of surfactants were reduced by 1-2 weeks, there was less hereditary weight, and relapses
occurred only with drug rehabilitation [59]. Similarities between psychostimulants and psychotic
disorders caused by schizophrenia have previously been noted by other researchers [60]. At the
same time, psychotic disorders caused by taking met differ from schizophrenia in that, first of all,
visual and tactile hallucinations are often noted, and in rare cases, symptoms of negative
symptoms: impaired thinking, decency, emotional detachment, blurred effect, etc., what can be
used in differential diagnosis [61]. In the diagnosis of" endogenous "and" exogenous " psychotic
disorders, many authors play a key role in the fact of taking surfactants before they appear [62].
However, the prevalence of" pure "cases of" endogenous " diseases is not so significant, as patients
with schizophrenia often abuse drugs [63]. Up to 60% of all patients with schizophrenia have been
recorded abusing Pav [64]. And here, G. A. Fastovtsov and S. N. According to oskolokova, an
important issue: at what stage of the "endogenous" violation there were "exogenous" symptoms as
a result of the intake of surfactants [65]. In addition, there is evidence in modern literature that
psychopathological disorders caused by SC uptake persist even after the immediate effects of
surfactants have ended, i.e. sometimes there is no direct parallelism
the effects and dynamics of psychotic disorder that allow this disorder to be reclassified as
"endogenous" [66]. In addition to the lack of parallelism with drunkenness, G. A. Fastovtsov and
S. N. According to Oskolokova,"exogenous" psychotic diseases caused by the use of SC are not
characterized by a clear sequence of syndromes, which is characteristic of "endogenous" diseases,
which can serve as one of the criteria for their differential diagnosis. Also, in their opinion, in the
differential diagnosis of exogenous and comorbid psychotic diseases, the "response to therapy",
that is, the "main response" to antipsychotic therapy, can help. In addition, they suggest that the
picture of schizophrenia has undergone patomorphosis in recent decades, masked behind neurosis-
like and psychopatho-like manifestations, which can further complicate diagnosis, including
differential [67-70]. One of the important criteria for differential diagnosis is proposed to use the
duration and tolerance of psychotic symptoms [71]. According to the 10th revised International
Classification of diseases (ICD-10), the duration of hallucinatory-delusional symptoms should be
more than 10 days, but less than 6 months. If it lasts more than 6 months, it is preferable to make
a diagnosis from the categories of schizophrenia, schizotypal and delusional disorders [72]. The
presence of psychotic disorders in long-term (more than 6 months) surfactant consumers makes it
possible to speculate that they can be converted into a disorder of the Schizophrenia Spectrum. It
is no coincidence that in recent years the scientific community has been discussing the issue of
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introducing a separate category into ICD-11 – "psychotic disorder under the influence of
surfactants", since these diseases do not always correspond to the traditional criteria of
schizophrenia: these patients are critical of their condition, delusional disorders are mainly
associated with incorrect perception.. and the onset of psychotic diseases, as a rule, is associated
with the consumption of acute and surfactants. Also, with these disorders, visual perception
deceptions often prevail, patients experience more aggressive behavior, suicidal thoughts are more
common, and affective symptoms are observed [73-76]. However, factors that contribute to the
transformation of the psychotic disorder of intoxication into schizophrenia are also distinguished:
the absence of criticism of its condition, low premorbid function, the presence of schizotypal
personality traits and the history of psychotic disorders in relatives [77-79]. Thus, the initial
conclusion can be made that high rates of transformation can be associated both with the
development of psychotic disorders and with misdiagnosis. In many ways, the inaccuracy of
diagnosing schizophrenia in patients with long-term intoxication psychotic disorder can be
attributed to the premorbidity of psychotic disorder and its debut itself, as well as an insufficient
amount of catamnestic information. Affective Disorders in patients receiving synthetic catinones.
Disturbances in the emotional sphere are characteristic of dependence on all surfactants, including
psychostimulants [80]. Affective Disorders often dominate the clinical picture of removal
symptoms, and are also an integral part of pathological attraction to surfactants. Often the
formation of permanent remissions is hindered by disorders in the affective area of patients [81].
However, there is little research on the structure and phenomenological properties of
Affective Disorders in SK consumers. This may be due to the fact that the attention of individual
researchers is often directed to the diagnosis and description of hallucinatory-delusional
symptoms, as well as the fact that Affective Disorders in the reception of SC did not differ
significantly from other psychostimulants. There are many studies devoted to the study of SC
consumer suicide behavior. Over the past few years, more than 70 works have been published on
the connection of the use of SK with suicide [82]. At the same time, a characteristic feature of
Affective Disorders in patients taking synthetic catinones: a connection with drug use, uncertainty
of structure, weak differentiation, daily mood swings and lack of viability of the effect. Depressive
disorders resulting from the intake of synthetic catinones and cannabinoids during the
Postabstinent period are mainly represented by dysphoric type – 53%, apathetic – 27%, to a lesser
extent – sad variant (20%). At the same time, high levels of anxiety are identified in 23% of patients
and it is noted that affective disorders are directly related to PVN [83]. O. N. According to
Patrikeyeva et al..in patients taking synthetic drugs (catinones and spices), the 3-6 month
depression rate during remission ("vigilance") is not statistically different from the depression rate
of healthy people, and is statistically significantly less than the 6 month remission. The anxiety
level was statistically much higher than that of healthy individuals, and it remained virtually
unchanged by the "vigilance period" (equally high as in the 3-6 month period., and for over 6
months.) [84]. At the same time, there are separate studies showing that"depression predisposition"
is higher in SC-dependent patients (without indicating a "period of vigilance") than in healthy
people [85]. D. A. Lyubchenko et al. their work emphasizes that for patients using SC, the
presence of signs of subclinical depression and anxiety is common: emotional imbalance, tension,
inner restlessness, decreased mood, joyslessness, "the tendency to see everything through black
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glasses", etc. The main clinical picture of Affective Disorders in these patients, in their opinion, is
depression, the second most common anxiety disorder (social phobia, panic attacks, obsessive –
compulsive disorders). However, it has not been determined at what stage of treatment these
patients were in [86]. M. L. Rohlina described ephedrone and primary addiction, noting that
affective disorders such as clinically apparent dysphoria or sluggish-apathetic depression came to
the fore after overcoming acute removal disorders [87]. A. R. Asadullin's study mentioned 30.8%
of the occurrence of "suicide depressions" during the withdrawal period, 41% of patients had at
least one history of attempted suicide, and 59% of them recorded suicidal thoughts [88]. In general,
according to domestic and foreign literature, the proportion of patients receiving synthetic
catinones with suicidal behavior ranges from 26% to 73% [89, 90]. A. R. Asadullin's study argues
that suicide thought often arose during the withdrawal period, with suicide-related death being the
second most common cause of death in SC-dependent [91]. A number of researchers, on the
contrary, argue that the main reason for the suicide of such patients, on the contrary, is
hallucinatory-delusional symptomatology during psychotic disorders of intoxication [92]. There
is also evidence that an important prognostic sign of suicidal behavior of individuals receiving SC
is of constant concern both during the removal of surfactants and during the period of "long-term
withdrawal" [93]. O. N. According to Patrikeyeva et al., patients with a remission duration of more
than 6 months have a higher risk of suicide (3-6 months) than those with a lower risk of suicide.)
and in healthy people, which is related to their level of depression. At the same time, the risk of
suicide in patients with a" duration of consciousness " of 3-6 months did not differ from healthy
people [94].
Conclusion
thus, the following preliminary conclusions can be drawn based on a review
of the published data. Currently, the literature contains a detailed description of
psychopathological diseases that develop with systematic and episodic reception of SC,
highlighting their high comorbidity with a violation of the Schizophrenia Spectrum. At the same
time, little is known about the catamnesis of patients with psychotic disorders, as well as the results
of the treatment and rehabilitation of this group of patients. Issues such as the spread and causes
of psychotic disorders similar to schizophrenia, their conversion to schizophrenia and, accordingly,
differential diagnosis between them are still not well understood.
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