Lesson 4

DRUG ABUSE
Also called substance abuse
• Drug : any substance once introduced into the
body it modifies the function of the body
-Or has an effect on the body functions
• Drug - could be solid /liquid/gas.
• Modification means - if you have a headache
you take the drug – headache goes
Continuation of Drug abuse
• Taking a dug for other purpose but not medical
purpose
• Or taking a drug for other use which is not socially
accepted
• Taking a drug to commit a crime
• Almost all drugs can be abused e.g. chloroquine taken
to treat malaria if you take it to procure abortion that
is an abuse.
• Or you take Panadol just for fun that an abuse.
Psycho-active drugs
• Psycho-active drugs are those drugs that when
introduced into the body produces the
following effects
• Affect the mood of the individuals
• May become very sad /happy/jolly etc.
• They affect the behavior's of the individuals
Psycho-active
Psycho-means mind.
• Mind controls the behavior of an individual.
• Controls the mood of an individual .
• So this drugs have a great effect on the mind,
hence produces great change of mood/
behavior's.
Types of these psycho-active drugs
• Narcotic drugs
• Morphine /petlidine /coclein/heroine.
• Most of these drugs are used in our hospitals to
• Reduce or treat severe pain pethidine/morphine.
• Some mixed with cough syrup e.g. coclein.
• Minority of abuses may have introduced in the
hospital.
 Continuation of types
• Heroin(brown sugar).
• The most commonly abused drug in Kenya.
• Not used medically.
• Users get it in the streets .
• It is very cheap a close 120.
• Mostly available in the slums schools .
 Effects (initial effects).

• It produces euphoric state .

• Individual experiences sense of well being.
• It relaxes both mind and body .
• It suppress lungs – abused by the obese people.
• It potentiate the intention.
• Hence seem to be answers to every thing .
• It is commonly abused by Std.
 Continuation of effects
• Manamabas
• Disco goers
• School dropouts
• It gives you false image.
• Cheats you everything is okay
• Cheats you false satisfaction
 Later effects

• Because of giving you false image the

individual lives in the world of his own.
• Once the effect subside exposed to realized-
either you go for drugs or severely depressed.
• Some commit suicide.
• Remove social inhibition
• This drugs also cense sever defense.
 Continuation of later effects
• Sedatives
• Another class of drug abuse
• Diazepam/legartic/ phenobehitones
• They are used in the hospitals
• They depress the C.N.S
• Calming effects.
 Initial effects
• They sense mental/physical relaxation
• Inducing sleep intently
• They are used in the hospitals to reduce anxiety
/sedate pt-hypertension,peptic ulcers patient etc.
• Most of this drugs are abused by the hospital staffs
i.e. nurses, doctors pharmacy.
 Continuation of initial effects
• They cause mild dependence
• Individual no longer able to sleep without the
drug.
• They cause demons/anxiety/confusion if a
dose is missed.
 stimulants

• Another class of drugs which are abused.

• The class include-cocaine mandrax,
mentledrine. These drugs the stimulate C.N.S
Street name – speed/snow/gold dust.
Cocaine is mostly abused drug followed by
mandrax.
Effects(initial)
• A dose of these drugs causes excessive alertness
• Hence abused by driver/watchmen/ Std's.
• Includes excessive happiness/euphoric.
• Reduces anxiety and fear.
• Suppresses lungs- obsess.
• Gives extra ordinary energy to do whatsoever
you decide to do.
• It removes reality and put you into fantasy
Later effects
• The drug causes very severe dependence – you cant do
without it.
• When social inhibition is removed act anyhowly like
animal.
• Rape kill/homosexual sex with animals
• Rape old people /kids etc.
• Remove social inhibition
• Individual becomes irritable /agitated
confused
• Suffers from hallucinations
• Visual hallucination-million of small animal towards
him.
 Continuation of later effects
• Auditory-voices abusing him or her
• Delusion/hallucinations are mental illness problems.

• NOTE: These drugs have very pleasant effects at

starting
• Enters you in
• Later they become poison
• Be careful.
Hallucinogenic drugs
• Another class of drug abuse.
• They include altered state of conscious leading
to abnormal behaviors.
• They induce hallucinations to individuals.
 Continuation of hallucinogenic
drug
• Hallucination
• Abnormal conditions where sensory impulses are
distorted.
• Mental illness
• Affects all the five senses-
sight/hearing/feeling/taste/smell
• Examples
• Bhang(marijuana)mescaline/LSD(acid)
Continuation of hallucinogenic drug
• Bhang(marijuana)
• Mostly abused drug
• Very cheap and also available.
• Types
• Bhang – dry leaves which are smoked
The most mild form.
Very cheap- common to the
slums/stds/watchman/school drop outs.
 Continuation of hallucinogenic drug

• Ganja
• Drug made from the flower of the tree
• Very expensive
• Very strong
• Comes in form of grains like sugar.
 Continuation of hallucinogenic drug

• Hashish- chars.
• Made from the juice of the marijuana tree.
• Comes in form of syrup or liquid or powder.
• Very expensive and very strong.
• Only available to rich people.
Effects of marijuana (initial)
• It removes the reality from the individual.
• All the three types have the same effects
• Feeling of excessive power
• Feeling of excessive happiness and relaxation.
• Extremely excited by the surrounding environment.
i. If sadness extreme sad.
ii. if happiness-very excited.
iii. The bhang also potentiate the intentions hence becoming
answers for any problem.
iv. Remove social inhibition.
 Later effects
• They clistort sensory images
• Small seem appearing huge images
• Smell noise(ticking of clock) thunders.
• Severe hallucinations-see people killing
• They also experience floating sensations and at times
believe they are floating like a bird (flying)
• Going trips with drugs
• A good trip –where excessive happiness one enjoys
extra ordinary strength.
 Later effects cont’d
• After the experience – collapse and die due to
exhaustion.

• NOTE: Bhang causes very little dependence –

it is a gate to other hard drugs.
• Also cause mental illness.
 Continuation of later effects
• Bad trip – abnormal feeling of sadness/depression-suicide.
• Others-develop abnormal conviction that he/she can’t die/feel
pain/cant bleed even when cut;bwn themselves to prove –die.
• Flashbacks
• Patient may suffer severe hallucinations after a period of
these drug effects
• Flashbacks can come one week /month after stopping of
drugs.
• Can come anytime –causing severe accident or destruction.
Khat-Mirra
• Also a drug of dependence
• Stimulant though mild
• Chewed and absorbed from membrane of oral cavity
• Causes-state of well being
• Keep out sleep
• Causes excessive alertness
• Suppress lung it induces the user to other hard drugs.es.
• Increases the sexual libido
• Its pleasant effects makes the user keep on taking it all the
time
Volatile solvents
• These substance are inhaled
• Absorbed mucous membrane of nose/other
respiratory parts.
• Petrol/shoe glue
• They are depressant to C.N.S
• Censing alcohol like symptoms.
Effects
• The boys become happy
• State of well being
• Remove the reality –live in dream
• Make them forget their status.
• Induces some grandiosity
• If large dose is used-coma-death.
• They do not sense severe dependence but gate way to
other drug.
• Once these boys grow up-move to the next level.
Cigarette Smoking
•Also a drug
•Causes mild satisfaction.
•Relaxation
•Tend to remove anxiety
•Psychological happiness and feeling of self worthy.
•Causes mild dependence.
•Mild craving/headache etc.
•But it is gate way to other drugs.
•Smokers-bhang-hard drug.
 NOTE :
• All these drugs produces very goods effects on
starting
• Pleasant feeling/experience.
• Drugs causes thick darkness around an individual.
• They remove the reality
• If you are a failure- removed because of that they
tend to use drugs continuously to avoid reality.
• Once these drugs are used for a period of time
causes dependence.
Dependence to drug
• Repetitive intake of drug to such an Extent that it
interferes with normal functioning of the body.
• It interferes with physical health
• Infections
• Lack of food
• Interpersonal relationship: poverty
• Friends
• family
• Government
• Economic status of the individual all the monthly
used for drugs.
• Yet the individual cant stop the behaviors at this level
 Continuation on dependence of drug

• The body cells becomes used to a certain level of the

for it to function properly.
• If the level of drug for individual suffers from what is
called withdrawal symptoms
• Which are very unpleasant
• The individual has to take the drug on continuous
basis to prevent this unpleasant feeling
• At this level where he cant do without drug we say
he/she hooked to drug.
• At this level also the drug doesn’t cause any good
experience but taken to save life.
• Become a slave to the drug.
 Continuation of dependence to drug
• Or become gradiosed
• Chronic absenteeism from classes
• If on injection – spots on the vein
• Excessive dullness- heroine
• School petty crimes-stealing
• Or cheating parents for more money-to buy the drug
• Eventually if nothing is done dropout of school.
 Continuation of dependence to drug

• Withdrawal symptoms
• Physical symptoms
• Psychological
• Physical symptoms
• Experience immediately the drug is finding in the blood
stream.
• Excessive sweating
• Sudden severe headaches
• Tremors of hands/legs/tongue.
• Severe abdominal pains
• Diarrhea /
• Vomiting/running nose
• Conviction
• dehydration,/coma/death
Continuation of dependence to drug
• Psychological symptoms
• When the drug is fading – you start seeing the reality
• The poverty that surrounds you
• Like being removed clothes in the market
• Individual feels very bad/sad
• Becomes depressed- suicides.
• Once an individual is hooked no longer control himself
• Drugs now takes over
• Once the individual senses the slightest of the symptoms
takes the close .Because not know when the symptom
may appear.
• They carry drugs everywhere they go.
Routes of administration
• These drugs are introduced into the body through
the following
• Orally : taken with tea/soda/ cocaine/Mandrax/LSD
• Smoked-bhang
• Inhaled-cocaine/mescaline
• They are bought on cookies you inhale the smoke
• Intravensly
• Individual is injected into the vein-e.g. heroine.
How do you know that one is on drug
• Student
• Schoolwork dropping in class
• Poor work(not doing assignment)
• Start neglecting personal hygiene
• Having new sets of friends – not visiting home-sad
ness-no drug
• Mood change –happiness
• Speech sluggish- excessive dose
• Reddiness of the eyes
• Well beloved std-suddenly rude
 Continuation on how do you know one is
on drug

• Or become grandiose
• Chronic absenteeism from classes
• If on injection – spots on the vein
• Excessive dullness- heroine
• School petty crimes-stealing
• Or cheating parents for more money-to buy the
drug
• Eventually if nothing is done dropout of school.
 Characteristics of general
population on drug abuse
1.Total dependence
•No life without the drug
•Drug the priority-not occupation
2.Tolerance to drugs
•Need more /higher dose of the drug
•More money required to maintain the habit
•Sometime two or more drug e.g. needed to produce required effect.
3.Malnutrition
•Majority suffers from the above
•No money to buy food – drug first
•Very poor appetite when the food is available
•Suffers from chronic diarrhea.
 Continuation of characteristics
4,Infection
•Hepatitis b
•Septicemia
•Septic wound
•Aids
5.Crimes
•Break chemists to get drugs
•Stealing office equipment's/house hold equipment
•Drugs removes social inhibition
•Can rape/kill/assants.
•Nyeri boys – who bought several collogues.
 Continuation of characteristics
• Crimes
• Break chemists to get drugs.
• Stealing office equipment/house hold equipment.
• Drugs removes social inhibition.
• Can rape/kill/ assants.
• Nyeri boys – who bought several colleagues.
• Also commit crimes under the influence of drugs.
• Causes severe accidents etc.
• In and out of prison.
 Continuation of characteristics
6.socially
• Unacceptable control of behaviors .
• Isolated from community socially rejects
• Drugs kills the feeling :dad is dead : okay
7.Sexually.
• Promiscuous-to get drugs.
• Homosexual-for drugs.
• Don’t have permanent sexual partners.
 Continuation of characteristics
8.Family life.
• No families.
• once they start-break it.
• No emotional attachment with any body.
• No money to maintain the family.
• No job - drugs make them very lazy.
• Drug abusers are total nuisance to.
themselves/family/community/government.
• No responsibility-apart from maintaining their drug
issues.
• Move like zombie- useless /dead like/helpless person.
What kills the drug abusers
1.Infections associated with their behaviors-
hepatitis B/ septicemia /AIDS.\
2.Over dose of their drugs.
 Continuation of what kills the drug
abusers
3.Liver complications-hepatitis/liver cirrhosis.
4.Accidents-jumping from height.
• Lead accidents.
• .Sometimes burn themselves.
5.Suicides: majority commit suicide.
• When life become intabable.
 Continuation of what kills the drug
abusers
Note
• Drugs act like Satan .
• Satan steal ,destroy and kill.
• Satan will entice you but eventually
steal/kills/destroy-the same with drugs
Who are at risks of drug abuse

1.Adolescents (18 – 23 yrs.)

• Adolescent value the company of his/her peer.
• He/she values their teaching more than the
parents/teachers
• Spent a lot of its time with peer .
• So if the company takes drugs.
• He will not escape.
• They take the drug to confirm with the ground.
• Adolescent also is salient experiment and discoveries.
• Drugs are taken in the process of the experimentation.
• Adolescence is a stage of rebellious.
• If the parent disapproves drugs/alcohol-he will take them
to rebel from the parental role.
 Continuation of who are the risk of drug
abuse
2.Students full of anxiety – exams:
i. Take time to study nudes.
ii. They take cocaine for that.
3.School dropouts .
• Exposed to a lot of problems .
• Life is not easy.
• They feel worthless/hopeless.
• Lack hope in life.
• Go for drugs.
 Continuation of who are the risk of drug
abuse
4.Occupation.
• Mortuary attendance
• Prostitution.
• Pharmacist/nurses/doctors.
• The availability of drugs .
 Continuation of those who are the risk of
drug abuse
5.Social classes.
(i)Low class peer.
• Life in slums – availability of bhang.
• Exposed to a lot of problems.
• Broken families.
• Accommodation poor- one room with.
kids/fathers/mothers.
 Continuation of those who are the risk of
drug abuse
(ii)High class people.
• Anxiety because of there business.
• Fear of loosing political powers.
• Lonelessness-very big house.
6.Personality.
• People with week personality .
• Not sure of themselves.
• Devaluates themselves.
How do they get this drugs

• Most of this drugs are sold in the streets.

• Although illegal.
• Drug abuser know where to get them.
• There are agents who pendals these drugs.
 Continuation on how do they get these
drugs
Students boarding schools
• School workers /watchmen/cooks/etc.
• Small business men around the schools
• Neighbors of the schools
• Old men who may be gracing their cows around the
school.
• Very rarely a teaches who is also an abusers of the
drugs.
• We also hear student who are agents.
How do we prevent this problem
• Fear the lord starting of knowledge
• Fear the lord you will never be got by drugs.
• Avoid those areas where they are sold.
• Discos/ video/dances/parties-canal
Continuation on how to prevent the
problem
• Teach the youth about the drugs
• Let them have the knowledge leave them either to use
the knowledge or not.
• One thing to use that knowledge or another thing to
use that knowledge to help you.
• Counsel the married people to maintain there families
to prevent marital brockages;children in the streets.
• If problem seek help in hospitals etc.
• If you walk with drugs abusers then you are.
• Select your friends wisely.
 Continuation on how to prevent the
problem
• Select those friends who will add value to your
life.
• Have nothing to do with them
• Be careful where you go/whom you go with.
Avoid eating with anyone/anywhere
questionable places.
• Avoid receiving drinks from anybody
 Continuation on how to prevent the
problem
• Encourage productivity to the youth
• Be productive/be occupied
• Avoid idolness;ideal mind work.
• King David-idolness-urias wife-death.
• King David in the house doing nothing
• His soldiers in the war.
• Failing exam is not the end of life.
• Becoming pregnant before marriage is not the end of
life.
• Move on with productive work.
 Continuation on how to prevent the
problem
• Drugs are illegal: abusers commit crimes to the
government load.
• Avoid committing this crimes
• Have nothing to do which does not value to your life.
• Be serious with life.
• What ever you decide to do with all your strength.
• Are you in college-take study serious
• Do you love Jesus: be serious
• And you will live and overcome drugs.
Summary
• Drugs are like Satan-entices to grave
• Anytime you take drugs unnecessarily a step to
grave.
• Drugs are sins-death
• Drugs destroys the individual
/family/community/nation.
• Government spent a lot of money to fight against
the drugs.
• If you insist on testing them.
 Continuation of the summary
• Eventually use your strength to:
 Preach Jesus .
 Work for the lord.
 Build your future.
 Your careers.
 Work hard in the school.
 Lesson 5
ALCOHOLISM
• One is considered to be alcoholic when he/she has
become so dependent on alcohol that it interferes with
his performance in life and yet he/ she is unable to
control it.
i. Interferes with his personal health .
ii. Interferes with his family.
iii. Interferes with his social life.
iv. Interferes with his profession.
v. Interferes with his personality
 Causes of alcoholism
• Causes are not known but the following are factors
associated with it :
(a) Cultural factors:
i. African taking alcohol on several occasions'
(b) Social class of people.
Mostly associated with high/low class.
(i) Low class – exposed to a lot of problems.
-availability of alcohol.
-alcohol taken to escape reality in life.
 (b) High class

• Exposed to parties .
• Exposed to a lot of anxiety for business.
• Fear of national security.
• Loneliness – most of the time out of the country and
their families.
 Occupation
a) Mortuary attendance.
b) Prostitution – emotional stressing career.
c) Musicians – take alcohol to perform with
confidence.
d) Politician – some take to be able to address
the people and his colleagues.
 Genetic factor

• Alcoholic families tend to produce alcoholic

children's.
• Probably due to exposure of alcohol children's
copies their parents behavior
 Personality problem
• Some people feel inferior like is to boast their
ago.
• Other people anxiety personality – alcohol
make them overcome this.
• People tend to overcome reality by taking
alcohol.
 Alcoholic personality

• Immature people.
• Passive dependency.
• People with unrealistic objectives life.
• They expect a lot of praises and appreciation
from others.
 Psychological stresses
• From marital problems .
• Examinations.
• Physical illness.
• Individual who eliminate themselves.
• Nothing good they think they have.
• Tend to think they can manage in life.
 Effect of alcohol

• Alcohol depressant affecting the central

nervous system.
 Small choses.
• One becomes sociable.
• Very talkative.
• Develop a sense of well being.
At this level one can face his wife confidently.
• A young one can face a girl and request for a date.
• Sexual grids – but fear and anxiety reduced which
reduces the grids.
• Some people become very friendly to the children's.
 Large choses
• Alcohol blood level 0.1 %
1. The person is quite intoxicated.
2. Inhibition Centre not controlled.
3. Leading to schematic acts.
4. Motor center impaired.
5. Perception center impaired.
6. No cold pain.
7. Exposure to cold pneumonia.
8. Deep cuts with no pain
9. Speech impaired – a lot of nonsenses
10.Visual impaired – two people issuing to one people
 Alcohol blood level 0.5 %

• Too much for the individual.

• Individual passes out.
• Become unconscious.
• Anything can happen to him while unconscious
.severe aspiratory of pneumonia.
• This level pass out is also called safety device.
• Prevent the person from taking more alcohol
because above this level of 0.55%.
• Ethel dose which is very commonly kill the
alcoholic
 Level of alcoholism
• Pre-alcoholic symptomatic level.
• The first level of the problem.
• The individual discovers that alcohol reduces
his tension.
• He there for learn to take alcohol occasionally
to reduce his tension.
• Whenever he is having a stress or slight
anxiety then goes to alcohol.
• Soon the individual start taking alcohol daily
because the life is full of anxieties ,tension etc
 The prodromal phase
• Progression from the above phase.
• At this stage the individual suffers sudden
black out, following the black out severe
anemia.
• Not consciousness.
• Usually taken home by other colleague they
cant remember how they went home.
 Behavior at this stage

• Surreptitious drinking:
• individual take some beer hiding from his
friends.
• They join them to continue .
• He fears they will complain of his drinking.
 Pre – operation with alcohol
• Get worried that beer night get finish before he
get a share.
• Inverted for parties /dinners worries whether
there will be alcohol.
• He may pass through bar and take some few
bottles before he attend the party.
• Avoid drinking but get the fist bottle he is
overfed.
 Continuation of the pre occupation with
alcohol
• He also demand to drink from a large glass.
• At this stage he becomes guilty of his drinking
behaviors but the cant help it.
• Patient reached at this time can be prevented
be prevented from being a total alcoholic.
 Crucial phase
• Progression from the above:
• Characterized by loss of control in drinking.
• Alcohol may be taken as breakfast and the
individual take too much until he is quite
unnoticed.
• Patient may abstain from taking it for some
time
• But soon little tension drive him to alcohol
 Continuation of crucial
• Only they say will take only one.
• As time goes by he becomes so much in it that he can go
back.
• He start rationalizing the behaviors .
• The rationalization only serve his purpose.
• A way of protecting his ago.
• Self esteem is lowered no need to care for his appearance.
• He becomes boastful and blame others for his behavior.
• Start having problem with his collogue at work.
• Problem with family members.
• Quarrels some at home and breaking of the family.
• Start missing on duties.
• All these is are cause of alcohol
 Alcoholic jealousy
• He becomes jealousy to his wife.
• Also wife not interested with his sexually due
to quarrel, dirty and smelling bad ,drankness.
• He suspect his wife in getting out.
• Some time fabricates stories of how she
conducted herself.
• Demand to check the part.
• Lead to him killing his wife.
 The chronic phase

• He reaches a point of no return.

• He no longer now can control the alcohol.
• His body now is used to certain level of alcohol in the blood.
• The alcohol now takes time to control him.
• If the alcohol level fell in the body he suffers from
withdrawal symptoms.
• These symptoms so severe that he will be forced to go and
look for alcohol.
• At this level he is severely malnourished.
• Some people can conduct themselves at this stage as long as
alcohol is available.
• They carry alcohol every where they go (cars, bedrooms,
offices, )
 Withdrawal symptoms
• Sweating excessively.
• Severe painful muscle clamps.
• Anxiety .
• Tenuous of the tongue and hand.
• Confusion
• Severe headache.
Psychosis associated with alcohol
• 4 types of psychosis ;
1. Pathological intoxication.
2. Acute alcoholic hallucination.
3. Korsakoffs psychosis
 Pathological intoxication
• Occurs to those patient whose alcohol tolerance is
low.
• E.g. severe exhaustion.
• Emotional stress.
• Epileptic people
• Individual takes little alcohol and becomes very
intoxicated.
• Start having hallucination
• Becomes disoriented
• Becomes very aggressive
 Pathological intoxication cont’d
• Can cause a lot of chaos
• Also become homicides.
• After that he drop down to a very deep sleep.
• On waking up he has got complete amnesia of
what happened last night.
• The episode repeated while treatment is done.

• Note
• Some of the people their names written in the
peruses not to be sold beer there.
Delirium tremeus
• Follows sudden withdrawal of alcohol
• Normally noticed in casualty department.
• Prison if alcoholic is jailed.
• Or police custody .
• Admission ward.
• The above preventing the patient from having his
usual dose of alcohol: behavior result when alcohol
level in the blood
• Individual becomes restless/irritable
• Suffers from insomnia
• Becomes very uneasy
 Delirium tremeus cont’d
• Also very apprehensive
• After that he becomes very disoriented for
place/time/people.
• Doctors and nurses-his old friend.
• Hospital-prison
• Or police custody
• When he is quite fully awake
• He sees million of small animals towards him.
• Severe illusion- pens, snakes-belt snakes.
Extreme suggestibility
• Patient cant be made to see any amid you
suggest
• Or ask what he sees on the well
• Tremous of the hands/ tongue /lips.
• Muscles ceeps/fits/sweating/coma.
• Crisis takes 3-6 days
• After that he settles
• Very exhausted
Acute alcoholic hallucinations
• It follows a long drinking spree:
• Main symptom here is hallucinations.
• Mainly the auditory hallucination.
• Patient get this hallucination when the is fully conscious.
• Some time not over introxed.
• Patients fears voices from somebody else:
• Simple statement .
• Statement about.
• Statement of him commenting on his week points.
• Now there several voices from their people.
• The voice also discuss the punishment he is supposed to be
given.
 Continuation of acute alcoholic
hallucination
• Also hears the pistol shot.
• Also the sharpening of the knife to kill him.
• Then he hears the foot steps towards him.
• Terror stricken., he may screen for help or may commit
suicide.
• The crisis may take several days and weeks.
• He is very depressed but other personality is intact.
• After the crisis some gain the insight of their problem.
• Others continued with alcohol but others becomes very
reasonerbal and don’t take it any more.
 Korsakoffs psychosis

• Terminal stage of the illness.

• Described by a Russian psychologist
called korsakoffs in 1887.
• At this stage the brain is completely damaged by alcohol
affecter recent memory.
• Main symptom is the memory loss
• Patient come up with loss of memory by falsification or
fabrication which are meaningless.
• Cant remember anything.
• Confused moving hear and there.
• Cant recognize his relatives.
• .The one affected recent memory
 Continuation of karsakoffs
• Also malnourished
• Also home neuritis due to lack of vitamin B .
• A very sad condition.
• Nothing much is possible for him.
• No care for personal hygiene.
• General nursing till death.
• No feeling you have to feel him.
 Neuritis

• Inflammation of the nervous.

• Perivale nerves.
• Effects ; decrease or increase sensitivy .
• Other paralysis.
 Management of patient

• Acute phase.
• Admission.
• Admit in a clean room and well ventilated
with very few items which can hurt the patient.
 Room
• It should be a plain without calendar or any
other pictures on the wall.
• They increases illusion worsening the
condition.
 Bed
• Should also be plain and low bed .
• Should not be near the windows.
• With no coloured covers which also cause
illusion.
 Environment
• Should be calm.
• Cant stand even the
 Nurses allocations.
• They should be very few on them .patient
people used to them.
• Different nurses tend to confuse them.
 Dressing

• Should be plain with no much decorations.

• Should introduce themselves every time they
got the patient.
• Show them the door and the windows.
• A lot of effort needs to oriedete the patient
every time.
 Medication
• Librium (chlordiazapotide )
• Also cause the reducing their destructions.
• Largactic 200 – 600 mg – helps them to reduce
the illusion .
 Diet
• Patient malnourished.
• Needs a lot of food and balanced diet.
• A lot of fruits.
• Ensure he has taken the meals.
• Should not miss any meal.
 Occupations
• When the crisis is settling.
• Idleness leads to hallucination and occupy
them with what he like .
• Assign simple task which he can accomplish
first the complicate on making his bed and
help in routine
 Personal hygiene
• Ensure he has a bath daily .
• Cut his nails .clean his beading.
• Make sure he has clean hospital gown.
• Encourage oral hygiene.
 Alcohol
• High calorie food.
• Body able to utilize this at the level of 1 once per
hour.
• Other excess remain in the blood to be used as
need arises.
• Alcoholic therefore
• Totally depend on this for their energy.
• But misses other nutrients like vitamins and
proteins.
 Recreational activities
• Involve him in games of his choice.
• Slot with simple games like indoor and the n
goes to outdoor.
• This encourage his socialization skill
• Listening for the music ,radio.
 Group therapy alcoholic.

• The most best treatment for .

• Help them to gain their insight. Should be alone
when the patient has recovered from the crisis.
• Grouped small groups of 3 – 6 alcoholic.
Allowed to discuss any topic reveled to alcoholic
as they exchange ideas .
• Also support each other emotional and
encouragement emotional.
 Family therapy
• Quite important .
• Most have broken families.
• Need to join them together .
• Family help quiet a lot in the care.
• Wife and children encouraged to visit him in the
hospital.
• Encourage the wife to accept him.
• Sometimes if is very different let her accept him as a
sick persons and let them have health discussion.
 warning the patient from alcohol
• This is the best treatment for him but very
difficult at time.
• The warning takes long time so done as the
patient.
• Patient himself must be willing to stop alcohol
completely.
• If not willing should not be tempted.
• The family also must be involved so that it can
encourage the patient at home
 Procedure applied
• Queasier therapy
• Also called reflex conditioning.
• To associate the drinking
• Behavior with unpleasant stim hence alcohol
associated with unpleasant stimuli.
• Give time alcohol is psychological
discouraged by the alcoholic.
 Continuation of procedure
• Emetic drug can be used
• Patient given an injection of this drug.
or the drug given orally.
- The patient served with alcohol of his choice.
- Immediately the alcohol is taken introduces vomiting
quite severally.
- The procedure repeated several weeks of the month.
- Given time the sight of alcohol induces vomiting.
Associate vomiting with alcohol.
 Use of anta abuse
• Drug use the ridscufiram.
• The first treatment is done in the hospital .
• Therefore the patient after the experience is discharged.
• 500mg of the drug is given the n the dose to 250mg od x 5days.
• After that he is served with alcohol.
• What follows is like a night mare to him.
1. Sudden severe headache.
2. Rapid heart beat.
3. Rapid breathing.
4. Sudden blood pressure fall.
5. Vomiting and fainting.
 Continuation of drug abuse.
• Severe sudden attach of fear .
• Feeling like dying.
• Sometimes the patient may collapse Need to love
recitative drugs.
The experience is to threating that he may hear
alcohol straight away.
After that discharged on the drugs to be followed in
the out patient.
• Patient associate the terrible experience with alcohol
hence hate it.
 Electrical chair
• Patient made to sit on a chair which is attached to
electric current.
• He is served with alcohol as he tries to swallow it
is switched to give him a smell electrical shock.
• The procedure repeated about 3 -4 times.
• There he is served with other drink like sada and
tea.
• After some weeks or months of treatment
associate alcohol with the shock.
 Life experience.
• Alcohol – alcoholic coma – police hos -
mortuary – walking up.
• Alcohol – prostitute – dead body.
 Management
• Always three levels
• dying out the patient.
• Deconditioning the patient
• Psychotherapy – AA.
 Discharge of the patient
• Prepare him for discharge two weeks times.
• Before discharge inform the families members.
• Asses their reaction.
• If possible identifying the sense of the problem.
• Should be solved before he is discharged .
• Involve social workers if possible before he is discharged.
• Home visit must be done.
• Asses where he comes from.
• If he working visit the employer
Manipulation of the environment
• Check the locality if the environment is
problem.
• Transfer her home to his wife and children.
• Check of jobs if possible.
• Introduce him to other organization and
church members , football clubs.
 Alcoholic anonymous (AA)
• Voluntary organization by the church
members,
• Another psychotherapy can help them out of
the problem.
• After discharge to be followed.
 Prognosis
• A very hard problem to solve.
• Most of these patient keep on releasing very
few are helped out of this completely.
• Majority of these patients die of complications.
• Liver cirrhosis.
• Pneumonia.
• Accidents which is very common.
• Commit suicides.
 Summarizes the topic
Warning signs to alcoholic .
• 4 of them;
1.Morning drinking – with an excuse of killing
hangovers.
2. Increased tolerance for alcohol- leading to some
bottles before intoxication .
3.Extreme behaviors- that make the individual feel quilt
and embarrassed next day.
4.Black out – a person forgetting what happened the night
before the alcoholic
NB Any of the above should be treated with a lot of
 Lesson 6
NEUROSIS
• A group of mental illness which are
manifested by mental or physical suffering
without any organic cause.
• Patient will present with physical problem like
paralyzing the limb but which has no cause.
 Causes
• The cause of these problem are not known but the following
are factors that contribute to the illness:
1.Psychological or emotional problem.
• Major sense of neurosis.
• Always have the attack whenever they have a emotional
problem.
2.Failure to make a decision;
Because of the failures anxiety neurotic behaviors.
3. Heredity
Most of neurotic condition are with families.
Children's learn the behavior from their parents.
4. Drug |alcohol also causes these behaviors.
5. Physical illness causes infection and injuries.
 General characteristic of neurotic

(i) Inadequate personality;

• They feel inadequate in solving problems.
• They prefer running away from their problem
through being sick. But at the unconscious
level.
• They like to depend on pothers so much for
both decision and emotional support.
• All the time the want to lean on somebody.
 (ii) Low stress tolerance
• Cant stand even the slightest stress.
• Any little stress put them off.
• They always apply defenses whenever forced
with stresses.
• Because life is full of stress most of their life is
in hospital.
 (iii) Anxious and fearful people
• Very fearful people also very anxious.
• Always they expect something wrong to
happen to them, something they cant explain
because of that they fear.
• Always feel threated.
• Spend too much time solving problems which
are not there.
 (iv) Tension and irritability
• Because of their fear they tense and easily
provoked and can easily fight and easily get
annoyed.
• Something smell make them very angry.
 (v) Egocentric people
• They always think of themselves.
• Very selfish and talk about themselves and
their problems.
 (vi) poor interpersonal relationship.

• Because of their dependency and

• Tend to attract a lot of attention and
sympathy.
• All these makes other people to avoid them.
 Types of neurosis
1. Hysteria.
2. Anxiety state.
3. Phobia.
4. Neurotic depression.
5. New asthenia .
6. Hypochondriasis.
7. Anorexia neurosa.
8. Obsessive neurosis .

The first two are the most frequently seen.

 Anxiety state
• Chronic state of tension which affect both
body and mind.
• A little anxiety is quite normal and health.
• It warn us of the problem hence we prepare
for it.
 Physiology
• Whenever there is a problem the following
happens :(deals with emergency)
• Sympathetic parts of the antoxonomic
System .
• It stimulates adrenal glands.
• It produces adrenaline.
 Causes of Adrenaline.

• Blood vessel reluctant.

• Lungs rapid expansion, more oxygen digestive
system - - metabolic release more glucose.
• Muscles - tension – pupic dilation wide
vision.
 Parasympathetic
• Bladder construction – urine out ,faces out.
• These make the body light to fight .
• Skin – sweeting glands ,sweating hand .
• Make the body slippery.
• Present pyrexia.
 When the danger is over
• No antenalie is produced - Body goes back to
a normal state.
 Pathological anxiety
• It comes out of blue .
• There is no cause for the patient to worry for .
• This patient always appreciates no matter how better his life
seems to be.
• These fears lead to upsets and uneasy and discouraged.
• They fear making decision for possible errors,
• Yet when the decision are made for they still get worried for
possible error in future.
• They always feel that these possible errors may lead to
disaster they go far and wide to look something to worry
about.
 Continuation of pathological
• As soon as the cause of it is known they quickly look for
another one.
• Because of these the friends and the relatives get tired of him
an leave them alone.
• Even after going to bed they don’t get relieved.
• In bed they analysis all the mistakes they have done present
mistakes.
• Some of them are real others are imaginary.
• After they analysis they move and terribly regret for the
mistakes when they are not analysis their past mistakes.
 Continuation of pathological cont’d
• They start anticipating the problem which will come in
future .
• They also try to rehearse how they will solve the problem.
• Because they don’t make decision they leave them like
that.
• These make them feel very worried of future and most
quite a lot.
• After crossing and re crossing the present and future
bridges he drops to deep sleep.
• After sleeping the suffer from anxiety dreams.
 Continuation of pathological
• Keep on mourning about their suffering.
• Also suffers from intense quilt .
• Sometimes could be destructive to their
properties.
• Also are paramount and attack the one they
suspect .
• Also hydrondriacal in nature.
 Anxiety dreams.

• Falling from the high places.

• Being drowned in big rivers.
• Being chased by murderers and themselves
unable to run faster.
• Being shot by murderers .
• Being shocked.
These dream wake them when they are worried
and life continues.
 Note
• If symptoms are mild these people live fairly
well in the community.
• But they are worried that always have
something or another tot complain about and
to worry about.
• But they spent most of their life in the hospital
with minor complains here and there.
 Causes of anxiety.
• 1. genetic factor – this disease tend to ruin the
families.
2. Poor parental models – children of anxiety
parent copying their behaviors.
3. Personality - people with anxious personality
tend to wrong all the times.
Not sure of themselves and always feel something
will happier to them.
Anticipate problems always.
 Precipitating factors

• Physical illness.
• Fear of any kind – promotion, examination ,
marriage, making decision.
• Loss of either jobs ,status or even loved ones.
 Signs and symptoms
• Divided into two categories.
1 physical symptoms .
2. Mental symptoms.
Physical Symptoms
Headaches
Abdominal pains and diarrhea.
Dry mouth.
Sweating
Palpations.
Rapid heart pulse.
Impotency
Amenorrhea.
Problems of breathing
Wriggling of hands.
 Mental symptoms.

• Lack of sleep.
• Poor concentration.
• Irritability.
• Fear of death and fainting.
• Confusions.
• Felling that something will happen .
• Feeling of being choked.
• NOTE: these symptoms depends on the severity of sickness.
• If the sickness is mild – they are mild.
• If severe they are also severe.
 Panic crisis.
• When the symptoms are at climax sometimes referred to as panic
attack.
• It may last few minutes or several hours.
• Patient present with the following.
i. Heart pounds
ii. Difficult in breathing.
iii. Dizzy.
iv. Felling of suffocation.
v. Start gasping for oxygen.
vi. Intense feeling of cart atrophy .
vii.Feel like he is going to die and may shout for help.
viii.Very exhausted – collapse with extension.
ix. Storage enough no reason to fear that.
 Management of anxiety
• Majority of the patient managed from the out
patient department.
• Admission only necessary to remove the
patient from the anxiety provoking
environment.
 Admission
• A clean room
• Well ventilated.
• Ensure the bending are clean.
 Environment
• Should be calm .
• Patient not shouted at.
• No patient fighting around.
• Nurses calm.
• No item which can be used as weapon.
• All these reaches anxiety to your patient.
•
 Medication
• Minor tranquilizers.
• Librium – 10 – 50 mgs tds.
• Diazepam – 2 – 20 mgs tds.
• Midazolam – 5 – 10 mgs tds.
• Melleric – 200 – 600 mgs tds.
• These drugs reduces the anxiety .
• They calm the patient.
• Also reduces the physical exhaustion.
 Teaching of the patients.

• Heavy inpatient – patient believe they have

heart disease.
• Teach him about the symptoms and let him
know the relationship between these
symptoms and his illness.
• Rea-assure him very much.
 Acceptance of the patient.
• Show a lot of acceptance to him.
• Address him by his name.
• Explain all the procedures.
• Talk to him when you have time.
• Try to get the cause of anxiety.
• Please don’t emphasize on symptoms.
 Orientation
• Patient are very confused and disoriented .
• Proper orientation to staffs or patients.
• Let him know what is expected.
 Occupation
• Must be done with anything he can do in the
• Start with simple tasks he can do then to
complicate one.
• More complicated anxiety .
• More idle – more time to create problems to
wrong absent.
 Psychotherapy
• Very important for him.
• A part of treatment.
• Group them to group ,let them discus problem
affecting them.
• Some time patient gain sight.
• Should be done after the word is settled.
 Recreation activities
• Make them feel accepted .
• Also introduce the to socialization with other.
• Also no time to create problems to worry
about.
 Physical symptoms
• Feeling
• Make sure he has taken his meal.
• Have poor appetite.
• Serve them with little nutrients food but
frequently.
• Encourage a lot of fruits.
 Preparation of discharge
• Have visit very good.
• May identify the growth of stress.
• Have a time with his family members
employees.
• Asses home environment.
• Failures| successes.
• Solve the problem before discharge.
 Hysteria
• The term of greek word meaning ‘uterus’
• Hippocrates – the father of medicine was the first
to observe the condition.
• According to him only affected women who had
sexual difficulties.
• He therefore thought that a frustered uterus
which needed a baby was moving up and about
in the body.
• Hence caused hysterical symptoms.
 Doctor Galen.

• Observed the condition on men so he improved

hippoceles ideas.
• He observed it on the man.
• Hence believed the condition can be both on men and
women.
• This one suggested that the cause was retained semen of
men who were sexually slaved.
(i)either prisoners.
(ii) army forces.
(iii)sea men.
 Continuation of Doctor Galen
• He was psycho-analytic expert in studying
mind.
• He was the one who described the condition
the way we know it today.
• He discovers that hysterical symptoms are as
result of repressed material in the unconscious
part of the mind.
 Definition of hysteria.

• It is psychological reaction at the level of the

unconsciousness mind and it is caused by
unresolved problems.
 Malingering
• The patient hear does things at the conscious
level.
• He claim he is sick and pretend to be sick.
• But hysterical not pretending.
• He has no control of his symptoms.
 Conversation hysteria
• The psychological reaction affect the function
of the body;
• The patient present with physical illness
without organic cause.
• Any part of the body organ can be affected but
the vital organs are not like the heart, liver,
lungs etc.
 Symptoms
• Blindness
• Deafness.
• Stammering.
• Tremors.
• Unconsciousness .
• Fits like the epileptic ones.
• Loss of the voice.
• Paralysis of the limbs.
• Loss of sensation of – pains, touch ,taste, smell, feeling.
The above are the common symptoms the patient can come
up with.
 Esteems
• Hysterical patient can come out with any
condition you can think off.
• Come with malaria or even pneumonia.
• He will have even the raised temper abuse,.
• The symptoms they come with causes
1. Have been read on the paper.
2. The symptoms of previous illness.
3. Symptoms observed on a relative or a patient.
 Criteria to make diagnosis.

i. Labelle indifferences
• Lack of concern for the symptoms the patient present with.
• No fear of the symptoms.
• Patients happy with the symptoms.
• He is paralyzed but he does not show concern.
ii. Frequent failure of the destruction to confirm to the symptoms of
a particular diseases.
Patient paralysis – paralyzing not following medical aliment f the
body or patient fitting but there is no systematically like the
epileptics.
iii selective nature of the destruction.
• Paralyzed limb can be used to do some activities but not the others.
• Blindness but patient don’t see objects or people. fitting but not
biting of the tongue or hurting himself.
iv symptoms can be shifted from one organ of
the body to the others or removed while he is
deeply asleep.
• He can be tricked to use or talk after woken
from deep sleep.
• During the extreme emergencies the
symptoms clears.
 Dissociative types of hysteria
• This type only affect the function of mind or
mental function.
 Symptoms
• Loss of memory .
Patient may not remember anything.
Not even his name|age|place of birth |occupation
or his parents
e.g. a young man let down by a ones on the
weeding day later he could remember having
seen that girl in his life.
 Fugue
 Hysterical fugue;
 Impairment of patient awareness.
 Patient may wonder around without knowing
what he is doing.
 May move from one town to another without
knowing where he is or even without knowing
how he has moved to that place.
 Pseudo-dementia.

• Dementia – complete loss of intellectual

functionality, usually caused by complete brain
damage by either alcohol or age or accident
 pseudo dementia
False dementia.
His brain we treat, it is highly characterized b the
question.
Ask the patient cow has 5 or 3 legs but not 4.
a hen has 3 leg or 2.
When you look at the patient you will know the
answers but he cant say them correct.
 Mass hysteria.
• Affect a group of people in institution.
• Mostly affect girl school.
• May start with one person then spread to the whole
group.
• Behaviors could either be:
-crying
- laughing.
- fitting.
Cause is the stress in the school.
 Management
• Temporally closing of the school .
• Intensive interviewing to know the cause.
• Treat the causes of the stresses.
 Ganser syndrome
• Another type of hysteria.
• But only affect the prisoners especially
exposed to severe stresses .
• They present with hallucination .
• Approximate answers.
• Converse symptoms.
 Man chausses hysteria
• Patient present with several symptoms like of
severe abdominal pain or acute appendants.
Patient goes to theatre for operation nothing
abnormal is noted.
• Another stress – the way symptoms goes to
another hospital, another operational nothing
is noticed.
• The behavior is noted all through whenever is
there is stress.
 Causes of hysteria.
1. Avoidance of stressful situations.
- Patient avoiding stressful situation through
symptoms.
i soldiers developing blindness to avoid going to
war.
ii a man who does not want to marry fainting on the
day of marriage.
iii a student developing peer on the day of the exam.
 Continuation of causes of hysteria

2.Defenses against dangerous desires.

- Aphonia if you want to abuse your boss.
- A young man developing paralysis if he want
to beet his father who harass his mother.
 Continuation of causes
3. Secondary gain
- Patient would like to benefit from his illness.
- Sympathy /economical .
- Responsibilities
 Continuation of the causes
4. Poor parental models.
Hysterical parents bring up hysterical children
 Treatment
1.Admission
Only during the crisis;
- To remove him from the anxiety provoking area
also to identify the cause of stresses.
 2.Intensive history taking
- Keep to make the diagnosis from the patient.
- From the parents, employer or any relevant
person
 3. Drugs
• Not very helpful but they remove the anxiety
also sedate him to calm down
 4. Psychotherapy
• The best treatment for him.
• Aim hear is to identify the depressed material
at the unconscious level.
 Supportive therapy
• Patient allowed to express himself in a free atmosphere.
• Here patient given several section on interaction with
their past.
• Encouraged to talk as much as possible.
• The therapist should talk as little as possible but should
show concern and fending and encourage.
• Patient should not be harassed or rushed.
• After several session he feels relaxed and this helps
him.
 Hypnosis
• Here the idea is to make the patient feel
depressed material which causes problem.
• Here patient given some drugs to make
himself conscious and half unconscious.
• Or to make the patient take those material he
may talk under normal circumstances but
which are painful to him or her.
• The appropriate action taken.
 Another use of hypnosis
• A patient ordered to use his leg immediately he
wakes up ,he does exactly that bur risk to get
another symptom.
 Management
1.Admission
- Very good.
- To remove him or her from anxiety provoking environment,.
- Also for investigation.
2. Admission done doing the crisis.
When the symptoms is severe.
3. Environment
- Clean well ventilated environment .
- No tension at all.
- Staffs should be calm and welcoming.
4. Investigation
All possible investigation should be done for the
following:
-to ensure to physical causes.
- To convince the patient that she or he does
not have the disease.
- Before a patient is managed as an hysterical
patient
5. staffs.
- Should avoid to criticize the patient .
- No judgmental.
- All time should not be on the symptoms.
- But try to identify the emotional problem.
- Kindness or concern may make the patient to
have confidence with the staff so that he|she
will communicate the problem.
 Teaching
• About his problem.
• No physical problem but psychological
problem.
• Show him the investigation to prove the cause.
 Physical symptoms
• Dot not emphasize on them on real problem.
• Do not discuss about them.
• Strong suggestion should remove them.
• Do not discuss them at his presence.
 Secondary gain
• By all mean do not allow him to have any gain.
• No sympathy e.g. student being exempted in
the exam.
• Or a soldier exempted from going the war.
 Medication
• Do not help them much.
• But minor medication is given to reduce
anxiety.
 Psychotherapy
• Main treatment for them should be emphasized
by all mean.
• It is the main treatment.
 Occupation
• Routine to prevent him from thinking about
his systems.
 Recreational activities
• Involve him in indoor activities.
• Football ,netball and debating.