MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE WITH PSYCHOSIS A CASE REPORT *Parvin

Kaur Sandhu, S.Ked **Dr.Nyoman Ratep Sp.KJ(K), **Dr.Wayan Westa Sp.KJ(K) *Student, Udayana University/ San !ah "ospita!, Denpasar **Revie#er $, Psy%hiatrist, San !ah "ospita!, Denpasar **Revie#er $$, Psy%hiatrist, San !ah "ospita!, Denpasar

&'stra%t (enta! and 'ehavioura! disorders %an 'e %aused due to use o) stimu!ants. & menta! and 'ehavioura! disorder %an 'e said to 'e a menta! or 'ehavioura! pattern that %auses disa'i!ity or distress, and #hi%h is not deve!opmenta!!y or so%ia!!y norma!. * (enta! disorders are enera!!y de)ined 'y a %om'ination o) ho# a person )ee!s, thin+s, a%ts or per%eives. $n this %ase #e ta!+ a'out menta! and 'ehavioura! disorders %aused 'y a stimu!ant , an amphetamine overdose. -his %ase report is a'out a #oman, ./ years o!d, #ith dia nosis o) menta! and 'ehavioura! disorders due to use o) other stimu!ants, in%!udin %a))eine.0 Key#ords, stimu!ant, amphetamine, psy%hosis

GANGGUAN MENTAL DAN PERILAKU AKIBAT PENGGUNAAN STIMULANSIA LAIN TERMASUK KAFEIN DENGAN GANGGUAN PSIKOTIK SEBUAH LAPORAN KASUS *Parvin Kaur Sandhu, S.Ked **Dr.Nyoman Ratep Sp.KJ(K), **Dr.Wayan Westa Sp.KJ(K) *(ahasis#a, Universitas Udayana/ RSUP San !ah, Denpasar **Pemeri+sa $, Spesia!is Kesehatan Ji#a, RSUP San !ah, Denpasar **Pemeri+sa $$, Spesia!is Kesehatan Ji#a, RSUP San !ah, Denpasar

&'stra+ 1an an 1an uan menta! dan peri!a+u dapat dise'a'+an +arena pen unaan stimu!an. Se'uah menye'a'+an

uan menta! dan peri!a+u ada!ah po!a menta! atau peri!a+u yan

penderitaan dan yan tida+ norma! 'erdasar+an per+em'an an deve!opmenta! atau sosia!.* uan menta! umumnya ditentu+an o!eh +om'inasi dari 'a aimana seseoran merasa, an uan menta! dan peri!a+u unaan 'ertinda+ atau 'erpi+ir. Da!am ha! ini +ita 'er'i%ara tentan 'erusia ./ tahun, den an dia nosis stimu!an !ainnya, termasu+ +a)ein.0 Kata +un%i, stimu!ansia, amphetamine, psi+oti+ Introduct on &mphetamine %an 'e a potent %entra! nervous system stimu!ant and is o) the phenethy!amine %!ass. $t is used in the treatment o) 'oth disorder attention and de)i%it a!so in hypera%tivity and %o niive e))e%ts su%h as euphoria, %han e in !i'ido, in%reased arousa!, and improved %o nitive %ontro!. $t indu%es physi%a! e))e%ts !i+e de%reased rea%tion time, resistan%e o) )ati ue, and mus%!e stren this in%reased. 4 2ar er doses o) amphetamine are !i+e!y to impair %o nitive )un%tion and indu%e mus%!e 'rea+do#n. Su'stan%e dependen%e rare!y arises )rom proper medi%a! use. 53treme!y hi h doses %an resu!t in psy%hosis !i+e de!usions and paranoia #hi%h very rare!y happens at therapeuti% doses even !on 6term use. Re%reationa! doses are mu%h !ar er than pres%ri'ed therapeuti% doses, and re%reationa! use there)ore %arries a reater ris+ o) serious side e))e%ts.*,4 &mphetamine into3i%ation o)ten are an

yan dise'a'+an o!eh overdosis am)etamin. 2aporan +asus ini ada!ah tentan seoran #anita, uan menta! dan peri!a+u a+i'at pen

nar%o!epsy. &mphetamine is a!so used as a per)orman%e and %o nitive enhan%er and re%reationa!!y a!so used as an euphoriant and aphrodisia%. $n many %ountries it is a pres%ription dru , i!!e a! possession and distri'ution o) amphetamine is o)ten %ontro!!ed very ti ht!y due to si ni)i%ant hea!th ris+s asso%iated #ith un%ontro!!ed and a!so heavy a%ts to use.*,0 &mphetamine, in%rease 'io eni% throu h an a%tivation o) tra%e amine re%eptor, amine and e3%itatory neurotransmitter

a%tivity in the 'rain, and its most pronoun%ed e))e%ts is it tar ets the %ate%ho!amine neurotransmitters. &t therapeuti% doses, it %an %ause emotiona!

identi)ied 'y %han e o) menta! status. 7entra! nervous system %han es su%h as menta! status %han es, disorientation, and

heada%he, symptoms

a itation, o)

dys+inesias,

and

pupi!!ary di!atation, psy%homotor a itation (sometimes retardation), mus%u!ar #ea+ness, %hest pain or %onvu!sions.. C!"# I$$u"tr!t on & ./ year o!d !ady, #as 'rou ht to the emer en%y department o) San !ah hospita! 'y a sta)) at the hospita! #here the patient #as stayin #ith the %omp!aint o) tryin to 9ump o) the .th )!oor o) her hote!. Durin the intervie#, patient on!y hard!y responded and #as on!y a'!e to ans#er

stro+e.

7ardiovas%u!ar

symptoms !i+e %hest pain, pa!pitations. 1astrointestina! symptoms su%h as dry mouth, nausea and vomitin and diarrhea. 1enitourinary mi%turition. presentations symptom S+in su%h or as o) di))i%u!t %utaneous diaphoresis,

erythematous pain)u! rashes, need!e mar+s or in)e%ted deep u!%erations (e%thyma). &nd (ydriasis )rom o%u!ar e3amination.* 8or the dia nosis o) a%ute into3i%ation due to use o) other stimu!ants, in%!udin %a))eine the %riteria needed to 'e )u!)i!!ed are )irst!y enera! %riteria )or a%ute into3i%ation. -here must at !east 'e one dys)un%tiona! 'ehaviour or per%eptua! a'norma!ities sensation a%tions, repetitive auditory, orientation, ha!!u%inations, hypervi i!an%e, ar umentativeness, visua!, su%h o) as euphoria 'e!ie)s o) and or in%reased randiose or !a'i!ity or ta%ti!e #ith ideation ener y, a ression, mood, i!!usions, inta%t or 'ehaviours,

:uestions a'out her name #ith su))i%ient sound. &)ter that the patient re)used to ans#er. -he patient #as rest!ess and did not #ant to stare at the e3aminer;s eyes. 8a%e o) the patient seemed %on)used durin the intervie#. Patients hands #ere in a tremor. <n the se%ond day, Durin the intervie#, patient #as a'!e to respond #e!! and a'!e to ans#er any :uestions #ith su))i%ient sound. Patient seemed %a!m and %ou!d !oo+ at the e3aminers eyes. "is )a%e !oo+ed sad durin the intervie#. -he hands #ere sti!! havin a tremor. &t the time she #as 'rou ht to the hospita!, the patient had mentioned that there is a #ound on her !e 6 #hi%h she %onsiders a 'eauti)u! in9ury due to runnin around yesterday. 2ater, the patient said that she #as home and as+ed )or potatoes 'e%ause they #ant to %oo+. She a!so #anted to open a the ate at nurse station

a'usiveness stereotyped usua!!y paranoid

inter)eren%e #ith persona! )un%tionin . &nd at !east t#o si ns )rom the )o!!o#in must 'e present su%h as ta%hy%ardia (sometimes arrhythmias, 'rady%ardia), hypertension %ardia% (sometimes

hypotension), s#eatin and %hi!!s, nausea and vomitin , eviden%e o) #ei ht !oss,

'e%ause she said there #as a )au%et that #as turned on and she #anted to turn it o)). When her dau hter %ame and as+ed her to stop #hat she #as doin , the patient 'e%ame an ry and )e!t that that her dau hter did not #ant to he!p. She a!so 'rie)!y he!d the e3aminer;s )in er and said that the )in er #as sti!! 'reathin . Patient at the time de%!ined to ans#er :uestions= instead 6 pa%ed the terra%e #ards and out and in other patients room, #hi!e sayin #ords that #as not %!ear. When in9e%ted #ith 2odomer and Dia>epam, patient re'e!!ed, shouted rude!y )or *? minutes a)ter in9e%tion. <n the se%ond day, #hen as+ed a'out her )ee!in s durin the intervie#, the patient said she )e!t mu%h 'etter than the day 'e)ore 'ut no# she )ee!s depressed and sad #hi!e tears dripped. When as+ed #hy the patient )e!t sad she said her 'oy)riend that has 'een #ith her )or *0 months had !e)t her 0 days a o, a)ter they :uarre!ed and the patient to!d him their re!ationship #as over . Sin%e he !e)t on -hursday she had not heard )rom him . Patients said her 'oy)riend #as @#onder)u! @ and they on!y had pro'!ems 'e%ause the patient herse!) is a!#ays an ry and irrita'!e . When as+ed i) he tried to %ommit sui%ide the day 'e)ore the patient denied it . She said she never thou ht a'out sui%ide . When as+ed #hat she #as doin yesterday on the .th )!oor,

she %an not :uite remem'er . Patients a!so said that the events in this #ee+ #ere a !itt!e '!urry . Patient a!so said she disappeared )or a )e# days 'ut she %an not :uite remem'er . -he patient said that sin%e this mornin she did not hear voi%es or see shado#s. -he patient said she %ame to Aa!i )ive days a o )or a va%ation to %e!e'rate her dau hters 0*st 'irthday. Patient %ame to Aa!i #ith her 'oy)riend , her dau hter , 1eor ie and her dau hters 'oy)riend. $n Aa!i, the patient on!y !ived #ith her 'oy)riend in Aa!i 1arden "ote!, #hi!e her dau hter #as stayin at a separate hote! and a!so did not %ome in the same )!i ht. When the patient #as on the p!ane #ith her 'oy)riend , she vomited and had a %o!d s#eat. Patient had a !ot o) #ater , 'ut %ontinued to vomit and s#eat and )e!t dehydrated and her hands +ept sha+in . -he patient %!aimed to have had sei>ures t#i%e . "o#ever , a)ter that the patient said she #as not sure i) it #as a%tua!!y sei>ures, or she had simp!y %o!!apsed #hi!e at a restaurant . -he patient has 'een to the 5R in San !ah t#o days a o #ith her 'oy)riend 'ut re)used to stay and !e)t. &t that time the patient said he sa# a shado# o) someone #ho 'ro+e into her room and made noise in her room. She a!so heard the sound o) a

'a'y %ryin and said it #as the voi%e o) her son. -he %hi!d she #as ta!+in a'out #as B years o!d and is in &ustra!ia no#. Patient had said durin the intervie# that she )eared her son #ou!d 'e ta+en. &n emp!oyee o) the hote! #here the patient !ived said the patient #anted to 9ump )rom the .th )!oor o) the hote! 'ui!din . She did not +no# #hy patient #anted to 9ump 'ut said 'e)ore that patient thou ht a tree #as her )riend and a statue in the !o''y o) her hote! her parents and em'ra%ed the statue. Patient a!so seemed to ta!+ to a stone and ti!e -he patientCs dau hter said, in Aa!i, the patient seemed to 'e a di))erent person. -he patient had 'een an ry, %haoti% and )ear)u!. Patient;s mother said she )e!t the patient;s %ondition #as %aused 'y her the patientCs 'oy)riend #ho had 'een #ith the patient )or *0 months, su))erin )rom &D"D. -he mother )e!t that the patientCs 'oy)riend had s!ipped a dru into the patients drin+. Possi'!y his &D"D medi%ation. -his #as the se%ond time the patient had an atta%+ o) ha!!u%inations !i+e this 'oth the time the patient had 'een #ith her 'oy)riend, in the 0 months a o and no#. -he patient had ha!!u%inations and nausea and vomitin . -he patient at that time said she sa# a hairy man in her 'edroom. -he mother )e!t the patients 'oy)riend #as very )ishy and

had as+ed him #hether he had dru

ed her

the !ast time and he had 9ust i nored her :uestion. -he patients 'oy)riend to!d the hote! %!er+ 'e)ore !eavin the patient @ $;m not married to her , dea! #ith her@. -he patient has 0 !asses o) #ine everyday and smo+es o%%asiona!!y. -he patients '!ood pressure #as hi h *D//*//mm/" and pu!se #as a!so hi h *0/ times per minute. "er respiratory rate and temperature #ere hi her then norma! 0B times per minute and ./ de rees. She had a )ine tremor. Psy%hiatri% status o'tained on the )irst day redu%ed patient a#areness , disorientation o) p!a%e , time and peop!e . &'stra%t thin+in %ou!d not 'e eva!uated , memory and inte!!i en%e %ou!d not 'e eva!uated . (ood / a))e%t #as sad and innapropriate, -rain o) thou ht #as stran e ideas , de!usions #ith no preo%%upation . -here #as auditory and visua! ha!!u%inations , and i!!usions. -here #as insomnia, raptus or hipo'u!ia. Patient had tremors . Psy%hiatri% status on the se%ond day, patient had a %!ear %ons%iousness, orientation o) p!a%e , time and peop!e #as ood. 1ood a'stra%t thin+in , no memory disorders, inte!!i en%e a%%ordin to the !eve! o) edu%ation . (ood / a))e%t #as dysphori% and appropriate , train o) thou ht #as a history o) stran e ideas ,

sui%ida! ideation , de!usions and no preo%%upation. No auditory and visua! ha!!u%inations , and no i!!usions. "istory o) insomnia , raptus and hipo'u!ia. Patient #as dia nosed #ith (enta! and 'ehavioura! disorders due to use o) other stimu!ants m in%!udin %a))eine #ith psy%hosis. She #as iven Sero:ue! 0 3 ?/ ta', "a!operido! ? m $.( and Dia>epam */ m $.E #hen needed.

#ith

his

medi%ation.

-he

patients

'oy)riend had &D"D and amphetamine is a type o) &D"D medi%ation. -he patient did not have any other medi%a! disorder.. -he patient a!so had a !on history o) a!%oho! %onsumption on a dai!y 'asis. &%ute into3i%ation had a hi her !i+e!ihood o) deve!opin in a patient #ith a!%oho! or dru re!ated pro'!ems.0 &)ter the patients 'oy)riend !e)t her and the patient #as 'rou ht to the hospita! the patients %ondition improved. Patient #as iven a Aen>odia>epine, Dia>epam as a sedative to %ontro! 7NS stimu!ation and a!so as a mus%!e re!a3ant. She #as a!so iven a typi%a! antipsy%hoti% "a!operido! that %an 'e used to treat a%ute psy%hosis. She #as a!so iven an atypi%a! antipsy%hoti% Sero:ue!.*

D "cu"" on $n this %ase the patients symptoms )it the $7D6*/ %riteria. She had in%reased ener y, had 'een an ry, irrita'!e and a resive a%%ordin to her dau hter. She had a!so 'een moody. She had visua! i!!usions and thou ht that a statue #as her parents and a tree #as her )riend. She a!so had visua! and auditory ha!!u%inations, she sa# a shado# that entered her room and made noise and heard her 'a'y %ry. She #as paranoid, a%%ordin to her dau hter she 'e%ame a)raid o) shado#s. $t inter)ered #ith her a%tivities.0,4 She had ta%hy%ardia, hypertension, ta%hyarrhythmia, s#eatin and %hi!!s, hyperpyre3ia, nausea and vomitin , psy%homotor a itation and %onvu!sions. "er symptoms #ere that o) &mphetamine overdose and %oin%ided #ith her mothers suspi%ion that the patients 'oy)riend had spi+ed her drin+

R#%#r#nc#" *. Sado%+ AJ, et a!. Kap!an and Sado%+;s 7omprehensive -e3t'oo+ o) Psy%hiatry. Fth ed. Phi!ade!phia, Pa., 2ippin%ott Wi!!iams G Wi!+ins= 0//F. . Retrieved on De%em'er *4,0/*4 )rom http,//###.psy%hiatryon!ine.%om. 0. (enta! and Aehavioura! Disorders due to other Stimu!ant Use $n%!udin 7a))eine, -he $7D6*/ 7!assi)i%ation o) (enta! and Aehavioura! Disorders, 7!ini%a! Des%riptions and Dia nosti%

1uide!ines. 1eneva, Wor!d "ea!th <r ani>ation= De%em'er ###.#ho.or . 4. (enta! and Aehavioura! Disorders. $n, Dia nosti% and Statisti%a! (anua! o) (enta! Disorders DS(6 $E6 -R. .th ed. &r!in ton, Ea., &meri%an 0///. Psy%hiatri% &sso%iation= **, *FF0. 0/*4 Retrieved )rom

Retrieved De%em'er *0, 0/*4 )rom http,//###.psy%hiatryon!ine.%om. .. &mphetamine Psy%hosis, & (ode! )or Studyin the <nset and 7ourse o) Psy%hosis. &ustra!ia, -he (edi%a! Journa! o) &ustra!ia= 0//F. Retrieved De%em'er ###.m9a.or . *4, 0/*4 )rom